A Clinical Analysis of Delayed Traumatic Intracerebral Hemorrhage

The occurrence of delayed intracerebral hemorrhage is more frequent than previously reported and is associated with a poor outcome. Early detection and proper management is important in that aspect. The progression tends to be insidious. When the patient's consciousness gets worse or is not improving within resonable time, the second CT scan should be performed. In a retrospective study of 211 consecutive patients with traumatic intracranial hematomas, we identified 12 cases(5.6%) with delayed traumatic intracerebral hemorrhage(DTICH). Among these, five(41.6%) died of DTICH. Cerebral contusion on initial CT, acceleration-deceleration injury with rotational forces, surgical decompression would be important contributors in the development of DTICH.

A Clinical Analysis of the Patients Who "Talk and Deteriorate" as a Result of Delayed Traumatic Intracerebral Hematomas

During a six-year period, 15 cases of "Talk and Deteriorate"patients who were suffering from delayed traumatic intracerebral hematoma(DTICH) were found retrospectively among 1055 patients with head injuries. All fifteen had suffered initial mild head injury(GCS score, 13-15), and apoplectic events or progressive neurological deficits(GCS<8) requiring surgical intervention developed within 72 hours. Subsequent CT scanning showed worsening of the original contusional lesion in ten cases, new hematoma in six, and new lesion(contusion, ischemia and/or edema) in five. cases. The most common location of DTICH was the frontal lobe(11 cases) and the most common cause of injury was a fall(10 cases). The condition of most of these patients could not be predicted, and there was no clear evidence of secondary insults such as hypoxia, hypotension, anemia, or hypercarbia, but hyperglycemia and coagulopathy were seen. Our results demonstrated that in spite of an initially high GCS score, patients who had been injured during a fall and on initial CT scan showed frontal lobe hemorrhagic contusion and/or swelling should be observed closely for at least three days after the injury. Among patients in the "Talk and Deteriorate"group whose condition was caused by DTICH, early diagnosis and aggressive treatment may be the most important life-saving management strategy.

Clinical Analysis on 96 Cases of Traumatic Intracerebral Hematoma Treated with Operation

The authors had studied 96 cases of traumatic intracerebral hematoma surgically treated in the Department of Neurosurgery, Masan Koryo Hospital from January 1987 to December 1991. The results were as follows: 1) The patients' age ranged from 8 to 73 years and sex distribution was dominant in male. 2) The most common cause of traumatic intracerebral hematoma was fall. 3) The most common site of hematoma was frontal lobe, followed by temporal lobe. 4) The neurologic status on admission was closely related to prognosis. 5) DTICH(Delayed traumatic intracerebral hematoma) was found in 7 cases(28.1%) which had poor prognosis. 6) Total mortality rate was 28.1%.