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[Follow-up of computerized tomography findings in traumatic intracerebral hematomas]
1Neurochirurgische Universitätsklinik am Knappschaftskrankenhaus Bochum-Langendreer.
Insights
Traumatic intracerebral hemorrhage (TICH) hematoma size on CT scans correlates with patient outcomes. Early anisocoria (unequal pupils) in TICH patients indicates a poor prognosis.
Area of Science:
- Neurosurgery
- Radiology
- Neurology
Background:
- Traumatic intracerebral hemorrhage (TICH) is a severe injury.
- Predicting outcomes in TICH patients is crucial for clinical management.
Purpose of the Study:
- To investigate the relationship between hematoma and edema volume on CT scans and clinical outcomes in TICH patients.
- To identify early indicators of prognosis in TICH.
Main Methods:
- CT scans were used to measure hematoma and edema volumes in 27 TICH patients surviving beyond 14 days without surgery.
- Clinical parameters, including consciousness and neurological outcome, were recorded.
- Anisocoria was specifically monitored as a potential prognostic sign.
Main Results:
- Hematoma volume peaked around the fourth posttraumatic day.
- Early CT-measured hematoma size correlated well with patient outcomes.
- Two groups of patients were identified based on early edema formation.
- Anisocoria was observed in patients with an average hematoma volume of 37.7 cm³ and was associated with unfavorable outcomes.
Conclusions:
- CT-derived hematoma volume is a significant predictor of neurological outcome in TICH.
- Anisocoria is a strong negative prognostic indicator in TICH patients.
- Understanding early CT findings can aid in predicting TICH patient trajectories.
Abstract:
CT controls and follow-ups were conducted in 27 patients who had suffered traumatic intracerebral hemorrhage. Only such patients were included who did not die before the 14th day after the trauma and in whom operation did not become necessary during this period. In these patients the volume of the hematoma and perifocal edema was determined via CT and clinical parameters were measured or recorded such as state of consciousness at the time of admission and the neurological outcome. It was found that the hematoma had attained its maximum size on about the fourth posttraumatic day. However, even the size of the freshly CT-detected hematoma shows good correlation to the outcome of the patients. Examination of the edema size points to the existence of two groups: one with only slight edema formation in the early posttraumatic stage, and another with an immediate considerable edematic border. From approximately the 8th posttraumatic day the hematoma/edema ratio is approximately the same in both groups, namely, 0.3. Anisocoria, or inequality of the pupils, occurred early in patients with an average hematoma volume of 37.7 cm. Of these, none left the hospital without neurologic signs, so that anisocoria must be considered as a prognostically unfavorable sign.