A consecutive series of 41 patients aged less than 16 and admitted to the Department of Neurosurgery of the University of Milan in the period 1977-1978 following serious cranioencephalic trauma with Glasgow Coma Score (GCS) less than or equal to 7, duration of coma longer than 24 h and CT picture of diffuse lesion has been examined. These patients account for 5% of the paediatric cranial traumas observed in the same period and 66% of those in a state of coma. The CT picture made it possible to split patients into 3 groups: a) those without visible cerebral lesions and with subarachnoid and cisternal spaces present; b) those with small hyperdense lesions due to intraparenchymal or median/paramedian subcortical shearing lesions; c) those with marked constriction or absence of the 3rd ventricle and of the perimesencephalic cisterns. The first two pictures (a, b) were considered to be the expression of diffuse axonal damage, the last (c) of diffuse cerebral swelling. Intracranial pressure was monitored in about 50% of patients. The overall outcome of the series was favourable in more than 68% of cases with total mortality of 26.8%. Analysis of individual tomographic categories, however, showed that whereas the group of patients with diffuse axonal lesion presented nil mortality, those with diffuse cerebral swelling had 52% mortality owing to the onset of refractory intracranial hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

This study assessed with a neuropsychological battery the outcome of 27 patients operated on for an aneurysm of the Middle Cerebral Artery a mean of 35 months before, and of 27 patients operated for aneurysms of the Posterior Communicating Artery, a mean of 47 months before. Both groups showed a defective pattern of performance that was related to the hemispheric side of the aneurysm with left-sided patients impaired on naming, verbal fluency and verbal short-term memory and right sided patients on both short-term and long-term spatial memory and discrimination of line orientation. In single cases, the scope of neuropsychological impairment was sometimes wider than that expected only on the basis of the competence of the affected hemisphere.

One hundred and fourteen patients operated on for an intracranial aneurysm were followed up in order to investigate their neuropsychological outcome and to detect if there were any clinical features assessed around the time of operation that had prognostic significance. The neuropsychological examination evaluated language, apraxia, memory, intelligence and spatial ability. In the statistical analysis the overall severity of neuropsychological disorder was studied. "Late surgery timing" had a negative influence upon the neuropsychological outcome. There was not a difference between different aneurysm sites. Several patients with an apparently good clinical outcome showed neuropsychological deficits. Neuropsychological assessment is important in the evaluation of outcome after subarachnoid haemorrhage.