[Head injuries in the acute phase]

Half of patients with traumatic head injuries are comatose (Glasgow coma scale < or = 8); motor vehicle accidents among young people are the predominant mode of injury. CT scanner reveals a large variety of lesions such as extracerebral hematomas, focal or diffuse hematomas, deep lesions. Surgery is performed in one quarter of these patients and indications are extracerebral hematomas, depressed fracture or craniofacial wounds. Indications for surgery in focal intracerebral lesions are difficult and depend on patient age, evolutivity and delayed intracranial hypertension; shift on CT scanner and compression of basal cisterns are the predictors of developing intracranial hypertension. Medical treatment depends on patient severity state; with comatose patient, intensive care unit is required with intubation, ventilation and intracranial pressure measurement by ventricular drain. If the pressure is greater than 20 mmHg, barbiturate therapy is indicated.