Traumatic intracerebral lesions without extracerebral haematoma in 218 patients

Abstract

218 of the 852 patients in the HIT-2 study of head injury had intracerebral lesions only. They were analysed to get more information on the optimal treatment of these severely injured patients. The initial CT scans were reviewed to exclude patients with extracerebral lesions, and to make a radiological diagnosis of contusion, contusion under a depressed fracture, diffuse axonal injury, or intracerebral haematoma. Deterioration after admission to hospital was seen in 71% of patients. Patients with contusions, and contusions from depressed fractures in particular showed a worse outcome than expected, while patients with diffuse injury had a tendency to improve rather than to deteriorate. Patients with intracerebral haematoma seemed to improve if the mass was evacuated. Nimodipine had an impact only in patients with contusions. Our findings mandate surgical evacuation of contusions and intracerebral haematomas in patients with lesions larger than 20 ml who also have radiological signs of a mass effect. Regardless of an apparently good clinical state in the early phase, intracerebral lesions larger than 50 ml seemed to benefit from surgery as compared to nonsurgical treatment. The findings indicated that a further refinement of diagnostic criteria may enable individually tailored head injury treatment to interfere with most important pathogenic mechanisms. More accurate diagnoses will improve head injury treatment and outcome, and are a prerequisite for making successful pharmaceutical trials of head injury in the future.

Dexamethasone and colchicine reduce inflammation and delayed oedema following experimental brain contusion

“…They concluded that a late influx of monocytes with a maximum on days 4-7 would constitute a secondary event with little pathogenetic importance, since cellular death was widespread already in an early phase. In contrast, our finding of an attenuated brain oedema parallelling the pharmacologically induced decrease in cellular inflammation suggests that these are important secondary events in brain contusion, since delayed oedema may be deleterious in patients with contusions [29,30,37,38,40].…”

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

“…3,19 Future studies are warranted to investigate whether these radiological parameters can predict clinical deterioration and therefore can be useful as guidelines for surgical indications before the onset of GCS score worsening. The reasons underlying why hematoma increase and/or pericontusion edema increase do not influence clinical deterioration are probably associated with the complexity of the anatomic lesions in these TBI patients.…”

Neuroprotective effects of N-acetylcysteine amide on experimental focal penetrating brain injury in rats

“…Therefore, we studied the effects of NACA in a novel model of focal penetrating brain injury [24], which is particularly prevalent in war zones [25] and in areas with a high incidence of gun related violence [26]. Outcomes are worse in patients with penetrating brain injury plus contusion as compared to contusion only [27]. We analyzed markers of inflammation, oxidative stress, neuronal degeneration and apoptosis at 2 and 24 hours after injury with NACA treatment and no treatment, corresponding to the peaks of post traumatic inflammation in the brain [5,28].…”