Delayed traumatic intracerebral hemorrhage: a study of prognostic factors.
Experience in the management of 32 patients with delayed traumatic intracerebral hemorrhage (DTICH) is presented with emphasis on the incidence, clinical significance and factors affecting the outcome. The incidence was 1.4% of all hospitalized head-injury patients, or 5.9% of only those patients with neurologic signs or abnormal findings on computed tomography (CT) identified on admission. After an injury, every patient had an immediate CT scan to diagnose intracranial pathology. Initially, nine patients underwent a craniotomy for intracranial hematomas, and 23 patients had nonoperative treatment. CT follow-up was carried out in 10 patients due to clinical deterioration and on 22 patients due to failure to recover neurologically. The delayed hemorrhage was found after a time interval varying from seven hours to 10 days (average, three days and seven hours). Six patients underwent operations for DTICH, and 26 were treated conservatively. Twenty-four patients (75%) were functional (good or moderately disabled condition) after one year of follow-up treatment, as measured on the Glasgow Outcome Scale. The mortality was 16%. The patients were predicted to have a poor prognosis if associated with an earlier occurrence, the hematoma was large, the patient had a poor Glasgow Coma Scale score at the time of CT follow-up, clinical deterioration was noted, or partial or complete effacement of the suprachiasmatic cistern was noted on the CT scan. The results indicate that the prognosis of DTICH is not as poor as it was previously thought to be, and the factors affecting the outcome in this study seem to justify a more vigilant approach.
Department of Neurosurgery, Poh-Ai Hospital, Lo-Tung, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
S H
SH
Tseng
D000293:Adolescent; D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality*; D002648:Child; D006259:Craniocerebral Trauma / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013997:Time Factors; D014057:Tomography, X-Ray Computed