title: [Progressive brain injury].
abstract: The aim of this study was to evaluate the clinical manifestations and prognostic factors of progressive brain injury following trauma. We reviewed the records of 779 patients with head injury who had an admission Glasgow Coma Scale of 9 or more; 70 (7.0%) developed progressive brain injury as evidenced on serial CT scans. Of these 70 patients, 19 (27.1%) had a subdural hematoma, 19 (27.1%) an epidural hematoma, 16 (22.9%) a cerebral contusion, 13 (18.6%) an intracerebral hematoma, and 3 (4.3%) a diffuse brain swelling. Three months after injury, 36 (51.4%) patients died, 2 (2.9%) were left in a vegetative state and 23 (32.9%) had a favorable outcome. The appearance of progressive brain injury was associated with patient age, admission Glasgow Coma Scale, injury mechanisms, skull fracture and hemorrhagic lesions on the initial CT scan. Patients with the extracerebral lesions deteriorated 4 hours after injury, whereas those with intracerebral lesions deteriorated 8 hours after injury. The outcome based on Glasgow Outcome Scale was significantly associated with age, type of intracranial lesion, Glasgow Coma Scale following deterioration, the mechanism of injury and surgical treatment. It is concluded that early repeated CT scan is indicated in patients with risk factors of developing progressive brain injury.
authors.affiliation: Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sawauchi
authors.forename: Keisuke
authors.initials: K
authors.lastname: Taya
authors.forename: Takuo
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Takuya
authors.initials: T
authors.lastname: Ishii
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Otsuka
authors.forename: Satoru
authors.initials: S
authors.lastname: Morooka
authors.forename: Kenji
authors.initials: K
authors.lastname: Yuhki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takao
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Murakami
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Abe
mesh_terms: D000328:Adult; D000367:Age Factors; D001924:Brain Concussion; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D018450:Disease Progression; D015600:Glasgow Coma Scale; D020199:Hematoma, Subdural, Acute; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed