Traumatic Intracerebral Hematoma

During a 36-month period, clinical outcome in 170 patients with traumatic intracerebral hematoma(TICH) was analysed. These patients represented 5.1% of 3328 consecutive patients with head injuries admitted to the Soonchunhyang University Chunan Hospital. The overall mortality was 33.5%. A significant number of patients(52.6%), who were not comators at the time of admission(GCS0.005) ; 2) the presence of associated lesions(p>0.01) ; 3) time delay of two hours or more from admission to operation(p>0.05) ; 4) actual midline shift of 4.5mm or above on initial CT scan(p>0.005) ; 5) obliteration of suprasellar cistern(p>0.005) ; 6) the presence of delayed traumatic intracerebral hematoma(DTICH) in non-surgical patients with GCS score of 8 or above(p>0.01). Age and location of hematoma did not affect outcome, but the patients with multiple located hematoma showed higher mortality than the others. Time delay in the treatment of TICH and DTICH contribute significantly to poor outocme. Rapidly progressive DTICH within 48 hours after trauma is high in mortality. Follow-up CT scan might as well be performed till 48 hours after injury and 8 hours after initial operation, even though neurological status did not alter for the worse.

A Clinical Analysis of Chronic Subdural Hematoma with Special Reference to the Follow-up CT-scan and Osmolarity of Hematoma

A series of 70 patients with chronic subdural hematoma, admitted to the Department of Neurosurgery of Kyung Hee University Hospital from Aug. 1, 1977 to July 31, 1982 is presented. The following results were obtained. 1) Males were more frequently involved than female with the ratio of 4.8 : 1. Peak age incidence was 6th and 7th decade. Bilateral subdural collections were only 4 cases and others were unilateral. 2) Older age(more than 50) had more frequently focal neurologic deficit such as hemiplegia, however younger age(less than 50) presented as increased intracranial pressure signs such as headache and vomiting. 3) The hematoma density of CT-scan on admission was hypertense, 3 cases(4.9%); mixed density, 20 cases(32.8%); isodense, 18 cases(29.8%); and hypodense, 20 cases(32.8%) respectively. 4) The operative method between simple burr hole drainage and craniotomy with membranectomy didn't affect the postoperative results. The operative mortality was 2.9%. 5) Follow-up CT scanning was performed in 32 patients, only 8 of them showed normal CT findings within one month after operation. One patient still showed remnant of hematoma on 50th postoperative day. 6) Osmolarities of the hematoma and systemic venous blood were measured simultaneously 10 times in 8 cases. Hematoma osmolarities were isosmolar 1, hyperosmolar 6 and hyposmolar 3 compared with systemic venous blood.