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✓ Two cases of postoperative neurological deterioration following routine neurosurgical procedures are presented. In each instance, the patient was found to have hematological abnormalities present preoperatively consistent with vitamin B12 deficiency and to have undergone general anesthesia involving N2O. This caused inactivation of the remaining marginal stores of B12 with resultant neurological decompensation. The frequent use of N2O in general anesthesia and the significant incidence of B12 deficiency make it imperative that the surgeon be aware of this complication and its easy prevention. The preoperative recognition of B12 deficiency and N2O-induced neurological deterioration in patients with B12 deficiency is reviewed.

✓ A consecutive series of 330 severely head-injured patients was studied prospectively. All of the patients were treated with the same protocols by the same physicians and staff in the same intensive care unit. All of the patients had intracranial pressure (ICP) monitoring. Of the 330 patients, 100 were in the pediatric age group (0 to 19 years of age) and 230 were in the adult group (20 to 80 years of age). Statistical analyses were performed with regard to outcome, Glasgow Coma Scale (GCS) score, ICP course, and incidence of surgical lesions. The average emergency room GCS score as well as the 24-hour GCS score for each group was the same. The percentage of patients having ICP that was normal, increased but reducible, and increased but not reducible in each group was the same. The pediatric patients had a significantly higher percentage of good outcomes (43%) than the adult patients (28%) (p < 0.01). They also had a significantly lower mortality rate (24%) than the adult patients (45%) (p < 0.01). At 1 year following injury, 55% of pediatric patients had a good outcome compared to 21% of adults (p < 0.001); this trend was evident at 3 months, with the same p value. Pediatric patients with normal ICP had a higher percentage of good outcomes (70%) than the adult patients with normal ICP (48%) (p < 0.05). There was no significant difference in outcome in pediatric and adult patients with mass lesions or with increased ICP, regardless of whether or not the pressure was reducible. There was a much higher incidence of surgical mass lesions in adult patients (46%) than in pediatric patients (24%) (p < 0.001).

A series of 100 patients 19 years of age or younger is presented. Age, mechanism of injury, Glasgow coma score (GCS), diagnosis, outcome, and other factors are analysed. Ninety-four per cent of the patients had ICP monitoring, 68% had a good or moderately disabled outcome; that is, they were functioning. There was a 24% mortality. There was a 25% incidence of mass lesion and these patients did worse. The major cause of death was neurologic injury.