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This study shows that the continuing presence of activity similar to normal sleep in the EEG in conjunction with the EEG polygraph (EEGP) can be used to determine the severity of brain damage after head injury. Recordings were taken within seven days of head injury from 154 unselected patients after resuscitation and emergency surgery. Sixteen patients with ongoing seizures were excluded. In the remaining 138 patients the presence of activity in the EEG, EEGP, or both, which can also be recognised in normal alertness and sleep, was noted. Particular attention was paid to the presence or absence of arousal related phasic activity involving EEG, motor, and autonomic changes. The traces were allocated to one of five groups: group 1, wakeful traces with normal alpha in at least one hemisphere; group 2, sleep-like traces with K complexes responsive to stimulation; group 3, traces with phasic activity related to abnormal spontaneous arousal including EEG changes; group 4, traces with abnormal spontaneous arousal activity without EEG changes; group 5, traces with no spontaneous arousal activity. The mean follow up was 21.5 months. Groups 2 and 3 were significantly associated with a good outcome and group 5 with death or a vegetative state. Comparison between the EEG/EEGP findings and the Glasgow coma scale at the time of the recording showed the EEG/EEGP to be the better predictor of outcome, particularly for individual patients.

An approach to evaluating the cost-effectiveness of high-technology diagnostic equipment has been devised, using the introduction of computerised axial tomography (CAT) as a model. With the advent of CAT scanning, angiography and air encephalography have a reduced, though important, role in investigating intracranial disease, and the efficient use of conventional equipment requires the centralisation of neuroradiological services, which would result in major cash savings. In contrast, the pattern of demand for CAT scanning, in addition to the acknowledged clinical efficiency of the scanner and its unique role in the head-injured patient, ephasies the need for improved access to scanners. In the interest of the patients the pattern of service must change.

Thirty-five patients were studied by EEG with recordings taken the day before, two weeks after, and six months after psychosurgery. Most showed a characteristic frontal slow activity of varying degrees after operation with varying enhancement of background activity. The amount and spread of the frontal slow waves two weeks after operation showed a significant positive correlation with the clinical outcome one year later, which suggests a relatively objective and very early indication of the subsequent clinical response to psychosurgery.

The records of the first 571 patients to be examined with an EMI brain scanner were assessed. The patients were divided into diagnostic categories according to their clinical presentation. The intracranial investigations that would have been performed had the scanner not been available were compared with the investigations that were actually performed. As expected, the number of contrast investigations fell, but the reduction surpassed expectation. If the full clinical impact of the scanner is to be realised the patient's illness must be defined in detail and strict attention paid to radiographic detail. By reducing the number of special contrast investigations use of the scanner enables existing contrast facilities to serve a wider population; and use of the brain scanner in district general hospitals would improve the service to patients, especially those with head injuries.