[Delayed intracranial hematomas following cranio-cerebral trauma].
We present a retrospective study of 30 cases of delayed intracranial hematoma, of which 28 were intracerebral, 5 epidural and 2 subdural. Follow-up of the neurologic and radiologic evolution aimed at determining the risk factors capable of predicting the occurrence of delayed intracranial hematoma. 14 patients had a Glasgow score of 15 on admission. 11 patients were neurologically entirely normal and did not undergo an initial CT-scan. In the 19 cases where it was performed the initial CT-scan showed contusion in 9 cases, edema in 6 and epidural hematoma in 7. A skull fracture was diagnosed in 22 patients. The most significant prognostic factor was the level of the Glasgow score on admission. Of the 14 patients who had a score of 15, 7 made good recoveries, 4 had a minor handicap, 1 a severe handicap and 2 died. Delayed intracerebral hematomas are highly unpredictable and can occur in any age group, in patients who are fully conscious on admission, and in patients with a normal CT-scan, with or without fracture. Our current policy is the following: no concussion but normal neurological findings: discharge home; concussion but normal neurological findings on admission: plain skull films; if fracture, 24 hours' hospital supervision; if no fracture, discharge home; abnormal neurological findings on admission: CT-scan; repeat CT if there is secondary neurological deterioration, secondary rise in intracranial pressure, or lack of improvement after 24 hours, and in all sedated and hyperventilated patients after 24 hours.
Iuvara-Bommeli
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A
Service de neurochirurgie, Centre hospitalier universitaire vaudois, Lausanne.
de Tribolet
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N
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D006259:Craniocerebral Trauma / Q000150:complications* / Q000175:diagnosis; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000175:diagnosis / Q000209:etiology*; D006407:Hematoma, Epidural, Cranial / Q000209:etiology; D006408:Hematoma, Subdural / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012887:Skull Fractures / Q000150:complications; D013997:Time Factors; D014057:Tomography, X-Ray Computed
Les hématomes intracrâniens retardés après traumatisme cranio-cérébral.