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

ABSTRACT

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.