The encephalopathy that is seen in about 25% of all cases of lead poisoning in young children is a grave complication. In the space of 3 years in a county hospital, 101 children with this complication were treated. About one-third of the cases terminated in death. In many instances the diagnosis was made late, and there is no completely satisfactory therapy. In 25 cases with especially bad prognosis the medical treatment (urea as dehydrating and edathamil calcium-disodium as chelating agent) was supplemented with surgical treatment (flap craniectomy). One apparently moribund child was definitely rescued by surgical means, but 16 of the 25 died. No conclusion as to the place of surgery in the treatment of plumbemic encephalopathy was possible.