The Value of Early Diagnosis in the Management and the Prognosis of Delayed Traumatic Intracerebral Hematoma

ABSTRACT

Ten cases of delayed traumatic intracerebral hematomas(DTICH) were found retrospectively among 129 patients with traumatic intracranial hematoma in about 3-year period. The interval from cranial injury to diagnosis of DTICH varied from 1 day to 13 day. The diagnosis was made on repeat computerized tomographic(CT) scans, obtained following neurological deterioration, lack of improvement and/or increase of intracranial pressure(ICP). For early diagnosis of DTICH, continuous ICP monitoring was more effective than routinely repeating CT scan and neurological observation. To analyse the factors influencing the prognosis, we divided DTICH into four groups by initial CT findings:Group I, one case, had negative CT scan on admission. In group II, two cases, an area of parenchymal contusion was noted on the initial CT scan with DTICH subsequently developing in the contused region. In group III, six cases, the initial CT scan showed intracranial hematoma and prior surgical management was done on admission. Group IV, one case, showed generalized brain edema. The prognoses of group III and IV were poorer than those of group I and II. The overall mortality was about 20%. We also discussed the pathogenesis and prognostic factors of DTICH in light of pertinent literatures.