Serial computerized tomographic evaluations in traumatic head injury

Severely head injured patients often develop lesions requiring neurosurgical intervention after admission to a rehabilitation unit. It is postulated that routine computerized tomography (CT) at regular intervals during inpatient rehabilitation may assist in the discovery of these lesions. This study explores the value of obtaining sequential CT scans in a population where it is often difficult to objectively assess progress and potential outcome. This series is based on 47 patients with traumatic head injuries who were admitted to a comprehensive inpatient head injury unit over a two-year period. CT scans were performed on each patient by prospective protocol at admission, one month, and three months later, unless marked clinical improvement was observed. Nine of 41 patients (22%) scanned required neurosurgical intervention for ventricular enlargement, subdural hematoma, or cerebral abscess after admission to the unit. Two of the nine (22%) had changes noted on preadmission scans and seven (78%) had pathologic changes detected on CT only after admission to rehabilitation. Thus, significant numbers of neurologic lesions were identified in the postacute phase during the inpatient rehabilitation program. Serial CT scanning may allow earlier diagnosis and thereby minimize further brain injury in the rehabilitation setting.