Significance of Unilateral Dilatation and Fixation of Pupil in Severe Skull Injuries

No problem in emergency surgery presents greater difficulties of decision than the care of patients who are unconscious following fractures and injuries of the skull. The reasons for these difficulties are many. The occurrence of contralateral brain injury by "contrecoup," the fallacy of interpreting external damage (or absence of it) as an indication of the extent and location of the internal injury, the wide varieties of internal damage that may occur, and the relative greater or lesser importance of such damage according to its location, all combine to make standardization of the procedure to be followed quite impossible. On occasions, rare but nevertheless of sufficient frequency that their occurrence must be constantly borne in mind, the slightest delay in surgical intervention may place the patient beyond relief. One such experience stands out with particular vividness. Case 1. —A young baseball player was hit on the side of the head by