GSWH patients suffer global cerebral metabolic disturbances that are at least as severe as those seen in non-GSWH patients with injuries of comparable severity. This selected population of GSWH patients may enjoy outcomes comparable to those of non-GSWH patients if they are treated by the same aggressive protocols.

A female patient with non-missile head injury is described. She showed slight improvement in her level of consciousness, and survived for 6 1/2 years after injury. At autopsy, the white matter lesions were localized rather than diffuse in distribution. In addition to lesions in the corpus callosum, anterior commissure and dorsolateral quadrant of the rostral brain stem, those in the parasagittal cerebral white matter, and in the hilus of the dentate nucleus and superior cerebellar peduncle were considered to be due to primary axonal injury. A cavity in the frontal white matter was remarkable in that there was no evidence to indicate expansion of the lesion due to haemorrhage. These features suggested that the injurious physical forces had acted parallel to the direction of the axons.

To clarify the early prediction of outcome in severe head injury patients with evacuated mass lesions, 32 patients with a Glasgow Coma Scale (GCS) score of 8 or less were classified as having a good outcome (11 cases) or a poor outcome (21 cases). The following parameters affecting the prognosis were analyzed, i,e., the patient's age and sex, type of injury, the presence of hypotension and/or hypoxia, time from injury to arrival at the emergency room and/ or operating room, the admission GCS, pupillary abnormalities, CT findings, and continuous monitoring of intracranial pressure (ICP), cerebral perfusion pressure (CPP) and jugular venous oxygen saturation (SjO2) for 1-5 days after the injury. The patient's age, the admission GCS score, ICP on day 1 after the injury, and CPP on day 0 after injury were powerful factors that affected the prognosis. Other parameters showed little difference between the two groups. However, the presence of hypotension and/or hypoxia showed a tendency for poorer outcomes, and episodes of jugular venous desaturation (SjO2<50%) were common during the initial 3 days in the poor outcome group. These results suggest that the first prognostic evaluation can be performed after 3 days by considering primary and secondary brain damage. (JJAAM 1998; 9: 95-101)

No abstract