[Value of computerized axial tomography in cranio-cerebral injuries]

Since May 1975 was have been working in the field of C.A.T. and its application to study head injuries. We are presenting differents groups of patients studied by C.A.T. I. -- DATA OF C.A.T. IN THE CASES OF EMERGENCY AND IMMEDIATE POST-OPERATIVE FOLLOW-UP OF HEAD INJURIES A) EMERGENCY STATE As soon as the clinical state of an head injured patient was supposed to need an operation, C.A.T. was realized; so differents abnormal scanners may be observed: 1. epidural hematoma, 2. subdural hematoma, 3. intra-cerebral hematoma, 4. acute subdural hematoma or contusion. We must do some comments: -- The Emi-scanner is pre-eminent in showing the exact topography of the lesion : so, the flap is easier to realise. -- In most cases the Emi-scanner is easier to interpret than angiogram for example contusion and hematoma. We know the goods results in hematomas and the poors results in surgery of contusions. -- But the senior advantage of C.A.T. is to provide all the informations in the totality of skull content. Emi-scanner shows bilateral lesions, ipsilateral lesion. C.A.T. is pre-eminent in showing the presence of this two lesions, more accurately than senior methods of investigations, so C.A.T. permits emergency neurosurgical treatment. B) C.A.T. AND FOLLOW-UP Repeated studies at post-intervals can be accomplished without risk to the patient, thus making follow-up simpler and more effective to the neurosurgical attitude. C) POST-OPERATIVE CONTROL AND C.A.T. Post-operative complications are always hard to diagnosis. C.A.T. is painless, quick and safe, and easier to interpret than an angiogram. II -- SEQUELLAE STADE AND C.A.T. In this field certains advantages of C.A.T. are immediatly apparents. In most cases the C.A.T. is the best screening method. Patients carried out are: -- psychiatric troubles, -- post-traumatic epilepsy. The results are not reliable. There is no anatomical-clinical relation in most cases. Differents pictures are observed: -- asymetrical ventricle enlargment, -- global ventricule enlargment, -- partial cerebral atrophy. III -- DISCUSSION 1. We are at the beginning of our study. 2. This not always possible to obtain a C.A.T. in emergency for a head injury, especialy at night. 3. Patients investigated following head trauma are among the most difficult to study with C.A.T. These invididuals send to be restless and uncooperative. Numerous artefacts produced by patient motion may lead to erroneous negative or positive diagnosis, so general anesthesia is often helpful. It is hoped that as a more rapid scanners become available this problem will be obviated. The C.A.T. alone is not capable, to provide all the necessary date concerning head injury. The C.A.T. is, however, re-adjusting our total investigation (E.E.G., angiograms) philosophy and practice rather than replacing the standard neuroradiological technique, except, may be, with epidural hematoma.