Analysis of the Evolution of Traumatic Intracerebral Hematoma

Abstract

Fifty-eight cases of traumatic intracerebral hematoma were investigated by sequential computed tomography (CT) to clarify the time when the hematoma appeared and was completed after head trauma, and to determine if the term “delayed traumatic intracerebral hematoma (DTICH)” should be used for hematoma in the acute stage. They were classified into two groups, A and B. In Group A, 49 cases, initial CT was performed within 3 hours after head trauma, and in Group B, 9 cases, it was performed more than 3 hours after head trauma. Among the 49 cases of Group A, 19 were cases of non-delayed traumatic intracerebral hematoma (N-DTICH) in which the hematomas were found by the initial CT. Emergency surgery was performed on 6 cases out of the 19. In 9 cases out of the remaining 13, the hematoma increased in size within 24 hours and their outcome was worse compared with the outcome of 4 cases of non-enlarged hematoma. The cases of DTICH in which the hematomas were found by the follow-up CT numbered 30. In these 30 DTICH cases, those in which the initial CT finding was normal were 7 and their outcome was good. However, 10 cases of DTICH appeared several hours following removal of extracerebral hematomas, and their outcome was poor, with death in 6 cases. The appearance times of the hematomas were investigated using the sequential CT of the 49 cases in Group A. Twenty-two cases of hematoma were found within 3 hours, 18 were found 3 to 12 hours, and 7 were found 12 to 24 hours following head trauma. The completion time of the hematomas was investigated by sequential CT in 43 cases of Group A and all 9 cases of Group B. The hematomas were already completed within 6 hours after trauma in 13 cases out of the 52. The other 14 cases of hematoma were completed 6 to 12 hours after trauma, and the remaining 21 except 2 were completed 12 to 24 hours after trauma. It could be said that the hematomas appeared and completed their growth within 24 hours after head trauma in 96% of the cases. It may be postulated that almost all traumatic intracerebral hematomas appear relatively early after trauma and gradually change their size and shape with the lapse of time, and complete their growth around 24 hours from the occurrence of head trauma. Therefore, the term “DTICH” should not be used for the delayed type of hematoma which appears during the acute stage, especially 24 hours following head trauma.