Posttraumatic cerebral hemispheric swelling. Analysis of 55 cases studied with computerized tomography

Area of Science:

• Neurosurgery
• Neurology
• Trauma Care

Background:

• Cerebral hemispheric swelling is a severe complication of head injury.
• It is associated with high mortality and short survival periods.
• This condition represents 10.5% of severe head injury cases studied with CT.

Purpose of the Study:

• To analyze the clinical course and intracranial pressure (ICP) changes in patients with severe head injury and hemispheric swelling.
• To evaluate the impact of associated extracerebral hematomas and their evacuation.
• To assess the effectiveness of thiopental in managing intracranial hypertension.

Main Methods:

• Analysis of clinical data and ICP monitoring in 55 severely head-injured patients with hemispheric swelling.
• Review of computerized tomography (CT) scans to identify associated lesions.
• Evaluation of treatment strategies, including surgical evacuation and high-dose thiopental.

Main Results:

• 87% mortality rate in patients with hemispheric swelling.
• 85% of cases had associated subdural hematomas, 9% epidural hematomas.
• Early surgical evacuation (within 4 hours) had limited impact on neurological status.
• High incidence of hypotension, hypoxemia, and severe clinical presentation at admission.
• High-dose thiopental failed to control ICP in 51% of patients.
• ICP control was achieved in 17% of patients, including all seven survivors.

Conclusions:

• Cerebral hemispheric swelling in severe head injury carries a grave prognosis.
• Management requires prompt identification and treatment of associated hematomas.
• Effective ICP control, potentially with barbiturates, is crucial for survival.
• Continued barbiturate therapy is recommended until CT confirms mass effect resolution.