[Primary unrecognized severe craniocerebral injuries in psychiatry]

Among 11,136 psychiatric patients admitted between 1977 and 1982 14 cases of initially unrecognized severe head injuries were originally admitted for psychiatric disorders in connection with alcohol abuse. While the overall incidence at 0.13% was low, this figure increased for the 1310 alcoholic patients of this period to 1.06% and 2.1% respectively, depending on the ready availability of computerized tomography. Plain skull X-rays showed fractures in only 2 patients and in 6 cases trivial head injuries indicated a more severe trauma. In the lucid period 2 patients talked of having fallen. Information from relatives revealed in 10 cases that the patients had had a fall, the majority during an epileptic fit in a predelirant state. Five patients underwent surgery on the day of diagnosis, 4 patients died before a correct diagnosis could be made. The avoidable factors contributing to death included above all, the failure to recognize an extracerebral hematoma.