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We performed an in-depth review of each of the 42 closed medical malpractice claims filed in the past 20 years against neurologist defendants covered by a common insurer. For each case, we determined whether the neurologist had rendered harmful, substandard care and noted the case outcome. In 23 of 42 claims (55 percent), there had been no harmful negligence, and payment on behalf of the neurologist occurred only once. The other 19 claims had negligent harm, but in 13 of them (68 percent) no payment was made on behalf of the negligent neurologist. In our series, the medical negligence system performed poorly, yielding a majority of inappropriate claims and no payment in a majority of appropriate claims.

This in-depth study of neurologic malpractice claims indicated authentic, preventable patient harm in 24 of 42 cases, enabling comparison with larger but administratively abstracted summary reports. Principal findings included the common occurrence of outpatient events, lapses in communication with patients and other providers, the need for follow-through by the consultant neurologist even when not primarily responsible, the frequency of diagnostic errors, and pitfalls associated with imaging.

• Hospital records of 53 children and adolescents, aged 18 years or less, with closed head injury were reviewed for information on long-term outcome. Computed tomographic scans were used to divide the patients into clinicopathologic groups. Within these groups, duration of coma was the major index of severity. Outcome was assessed using the Glasgow Outcome Scale and by evaluating social behavior, school performance, and vocational functioning. Patients with diffuse injury plus focal lesions fared worse than those with diffuse injury only. Coma lasting more than one month led to a poorer outcome in both groups. Many individuals had limiting emotional disturbances, which may have resulted from disruption of frontal systems modulating arousal and social behavior.

We studied eight children with acquired aphasia. All had left hemisphere lesions. In most, the correlation between the CT lesion site and the resulting aphasic syndrome duplicated an anatomic-clinical correlation described in adults. Rapid recovery of language fluency distinguished the children from reported adults. Late follow-up indicated poor scholastic achievements, reflecting an acquired handicap in new learning. Anatomic-clinical correlates and recovery patterns suggest that brain organization for language is similar but not identical in children and adults.

Femoral neuropathy secondary to iliac hematoma occurred in a patient receiving heparin injections. Pathologic mechanisms are discussed, and prevention by proper injection technique is emphasized.