Significance of bilateral abnormalities on the CT scan in patients with severe head injury

One hundred forty head injured patients, managed by a standardized protocol of early diagnosis, surgical decompression, and intensive therapy, had computerized tomographic (CT) scans within 1 hour or arrival in the emergency room. Ninety of these patients had serial scans during the subsequent week. On admission, 26 patients had normal scans, 75 had unilateral lesions, and 39 had bilateral lesions. Thirteen who had unilateral lesions on admission developed contralateral lesions during the first week for a total of 52 patients with bilateral lesions. These 52 patients could be separated into two distinct groups: (a) those with small ventricles and no change or a slight, homogeneous decrease in density of the brain parenchyma, who had better neurological status on admission, lower intracranial pressure (ICP), and better outcome; and (b) those with bilateral increased density lesions, who had poorer motor response on admission, higher ICP, and worse outcome. The value of CT scanning in management, prognosis, and outcome is emphasized.