[Delayed intracranial hematomas following cranio-cerebral trauma]

We present a retrospective study of 30 cases of delayed intracranial hematoma, of which 28 were intracerebral, 5 epidural and 2 subdural. Follow-up of the neurologic and radiologic evolution aimed at determining the risk factors capable of predicting the occurrence of delayed intracranial hematoma. 14 patients had a Glasgow score of 15 on admission. 11 patients were neurologically entirely normal and did not undergo an initial CT-scan. In the 19 cases where it was performed the initial CT-scan showed contusion in 9 cases, edema in 6 and epidural hematoma in 7. A skull fracture was diagnosed in 22 patients. The most significant prognostic factor was the level of the Glasgow score on admission. Of the 14 patients who had a score of 15, 7 made good recoveries, 4 had a minor handicap, 1 a severe handicap and 2 died. Delayed intracerebral hematomas are highly unpredictable and can occur in any age group, in patients who are fully conscious on admission, and in patients with a normal CT-scan, with or without fracture. Our current policy is the following: no concussion but normal neurological findings: discharge home; concussion but normal neurological findings on admission: plain skull films; if fracture, 24 hours' hospital supervision; if no fracture, discharge home; abnormal neurological findings on admission: CT-scan; repeat CT if there is secondary neurological deterioration, secondary rise in intracranial pressure, or lack of improvement after 24 hours, and in all sedated and hyperventilated patients after 24 hours.