Evolution of traumatic intracerebral hematoma (author's transl)

Abstract

Between December 1977 and September 1978, 85 cases of head injuries were admitted to the Toritsu Fuchu General Hospital. Among these 10 cases were noted to have intracerebral hematoma by CT scanning. Seven cases out of the 10 showed intracerebral hematoma with the initial CT scan which was performed 14 hours to 4 days after the trauma. One of these showed delayed occurrence of another intracerebral hematoma 5 days after the trauma which was later confirmed to be contusional hemorrhage by post-mortem examination. In 3 out of the 10 the initial CT scan had not shown intracerebral hematoma. However, secondary CT scan performed 7.5 to 30 hours after the trauma disclosed intracerebral high density area. In one case, tertiary CT scan performed 4 days later disclosed another high density area. Operation was carried out in 2 cases. Solid hematoma surrounded by contusion was found and evacuated in one and contusional hemorrhage was found in another. Details of these 4 cases showing delayed occurrence of traumatic intracerebral hematoma are presented with CT scan pictures. Included is a case, treated at another hospital, of delayed traumatic intracerebral hematoma which appeared on the secondary CT taken 3 hours after the trauma. Solid hematoma was found and evacuated at operation. At least 7 cases of delayed traumatic intracerebral hematoma shown by CT scan have been reported in the literature. Most of these authors considered this as manifestation of delayed traumatic apoplexy or “Spat-Apoplexie”. However, it may be reasonably postulated based on our cases that almost all traumatic intracerebral hematomas occur in delayed fashion from a few hours to days after trauma. They can be adequately divided into three types: namely, early-onset type; intermediate type; and delayed-onset type. Early-onset type is formed within several hours after trauma and is mostly composed of solid hematoma. Delayed-onset type is formed probably later than 12 hours and is aptly named contusional hemorrhage. This classification might be useful in interpreting CT pictures and choosing most the appropriate treatment for such patients.