SOME PROBLEMS PRESENTED BY HEAD INJURIES IN OLDER PEOPLE

In the increasing tempo of American mechanized life, the diminishing alertness of the aging individual, and his less efficient physiologic. adjustments, militate against him in the struggle for physical survival. If our youth and some of their elders could be taught the truth of the adage emblazoned over the rear of our traffic officers’ cruisers, that “Death begins a t forty,” and if older people acting as pedestrians would be more alert, the incidence of head injury could be very significantly reduced. Even with the application of such measures, there will still be the multiple problems of head injury to be faced and it is the physician’s responsibility to be prepared to meet them. It is not the purpose of this paper to discuss either lacerations of the scalpwhich may, on occasion, present formidable problems-or the matter of skull fractures. Rather it is our intent to concentrate upon those two very important categories of injury which affect brain function itself, namely, compressing clots and direct brain injury. Although it is true that an extensive depressed skull fracture may play a role in brain compression, no more than passing eomment upon this point is required. However, the usual lesions which cause shift of brain substance are the epidural and subdural clots and frequently, of no less importance, the development of a hematoma within the brain substance itself. Since the subarachnoid spaces are inaccessible surgically, and since the potentially phagocytic cells which line these spaces tend to dispose of hemorrhage, we do not need to be detained over a consideration of subarachnoid hemorrhage.