Traumatic tentorial hematoma in two-wheeler riders: Correlation with helmet use.
BACKGROUND
Tentorial hematoma is frequently seen in traumatic brain injury (TBI) patients, especially in motorized two-wheeler riders following head injury. However its relevance and prognostic significance are not known.


OBJECTIVE
To evaluate patients of TBI with tentorial hematoma using a simple grading system and attempt to correlate this grading with factors like helmet use and neurological outcome.


METHODS
This prospective study over a 1-year period included patients with TBI who had tentorial hematoma in the initial plain head. Patients were divided into three grades based on the initial CT findings: Grade I: Isolated tentorial hematoma, grade II: tentorial hematoma with midline shift but open cisterns and grade III: Tentorial hematoma with effaced cisterns. Clinical and radiological records of patients including admission GCS and GOS at discharge were assessed in all cases.


METHODS
A total of 1786 patients of TBI were admitted during the study period. Of these, 106 (5.9%) patients had tentorial hematoma. 84.9% (n= 90) were male and 15.1% (n= 16) were female with the mean age being 36.5 years (range 2-66 years). The mean admission GCS was 13, 11 and 8 in patients with grade I, II and III tentorial hematoma respectively. 43.4% (n= 46) of the patients had grade I, 32.1% (n= 34) had grade II and 24.5% (n= 26) patients had grade III tentorial hematoma. Seventy-one patients (84.5%) were riding motorized two wheelers with 63 (89%) wearing helmets. The majority of the patients wearing helmets (58.8%) had grade I hematoma with 35% (n= 22) having grade II hematoma and only 6.3% (n= 4) having grade III hematoma. Overall, there were 20 deaths. 50% (n= 10) of the deaths were in patients with grade III hematoma and 40% (n= 8) of the deaths were in patients with grade II hematoma. There were two (10%) deaths in patients with grade I hematoma (both unrelated to head injury). The mean GOS at the time of discharge was 5, 4.1 and 2.2 in patients with grade I, II and III tentorial hematoma, respectively.


CONCLUSIONS
Tentorial hematomas are very common in two-wheeler riders with TBI and could be a marker for indirect forces such as rotational forces experienced while wearing helmets.
Department of Neurosurgery, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Deepak
D
Agrawal
Department of Neurosurgery, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Pankaj
P
Dawar
Head injury; helmet; mortality; outcome; tentorial bleed; tentorial hematoma; traumatic brain injury
Neuroradiology. 1982;22(5):259-61
7063118
Pediatrics. 2010 Dec;126(6):1141-8
21078737
J Trauma. 2010 Nov;69(5):1101-11
21068615
Neurosurgery. 1998 Feb;42(2):363-71
9482188
Pediatrics. 2010 Dec;126(6):1149-55
21078726
JAMA. 2010 Dec 22;304(24):2683-4
21177499
J Trauma. 2010 Feb;68(2):441-6
20154556
Cochrane Database Syst Rev. 2008 Jan 23;(1):CD004333
18254047
J Trauma. 2001 Nov;51(5):949-58
11706346
BMC Public Health. 2009 Oct 20;9:393
19843325
Neurosurgery. 1998 Nov;43(5):1137-45
9802857
Ann Surg. 2010 Sep;252(3):573-4; author reply 574
20739866