A study on correlation of degree of midline shift on CT scan and Glasgow coma scale in patients of acute traumatic head injury.

Background: The present study is undertaken to analyses the patients of craniocerebral injury with special reference to correlation between Glasgow coma scale score and CT scan findings at the time of admission. Methods: A study was conducted on patients with acute traumatic head injury. Most common and important complication of traumatic head injury is the development of an increased intracranial pressure resulting in midline shift. The larger the amount of the midline shift on CT scan the poorer will be the outcome of traumatic head injury. Other variables such as Glasgow coma scale have been subsequently introduced to build more complex and accurate prognostic model. In Glasgow coma scale it was found that confident prediction could be made only after 24 hours. Results: Cerebral contusion was the most common CT scan finding followed by depressed fracture), subdural hematoma (15.3%) than extradural hematoma. Hemorrhagic contusion was the most common CT scan finding irrespective of GCS score. In patients with GCS 3-5 other outcome findings are extradural hematoma, subdural hematoma, & depressed fracture. In patients with GCS 6-8 other common findings are extradural hematoma, depressed fracture & hemorrhagic contusion. In patients with GCS 9-12 other common findings were hemorrhagic contusion, depressed fracture & intra cerebral hematoma. In patients with GCS 13-15 other common findings were depressed fracture, hemorrhagic contusion. Conclusion: The increased degree of midline shift in patients with head injuries by CT scan was related to the severity of head injury (GCS= 3-12) and was significantly related to poor final clinical outcome.

The Effectiveness of Decompressive Craniectomy with Dural Augmentation in Malignant Cerebral Infarction

OBJECTIVES: There is continuing controversy about the benefits of decompressive craniectomy in massive cerebral edema following space occupying hemispheric cerebral infarction. The aims of this study are to determine the effectiveness and to confirm the life-saving nature of decompressive craniectomy with dural augmentation for massive cerebral infarction. PATIENTS AND METHODS: We present twelve patients with medically uncontrollable hemispheric cerebral infarction. All were treated with extensive craniectomy and duroplasty without resection of necrotic tissue. We evaluated various characteristics(size of hemispheric infarction, Glasgow Coma Scale, volume of low density and midline shift in CT) at three different periods(preoperative, immediate postoperative and 3-4weeks after operation) and evaluated effectiveness of hemicraniectomy for massive cerebral edema after large hemispheric infarction. RESULTS: All patients have survived from surgery. Nine patients with nondominant hemispheric infarction showed significant functional recovery with minimal assistance, and remaining two patients with dominant hemispheric infarction and one patient with nondominant hemispheric infarction have functionally dependent. The volume of low density and midline shift in CT were significantly reduced after decompressive craniectomy. CONCLUSIONS: Our results indicate that decompressive craniectomy with dural augmentation without resection of necrotic tissue for massive cerebral hemispheric infarction not only reduce the mortality and infarction size but also significantly improve the outcome, especially for nondominant hemispheric infarction.

The Huge Epidural Hematoma: Analysis of 39 Cases

The authors analyzed 39 patients with huge epidural hematoma following craniocerebral trauma. Multiple factors such as bleeder, Glasgow Coma Score, hematoma site and its' volume, midline shift, and associated traumatic lesion on initial CT scan appear to expert bad outcome. The initial CT scan findings on admission were assessed and the results obtained are as follows. 1) The outcome harboring huge epidural hematoma is bad in 28% of total 39 patients. 2) The main bleeder is varied in origin according to the hematoma site. 3) The temporo-parietal epidural hematoma affects significantly the Glasgow Coma Scale(GCS) and the patient's outcome, compared with those of frontal and occipital area. 4) The patient's outcome is closely related to the hematoma volume, especially over 16% of total brain volume. 5) The midline shift over 15mm suggests the bad outcome, especially in temporo-parietal epidural hematoma.