Traumatic intracerebral hematoma--which patients should undergo surgical evacuation? CT scan features and ICP monitoring as a basis for decision making.

When a patient presents to the neurosurgeon with a traumatic intracerebral hematoma and has not deteriorated or developed new neurological deficit since the injury, the decision to remove the hematoma may be difficult. Of 244 patients with traumatic intracerebral hematomas, 85 were selected for intracranial pressure monitoring to assist in deciding whether surgical evacuation was indicated. None had deteriorated in conscious level or developed new neurological deficit since injury. Fifty-five patients (65%) demonstrated high intracranial pressure and underwent craniotomy. In 30 patients, intracranial pressure remained under 30 mm Hg, and their hematomas were not initially removed. Five of these 30 patients suddenly deteriorated or died 6 to 11 days after injury, with features of high intracranial pressure clinically or at postmortem. Intracranial pressure monitoring therefore failed to predict a late rise in intracranial pressure in 16.6% of those with low intracranial pressure initially. An analysis of computed tomography scanning and clinical features was therefore carried out to search for better predictors of the need for surgery. Our data suggest that basal cistern status, coma score, and the severity of edema surrounding the intracerebral hematoma should be used, in addition to intracranial pressure monitoring, to improve management of patients with traumatic intracerebral hematoma.

[Diagnosis of blood flow disorders in the common carotid arteries by the ultrasonic Doppler method]. / Rozpoznawanie zaburzen przeplywu krwi w tetnicach szyjnych wspólnych metoda ultradzwiekowa oparta na zjawisku Dopplera.

The aim of this work was evaluation of the usefulness of the Doppler ultrasound method for detection of blood flow disturbances in carotid arteries. The investigations were done in 110 patients with symptoms of cerebral circulatory disorders. In 45 patients carotid arteriography was done. In 30 cases arterial reconstructive operations were performed. The curves of blood flow velocity in the common carotid arteries were recorded with a UDP-10 ultrasound blood flow detector. The obtained curves were subjected to morphological analysis and the mean momentary velocity of the systolic and diastolic flow wave was calculated. In 80% of cases with impaired patency of the carotid arteries demonstrated by angiography abnormal curves of blood flow velocity in the common carotid arteries were obtained. The method of ultrasound recording of blood flow velocity is non-invasive and safe and it is very useful for establishing indications to angiography and for postoperative control.