Clinical aspects of traumatic intracerebral hematomas. Pathogenesis of delayed traumatic intracerebral hematomas

Abstract

Eighty three cases of traumatic intracerebral hematomas (maximum diameter of at least 3 cm) were classified into the following two groups. Group-1 consisted of 34 cases in which intracerebral hematomas were confirmed in the initial CT scans on admission. Group-2 consisted of 49 cases in which intracerebral hematomas were found not in the initial CT scans on admission, but in the second or later CT scans. This is the so-called CT-diagnosed delayed traumatic intracerebral hematomas which have been widely reported in recent years with the increasing use of CT scans. These two groups were studied clinically and the following results were obtained. 1) Traumatic intracerebral hematomas were apt to occur in middle-aged or elderly patients, and more delayed cases increased in patients of 60 or older. 2) The times when the formation of traumatic intracerebral hematomas were judged as completed showed two peaks: within 6 hours after the trauma and 12 to 24 hours after the trauma. 3) Excluding traumatic hemorrhages in the basal ganglia, there were many hematomas in the frontal lobes in the cases of coup injuries by anteroposterior force or contre-coup injuries by posteroanterior force and in the temporal lobes in the cases of contre-coup injuries by lateral force. Traumatic hemorrhages in the basal ganglia were seen in 10 cases, six of which were in Group-1. In all six of these cases, the intracerebral hematoma was confirmed within 6 hours after the trauma and the direction of the external force was unclear. Except for the findings described in 1) to 3), there were no differences in the basic pathogenesis and characteristics between the two groups. These results indicate that there is no essential difference in pathogenesis between CT-diagnosed delayed traumatic intracerebral hematomas and other intracerebral hematomas, as far as the present clinical studies are concerned.