Pathophysiology of posttraumatic temporal lobe lesions.
ABSTRACT Posttraumatic parenchymal lesions in the temporal lobe may cause neurologic deterioration. An analysis was made of the natural evolution of this type of lesion, with emphasis on its 2 components: hemorrhage (hyperdense on computed tomography [CT]), and edema and necrosis (hypodense on CT). The clinical repercussions were studied, and the factors that might influence such evolution were investigated.
Forty head-injured patients with temporal lobe lesions admitted within 12 hours after the injury were selected in a prospective manner. Computed tomography scans were systematically repeated within the first 36 hours and at 7 and 30 days postinjury. Factors such as interval between injury and the first CT scan, age, velocity of the injury, alcohol consumption, coagulation abnormalities, and the presence of decompressive measures were compared between the patients that had enlargement of the hemorrhage and those who did not. Increase in hypodensity was compared with that in hyperdensity.
Fourteen patients showed enlargement of the hemorrhage. In all cases but one, the interval between injury and admission was 3 hours or less. Other factors had no statistical significance as predisposing causes for such enlargement. In approximately half of the cases, the hypodense component increased in the first 36 hours and continued increasing until the end of the first week. Evolution of the hypodense component was not dependent on behavior of the hemorrhage, surgical drainage, or diameter of the hemorrhagic lesion.
The natural evolution of the hyperdense component of temporal lobe lesions was to enlarge within the first few hours after the injury. Edema and necrosis developed more slowly and with no significant clinical manifestations.
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ABSTRACT: Serial computed tomography (CT) scanning was performed on 138 patients suffering from severe head injuries (i.e., with scores of 8 or less on Glasgow Coma Scale). Standard practice called for scans to be done upon admission (within hours of the injury) and after 1, 3, and 7 days and 1 month. Subsequent CT scans depended on the patient's condition. Clinical results at the time of discharge were graded according to the Glasgow Outcome Scale. During the serial CT scan, there were new findings (not visualized on the initial CT scan but appearing on subsequent scans) in 91 of the 138 patients. These new findings were classified into seven types: (1) decreased density collection in the subdural space; (2) ventricular dilatation; (3) intracerebral hematoma; (4) intraventricular hemorrhage; (5) extracerebral hematoma; (6) edema; and (7) infarction. We defined intracerebral hematoma, intraventricular hemorrhage, extracerebral hematoma, edema, and infarction as new lesions. Of the 60 patients with new lesions, 12 had a good outcome and 48 had a poor outcome. Of 78 patients who did not have any new lesions, 60 had a good outcome and 18 had a poor outcome. A significant correlation was found between good outcome and the absence of new lesions and between bad outcome and the development of new lesions (p less than 0.001; X2 = 44.038). We conclude that serial CT scanning can help predict the outcome of patients with severe head injuries and may be very important in their examination and care.Surgical Neurology 08/1983; 20(1):25-9. · 1.67 Impact Factor
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ABSTRACT: Fifteen cases of delayed traumatic intracerebral hematoma (DTICH) operatively treated are reported. Patients who are awake or only drowsy on admission (Coma Grades 1 and 2, Grady scale) often undergo dramatic sudden neurological deterioration 48 to 72 hours after admission. Emergency computed tomographic scanning and prompt craniotomy for hematoma evacuation yield excellent clinical results in the majority of cases. Patients presenting in deeper grades of coma (Grades 3 to 5, Grady scale) who develop DTICH do quite poorly, often because the diagnosis is difficult to make and consequently is delayed. The development of DTICH is in our experience highly unpredictable, and often no clear secondary cause (hypercapnia, hypoxia, bleeding diathesis) can be demonstrated.Neurosurgery 02/1984; 14(1):22-5. · 2.53 Impact Factor
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ABSTRACT: From January 1, 1990, to April 30, 1994, 412 patients were admitted to our intensive care unit in coma after head injuries. Our study group consisted of 37 patients who were retrospectively identified as harboring lesions or developing new lesions within a 12-hour period from the time of admission. We defined the evolution of a lesion as an increase or decrease in the size of an already present hematoma or as the appearance of a totally new lesion. There were 25 male and 12 female patients (mean age, 34.9 yr), and the cause of trauma was road traffic accidents in 32 patients. Nine patients presented with shock, and six had evidence of abnormal coagulation at admission. Patients were divided into two different groups. In Group 1, 15 patients harbored lesions that evolved toward reabsorption. In Group 2, 22 patients harbored hematomas that evolved toward lesions requiring surgical removal. Fifteen of these patients had initial diagnoses of diffuse injury that evolved in this manner, whereas the remaining seven patients had already been operated upon and had developed second, noncontiguous, surgical lesions. Patients with lesions that required surgical evacuation had their computed tomographic (CT) scans obtained earlier and had a higher incidence of clinical deterioration. There was a significant difference in the evolution of the different lesions (P < 0.001), with subdural hematomas being more prone to reabsorption and intracerebral and extradural hematomas being more likely to increase in size or to appear as new lesions. Second CT scans were obtained because of clinical deterioration in 10 patients and because of increase in intracranial pressure in 5 patients. Scheduled CT scans were obtained in 13 patients, whereas in the remaining 9 patients, the diagnosis emerged from a combination of scheduled CT scans and intracranial pressure monitoring. There was a trend toward a poorer result among the patients with clinical deterioration, which, however, was not significant. A significant proportion of post-traumatic patients, particularly those who are unconscious, harbor early evolving intracranial lesions. When the first CT scan is performed within 3 hours after injury, a CT scan should be repeated within 12 hours.Neurosurgery 11/1995; 37(5):899-906; discussion 906-7. · 2.53 Impact Factor