SUMMARY Sixty patients with severe head injury who did not have an acute intracranial haematoma on CAT scanning are reviewed. The scans are correlated with the level of consciousness at the time of scanning and with the outcome six months after injury. The initial scan was interpreted as being normal in 38% of the cases. In the remainder the most common abnormalities were small ventricles and areas of mixed increased and decreased density interpreted as contusions. All the patients with small ventricles were under 20 years of age. Postmortem examinations were undertaken on 15 of the 19 fatal cases. There was evidence of a high intracranial pressure in 12, cerebral contusions were absent or minimal in 10, there was diffuse immediate impact damage to white matter in six, and there was moderate or severe hypoxic damage in four.The most obvious value of CAT scanning after recent head injury is to identify and localise acute intracranial haematomas, and this it does with a high degree of accuracy (Galbraith et al., 1977). But even in neurosurgical units which operate a selective admission policy, only a proportion of the patients referred have a haematoma, and the management of other patients who are in coma remains a difficult problem.We review here the CAT scans of 60 patients with a severe head injury who did not have an acute intracranial haematoma. Scans are correlated with the level of consciousness at the time of scanning, with the outcome six months after injury and, in those who died, with the neuropathological findings.
Patients and methodsThe patients had all sustained non-missile injuries, over 80% being the result of road accidents. Males were five times more common than females, and 68% of the patients were younger than 20 years.