Traumatic Intra Cranial Injury - Computed Tomography, Per Operative and Post Mortem Find Ings : A Prognostic Correlation

Abstract

The present study was undertaken in department of Radio-Diagnosis, Government Medical College, Kozhikode, Kerala, in 70 patients who underwent CT scan head for evaluation of head injury. CT findings in traumatic head injury patients were recorded and studied. CT findings were correlated with preoperative and postmortem findings. Sensitivity of CT in detection of various traumatic intracranial lesions and role of CT findings in predicting outcome of head injuries were assessed. The study group consisted of 64 males and 6 females between the ages of 1 to 70. Initial CT findings were evaluated. Those patients who were conservatively managed are followed up for three months, follow up CT findings and mortality was assessed. Those cases subjected to neurosurgical interventions were followed up and surgical & post procedural data are collected. Post-mortem findings in head injury deaths were collected and studied. Present study shows majority of head injuries in economically productive age group (21-30 year), in males and as a result of road traffic accidents. Skull fractures were seen in 50 % of cases. CT detection rate for linear fractures is around 90 % and for base of skull is 82 %. Most common CT finding was subarachnoid hemorrhage followed by cerebral contusions. 39 % of cases were managed conservatively and has got favorable outcome. 31 % underwent cerebral decompression procedures in which 85 % had a good post-operative outcome. Evacuation of extra axial bleed (EDH and SDH) was the common procedure undertaken. Extra axial bleed was the cause for 14 % of total mortality. Midline shift of approximately 8-10 mm corresponded to 100 ml of extra axial bleed. Present study showed a mortality rate of 32 %. Most common cause of death was multiple intra parenchymal bleeds, in which brain stem bleed was the major cause (44 %). CT detection rate for brain stem injury was around 75 %. Diffuse brain injuries were the cause in 22 % of deaths. CT detection rate for diffuse brain injury was around 70 % and mortality 60 %. Diffuse brain injuries and brain stem injuries were under diagnosed in CT. Even though some of the diffuse brain injuries were under diagnosed in CT, all the surgically correctable lesions were detected by CT.