Prognostic value of CT in head-injury coma

The brain CT findings in 54 patients in coma 1-5 (Bozza-Marrubini scale) following craniocerebral trauma are analysed retrospectively. Attention is focused on those of the CT features that constitute indirect signs of brainstem involvement: obliteration of the suprasellar cisterns, distortion of the perimesencephalic and quadrigeminal cisterns, dilatation of the temporal horn and widening of the cerebellopontine angle cistern on the lesion side, considered anatomically and clinically responsible for coma. The patients fell into three groups: 7 with negative CT, 31 with intracranial lesions not affecting the brainstem and 16 with CT evidence of descending transtentorial herniation. The CT signs correlated significantly with coma level and survival. These CT signs can be used alongside the clinical and other instrumental data -- EEG, VEP and intracranial pressure -- as a further criterion of severity in head-injury coma.