Evolving Brain Lesions in the First 12 Hours after Head Injury

Abstract

From January 1, 1990, to April 30, 1994, 412 patients were admitted to our intensive care unit in coma after head injuries. Our study group consisted of 37 patients who were retrospectively identified as harboring lesions or developing new lesions within a 12-hour period from the time of admission. We defined the evolution of a lesion as an increase or decrease in the size of an already present hematoma or as the appearance of a totally new lesion. There were 25 male and 12 female patients (mean age, 34.9 yr), and the cause of trauma was road traffic accidents in 32 patients. Nine patients presented with shock, and six had evidence of abnormal coagulation at admission. Patients were divided into two different groups. In Group 1, 15 patients harbored lesions that evolved toward reabsorption. In Group 2, 22 patients harbored hematomas that evolved toward lesions requiring surgical removal. Fifteen of these patients had initial diagnoses of diffuse injury that evolved in this manner, whereas the remaining seven patients had already been operated upon and had developed second, noncontiguous, surgical lesions. Patients with lesions that required surgical evacuation had their computed tomographic (CT) scans obtained earlier and had a higher incidence of clinical deterioration. There was a significant difference in the evolution of the different lesions (P < 0.001), with subdural hematomas being more prone to reabsorption and intracerebral and extradural hematomas being more likely to increase in size or to appear as new lesions. Second CT scans were obtained because of clinical deterioration in 10 patients and because of increase in intracranial pressure in 5 patients. Scheduled CT scans were obtained in 13 patients, whereas in the remaining 9 patients, the diagnosis emerged from a combination of scheduled CT scans and intracranial pressure monitoring. There was a trend toward a poorer result among the patients with clinical deterioration, which, however, was not significant. A significant proportion of post-traumatic patients, particularly those who are unconscious, harbor early evolving intracranial lesions. When the first CT scan is performed within 3 hours after injury, a CT scan should be repeated within 12 hours.

Hemostatic and neuroprotective effects of human recombinant activated factor VII therapy after traumatic brain injury in pigs

“…Such injuries are characterized by mechanical damage to the parenchyma and its vasculature, resulting in sub-sequent hemorrhage and edema formation. Although clotting may constrain hemorrhage soon after injury, there is considerable evidence to suggest that persistent bleeding can occur in the early hours post-trauma (Servadei et al, 1995;Oertel et al, 2002;Chang et al, 2006;Chieregato et al, 2005;Lobato et al, 1991). Current management of tICH focuses on the identification and surgical evacuation of lesions large enough to generate mass effect and likely result in further neurological deterioration (Bullock et al, 1996).…”

Travmatik Beyin Hasarlı Çocuk Hastalarda Tekrarlayan Bilgisayarlı Tomografinin Değerliliği ve Radyasyon Hasarı

“…In other study of Zumkeller et al, survival rate was reported as 50% in comatose patients with 18 mm subdural hematoma thickness and 20 mm middle line shift (18). In a study of Servadei et al, sizes of lesions decreased in 15 of 37 patients in first 12 hours while 22 showed increase in lesion sizes (19). In this study, in contrast to the literature, changes in hemorrhage thickness of CT (between zero and 23 mm) did not affect the operation-non-operation decision and the progression process with and without sequelae of patients.…”

Developing a Clinical Guideline for CT Scans in Closed Head Injury

“…7 These 37 patients represented 9% of all severe head injury patients. Of these patients, only 22 patients (5%) had lesions that worsened from their initial scan.…”