[Traumatic subarachnoid hemorrhage in acute severe head injury]

Traumatic subarachnoid hemorrhage (TSAH) is a frequent occurrence resulting from acute severe head injury. Computerized tomography (CT) accurately identifies the region, extent and nature of TSAH following trauma. But, to our knowledge, there have been few series detailing the characteristics of TSAH in acute severe head injury. The purpose of this study is to describe the findings, nature and prognosis of TSAH. Over a six and a half year period between April 1977 and September 1983, 414 severely head injured patients were examined by CT within 24 hours of the injury in the Department of Neurological Surgery and Critical Care Medicine, Nippon Medical School. Among them, 97 (23.4%) patients showed the appearance of TSAH in the Sylvian fissures, tentorium cerebelli, cortical sulci, basal cisterns and interhemispheric fissures. Conscious state on admission was defined using the Glasgow Coma Scale (GCS) and clinical outcome was defined using Glasgow Outcome Scale. There were 77 men and 20 women, ranging from 4 months to 83 years in age (means 44.3 years). TSAH therefore appears to be seen in all age groups, but especially in middle age groups. The GCS on admission was 8 or less in all cases; the GCS was 8 in 10 cases, 7 in 7 cases, 6 in 15 cases, 5 in 16 cases, 4 in 23 cases, 3 in 26 cases. The lower GCS scores, the more frequently TSAH was identified, and 67% of the patients had a GCS of 6 or less.(ABSTRACT TRUNCATED AT 250 WORDS)