Traumatic Intracerebral Hematomas: Timing of Appearance and Indications for Operative Removal

Soloniuk, Donald S.; Pitts, Lawrence H.; Lovely, Mary; Bartkowski, Henry M.

doi:10.1097/00005373-198609000-00003

Cited by 101 publications

(31 citation statements)

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“…1 Glasgow Coma Scale scores have also been shown to be highly predictive of prognosis. 6,32,35 One of the most interesting observations of our study is the high percentage (32% [111/352]) of patients showing clinical deterioration during hospitalization. A worsening of neurological outcome occurred overall for 1 patient out of 3 and, more specifically, for 5% of patients with mild TBI, 39% of patients with moderate TBI, and 62% of patients with severe TBI.…”

Section: Discussionmentioning

confidence: 77%

Patients with brain contusions: predictors of outcome and relationship between radiological and clinical evolution

Iaccarino¹,

Schiavi²,

Picetti

et al. 2014

JNS

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Object Traumatic parenchymal mass lesions are common sequelae of traumatic brain injuries (TBIs). They occur in up to 8.2% of all TBI cases and 13%–35% of severe TBI cases, and they account for up to 20% of surgical intracranial lesions. Controversy exists concerning the association between radiological and clinical evolution of brain contusions. The aim of this study was to identify predictors of unfavorable outcome, analyze the evolution of brain contusions, and evaluate specific indications for surgery. Methods In a retrospective, multicenter study, patients with brain contusions were identified in separate patient cohorts from 11 hospitals over a 4-year period (2008–2011). Data on clinical parameters and course of the contusion were collected. Radiological parameters were registered by using CT images taken at the time of hospital admission and at subsequent follow-up times. Patients who underwent surgical procedures were identified. Outcomes were evaluated 6 months after trauma by using the Glasgow Outcome Scale-Extended. Results Multivariate analysis revealed the following reliable predictors of unfavorable outcome: 1) increased patient age, 2) lower Glasgow Coma Scale score at first evaluation, 3) clinical deterioration in the first hours after trauma, and 4) onset or increase of midline shift on follow-up CT images. Further multivariate analysis identified the following as statistically significant predictors of clinical deterioration during the first hours after trauma: 1) onset of or increase in midline shift on follow-up CT images (p < 0.001) and 2) increased effacement of basal cisterns on follow-up CT images (p < 0.001). Conclusions In TBI patients with cerebral contusion, the onset of clinical deterioration is predictably associated with the onset or increase of midline shift and worsened status of basal cisterns but not with hematoma or edema volume increase. A combination of clinical deterioration and increased midline shift/basal cistern compression is the most reasonable indicator for surgery.

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Section: Discussionmentioning

confidence: 77%

Patients with brain contusions: predictors of outcome and relationship between radiological and clinical evolution

Iaccarino¹,

Schiavi²,

Picetti

et al. 2014

JNS

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“…Among the patients consecutively submitted to Xe-CT studies, at least one traumatic intraparenchymal lesions was present in 39 patients in whom, collectively, 59 traumatic intraparenchymal lesions were detected. Taking into account only patients with non-surgically evacuated traumatic intracerebral hematomas with a well-defined hemorrhagic core larger than 2 cm in diameter (Soloniuk et al, 1986), our case material comprises 22 patients with 29 traumatic intracerebral hematomas (49.1% of all studied traumatic intraparenchymal lesions).…”

Section: Patient Summariesmentioning

confidence: 99%

“…We know that the difference between traumatic intracerebral hematomas and hemorrhagic contusions lies in a continuum (Chesnut and Servadei, 1999), and a clear differentiation is not possible. Nevertheless, this type of contusion can be defined, according to Soloniuk (1986), as a "traumatic intracerebral hematoma " having a core of more than 2 cm in diameter of blood.…”

Section: Introductionmentioning

confidence: 99%

Centrifugal Distribution of Regional Cerebral Blood Flow and its Time Course in Traumatic Intracerebral Hematomas

Chieregato

Fainardi²,

Servadei³

et al. 2004

Journal of Neurotrauma

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Cerebral blood flow (CBF) alterations following post-traumatic contusions have been demonstrated in recent papers. We evaluated regional CBF (rCBF) by means of Xenon-enhanced computerized tomography (Xe-CT) in 29 traumatic intracerebral hematomas, from 22 patients with severe head injury (GCS < or = 8). Fifty traumatic hematoma/Xe-CT CBF measurements were obtained from 39 Xe-CT studies performed during the acute phase (corresponding to the first 20 days post-injury). The rCBF was measured in three different regions of interest: the hemorrhagic core, the perihematoma edematous low-density area, and a 1-cm rim of perihematoma normal-appearing brain tissue, surrounding the edematous low-density area. We found a centrifugal improvement of rCBF as well as a decrease in the rates of CBF levels below 18 mL/100 g/min from the core to the periphery (p < 0.0001), which persisted over time. Ischemic rCBF values were detected in the perihematoma low-density area only in 24% of the traumatic hematomas. The time course of rCBF levels showed a reduced flow in the first 24 h, with a recovery of flow from day 2 to day 4, followed by another reduced flow (p < or = 0.0001) both in the perihematoma edematous low-density area and in the non-lesioned tissue. Our findings suggest that the only area with persistent ischemic values was the hemorrhagic core. Low rCBF levels seen in the perihematoma low-density area may only be ascribed partially to ischemia and can possibly recover over time. These results could encourage a surgical approach based on an early evacuation of the hemorrhagic core associated to a preservation of the surrounding edematous tissue.

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“…Since elevated intracranial pressure is associated with poor outcomes, the ability to rapidly and correctly diagnose elevated intracranial pressure is crucial for prompt medical and surgical intervention [3][4][5][6][7]. Unfortunately, early bedside detection of elevated intracranial pressure secondary to TBI remains difficult.…”

Section: Introductionmentioning

confidence: 99%

Sonographic Optic Nerve Sheath Diameter as an Estimate of Intracranial Pressure in Adult Trauma

Strumwasser

Kwan

Yeung

et al. 2011

Journal of Surgical Research

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Traumatic Intracerebral Hematomas: Timing of Appearance and Indications for Operative Removal

Cited by 101 publications

References 0 publications

Patients with brain contusions: predictors of outcome and relationship between radiological and clinical evolution

Patients with brain contusions: predictors of outcome and relationship between radiological and clinical evolution

Centrifugal Distribution of Regional Cerebral Blood Flow and its Time Course in Traumatic Intracerebral Hematomas

Sonographic Optic Nerve Sheath Diameter as an Estimate of Intracranial Pressure in Adult Trauma

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