A consecutive series of 32 adult patients with chronic subdural hematoma was studied in respect to postoperative cerebral reexpansion (reduction in diameter of the subdural space) after burr-hole craniostomy and closed-system drainage. Patients with high subdural pressure showed the most rapid brain expansion and clinical improvement during the first 2 days. Nevertheless, a computerized tomography (CT) scan performed on the 10th day after surgery demonstrated persisting subdural fluid in 78% of cases. After 40 days, the CT scan was normal in 27 of the 32 patients. There was no mortality and no significant morbidity. Our study suggests that well developed subdural neomembranes are the crucial factors for cerebral reexpansion, a phenomenon that takes at least 10 to 20 days. However, blood vessel dysfunction and impairment of cerebral blood flow may participate in delay of brain reexpansion. It may be argued that additional surgical procedures, such as repeated tapping of the subdural fluid, craniotomy, and membranectomy or even craniectomy, should not be evaluated earlier than 20 days after the initial surgical procedure unless the patient has deteriorated markedly.

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Ten patients with a nontraumatic spinal extramedullary hematoma are reported, nine of the hematomas localized in the epidural space. Seven of the patients were taking anticoagulant drugs and five showed signs of liver disease, mostly due to alcoholism. The invariable first symptom was an intense local pain in the spine, followed in all but one case by radicular irradiation and in all by bladder disturbances and sensory and motor deficits of the spinal cord or cauda equina. All the patients had myelography to verify the spinal mass and were operated on as fast as possible. The outcome depended mainly on the preoperative neurologic status. If there was only an incomplete sensory and motor lesion before the operation, the patients recovered fairly well or completely. The patients who did not become capable of walking again were completely paralytic preoperatively.

Ensuring safety in rolling stock electrical storage and propulsion systems while maintaining the highest possible availability of equipment depends on identifying and dealing with faults at the earliest opportunity