[CT scan in severe head injury with special reference to Glasgow coma scale]

CT scan demonstrates the invaluable information about the parenchymal lesions of head injuries. The parenchymal lesions were classified into 6 categories; 1) isodensity without mass effect: I(-), 2) isodensity with mass effect: I(+), 3)high density: H, 4) high-low density complex: H-L, 5) low density: L, 6) diffuse cerebral swelling: DCS. Glasgow coma scale (GCS) and outcome scale (GOS) were international practical scales for the evaluation of severity and prognosis of severe head injuries. One hundred and seventy-four cases with severe head injury were analysed. I(+), H and H-L were common findings in the group of GCS 3-6, and I(-) was in GCS 7-12 and GCS 13-15. H and H-L were not related with GCS. DCS was most common in GCS 7-12. Acute epidural hematoma was frequent in the group of GCS 13-15, and acute subdural hematoma was in GCS 3-6. The prognosis was significantly poor in the group of GCS 3-6, with the mortality of 72 percents. On the other hand, the prognosis was quite good in GCS 7-12 and GCS 13-15. There were few reports about the traumatic subarachnoid hemorrhage (SAH). SAH was one of the important risk factors in severe head injuries and it was frequently associated with I(+), H and H-L. The prognosis of the patients with SAH was most unfavorable in the presence of I(+). Number of analyses were reported about the traumatic intraventricular hemorrhage (IVH). IVH was also one of the powerful risk factors and this was commonly associated with H and H-L. The prognosis of the patients with IVH was very poor. Finally, the groups of the patients, whose prognoses turned out to be unexpected results from GCS on admission, were analysed. First, the age was an important factor. In the patients, whose prognoses were good in spite of low GCS, I(-) was a mostly common finding, while SAH, IVH and obscured cisterns, esp. basal and quadrigeminal, were less common. In the patients, whose prognoses were poor despite of favorable GCS, H and H-L were common findings. SAH and IVH were also common. The poor prognosis was induced by secondary systemic complications, such as pneumonia and meningitis, etc.