[Conservative treatment of post-traumatic intracerebral hematoma]

Out of 184 patients with posttraumatic intracerebral haematomas 52 were treated conservatively. For this treatment patients were qualified with good consciousness level, in the range of 13-15 GCS score. Presence of massive neurological deficit was not an indication to treatment. Patients with haematomas in the central zone, with multiple haematomas or with contraindications to operation were treated conservatively. Eight patients died (15%), in 2 of them severe brain trauma with multiple haematomas were the cause of death, in 1 case primary brainstem trauma was present, one patient had deeply situated haematoma of the thalamus and ventricular system, and in 4 cases death was due to non-cerebral causes. The size of the haematoma in CT scan was not decisive for the choice of the treatment. Nearly in all cases compression of the ventricular system was present, but in only some cases the ventricles were shifted. In repeated CT scans resorption of the haematomas was observed. Twenty patients were discharged home in good general condition without serious neurological deficit. Twenty-four patients were treated later on in other hospital departments. Later outpatient control examinations showed that even serious neurological deficits regressed in most cases. The main symptoms were those of the post-trauma syndrome. About 25% of patients had epileptic seizures after the treatment. The author believes that if the patient is conscious and his consciousness is not worsening conservative treatment of intracerebral haematomas may be undertaken with good effects, on condition, however, of the availability of immediate surgical intervention if the condition of the patient is deteriorating.