Long term CT-investigations of nearly 6000 brain-traumatized patients undergoing rehabilitative measures in the past ten years, showed pathologic findings in 85-90%: 40% showed abnormalities of the ventricular system; 60% traumatic tissue lesions; and 15% abnormalities of the brain surface. Kind and frequency of occurrence of the ventricular changes found by CT were in similar to those found by pneumencephalography. Traumatic inner-hydrocephalus permagnus, which occurred in about 0.25% of our patients, is considered with regard to its rehabilitative meaning. Most traumatic defects were found in the frontal lobe (36%) or in the temporal lobe (46%). Presence and etiology of traumatic infarctions were shown in CT images in 3.5% of all traumatic cases. 25% of these were situated in the posterior area: 25% in the basal ganglia; 15% in the midcerebral artery region, and 30% were typical borderline area infarctions. Because of the frequent differences between CT-findings and neurologic or neuropsychologic symptoms, CT-findings are to be judged only in conjunction with the clinical picture. They should never serve as the only guide for the exaluation of traumatic brain defects, prescribing therapy or predicting outcome.
Vascular occlusions due to cerebral trauma have always been regarded as great rarities. However, we have found hypo-dense foci of vascular distribution in 3.5% of 3500 CT examinations for trauma during the late phase. Lesions in the vascular territory of the posterior cerebral artery are usually the result of supratentorial pressure rise from epidural and subdural haematomas, leading to compression of the vessels against the edge of the tentorium. Typical infarcts in the territory of the medial and anterior cerebral arteries were found only rarely by CT after cerebral trauma. Infarcts at the watersheds between the three vascular territories were found with surprising frequency and small infarcts were found in the basal ganglia. It is assumed that these were due to ischaemic or hypoxic events due to cardiac or pulmonary complications during the initial phase.
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