Traumatic isolated intracerebral hemorrhage in children

Among 314 children with craniocerebral injury, 21 were diagnosed as having traumatic, isolated intracerebral hemorrhage (TIICH) by computed tomography (CT) from 1980 to 1986 (basal ganglia, 7; frontal, 8; parietal, 2; frontoparietal, 1; temporoparietal, 1; intraventricular, 1; midbrain, 1). The level of consciousness was assessed according to the Children's Coma Score (CCS) and CT scan was subsequently repeated to evaluate the change in TIICH. The patients were classified into three types according to their clinical courses and CT findings: type I (4 cases), type II (14 cases), and type III (3 cases). Of the 21 cases, conservative treatment was given in 15 and surgical treatment in 6. The outcome showed: good recovery in 1, fair recovery in 7, poor recovery in 2, and death in 2. Type III had a poor prognosis. We discuss the mechanism of the formation of TIICH and speculate that impact to the head caused shear strain in the small perforating vessels and at the junction between white and gray matter which, in turn, caused vascular rupture.