Measurements of intracranial pressure by ventricular catheter were performed in 47 patients with severe head injuries. Thirty-three patients with decompressive operations such as osteoclastic craniotomy and dilatation by means of duraplastic have been compared with 14 patients with closed heads with regard to volume pressure response (intracranial elasticity). This was determined either by intraventricular injection of 2ml saline or by drainage of cerebrospinal fluid. The examination clearly shows that patients with closed heads have a much higher intracranial elasticity than patients who have decompressive operations, so that in the first group minor differences of the intracranial volume cause extreme deviations of the intracranial pressure. Therefore, the decompressive operation has been advised in severe head injuries with increased intracranial pressure as a measure additional to high dose dexamethasone therapy and hyperventilation.

Fifteen cases of peridural empyemas are reported. 12 patients reported with motor dysfunction of the lower extremities and pain radiating from the spine. In one case, localized pain of the spine was discovered and in two cases there were no signs of spinal or radiating pain. Treatment in all cases was laminectomy and systemic antibiotic administration. Microbiological analysis showed staphylococcus aureus in 11 cases. 9 patients recovered with no neurological defects, two had major improvement of the paresis, and one died. Three patients with paraplegia recovered from the primary infection.

Twenty-four h after permanent occlusion of the middle cerebral artery (MCA) in the cat, the hemispheric swelling due to edema is markedly reduced under treatment with large doses of dexamethasone than is the case with the untreated group. The increase of regional water and sodium content in the MCA territory is less in the dexamethasone treated group, whereas the potassium changes in the ischemic tissue showed only small differences between the two groups. The potassium content of the non-ischemic tissue is slightly increased in the dexamethasone treated animals when comparing with the untreated group. RISA activity in the tissue is increased in the grey and the white matter of both groups. The less marked RISA-131 activity in the cortical grey matter of the treated animals indicates blood-brain barrier damage of a smaller degree due to dexamethasone. These findings indicate a beneficial effect of dexamethasone on local ischemic edema. Regarding our results and the pharmacokinetics of this steroid the dexamethasone loading of a patient has to be in the range of about 100 mg per day for the adult, and has to be started immediately after the onset of a stroke.

The development of the intracranial pressure after a subarachnoid haemorrhage was evaluated in 21 patients. A statistically significant relation between the intracranial pressure and the neurological findings was found, whereas vasospasms did not influence the intracranial pressure. In patients in a clinically critical condition, rhythmic pressure waves of a frequency of 1/minute were repeatedly observed.

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