Extracerebral Hematoma and Parenchymal Lesion in Computerized Tomography of Pediatric Patients with Severe Head Injury

Abstract

Fifty children (13 years of age or under) with acute, severe head injury were analyzed, with special reference to the relations between initial computerized tomography (CT) findings, clinical severity, and outcome. Parenchymal lesions on CT were classified into five categories: normal, hemispheric swelling, hemorrhagic lesion, diffuse cerebral swelling, and low density. The severity and the outcome were evaluated using the Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS), respectively, adoption of GCS scoring being restricted to patients 3 years of age or over. Twenty-three patients (46%) showed extracerebral hematomas. The most common extracerebral hematoma was the acute subdural hematoma, which comprised 24% of the cases; epidural hematomas were found in 9 cases (18%). These figures coincided with the reported results of adult cases in severe head injury. All the epidural hematoma cases showed “normal” parenchymal lesion, and carried less clinical severity and better outcome. This might suggest that more trivial injury would cause the epidural hematoma in children than in adults. Hemispheric swelling was commonly seen in patients with acute subdural hematoma and was generally associated with low GCS scores (mean 4.8) and poor outcome (63% mortality). Compared with that in adults, hemorrhagic lesion in children was less often associated with extracerebral hematoma, and the outcome and severity of the cases with this lesion depended mainly on the multiplicity and the location of the hemorrhage. Eleven cases fulfilled the criteria of diffuse cerebral swelling, namely, slit-like ventricles and obliterated perimesencephalic cisterns, and only one had an associated subdural hematoma. Forty-two patients (84%) achieved a good recovery or a moderate disability. None were severely disabled or vegetative, and the overall mortality rate was 16%. Patients with GCS scores of 3 to 5 were uniformly poor in outcome (60% of mortality), regardless of parenchymal lesions, whereas those with GCS scores of 6 to 8 had only 8% mortality.