Traumatic Intracranial Hematoma Research Articles

Machine learning in action: Revolutionizing intracranial hematoma detection and patient transport decision-making.

Traumatic intracranial hematomas represent a critical clinical situation where early detection and management are of utmost importance. Machine learning has been recently used in the detection of neuroradiological findings. Hence, it can be used in the detection of intracranial hematomas and furtherly initiate a management cascade of patient transfer, diagnostics, admission, and emergency intervention. We aim, here, to develop a diagnostic tool based on artificial intelligence to detect hematomas instantaneously, and automatically start a cascade of actions that support the management protocol depending on the early diagnosis. A plot was designed as a staged model: The first stage of initiating and training the machine with the provisional evaluation of its accuracy and the second stage of supervised use in a tertiary care hospital and a third stage of its generalization in primary and secondary care hospitals. Two datasets were used: CQ500, a public dataset, and our dataset collected retrospectively from our tertiary hospital. A mean dice score of 0.83 was achieved on the validation set of CQ500. Moreover, the detection of intracranial hemorrhage was successful in 94% of cases for the CQ500 test set and 93% for our local institute cases. Poor detection was present in only 6-7% of the total test set. Moderate false-positive results were encountered in 18% and major false positives reached 5% for the total test set. The proposed approach for the early detection of acute intracranial hematomas provides a reliable outset for generating an automatically initiated management cascade in high-flow hospitals.

Efficacy of single burr hole with irrigation and sub-dural drain in the evacuation of chronic subdural hematoma

BackgroundChronic subdural hematoma (CSDH) remains one of the most common types of traumatic and spontaneous intracranial hematomas. The optimal method of treatment has not been definitely established. Surgical treatment options includes craniotomy, trephination, burrhole drainage and twist drill perforation. This study aimed at the evaluation of the clinical and radiological outcome after the efficacy of single burr hole with irrigation and sub-dural drain in the aim of successful evacuation of CSDH.ResultsA total of 53 patients were included in this study, the mean age of patients was 61.53 + 13.81 years. Results of the paired t test showed that the Glasgow coma scale has significantly improved by 0.89 points (p < 0.001) and that the average motor power has significantly improved for all individuals by 0.4 points (p = 0.043). We found that older aged patients have significantly less improvements in the postoperative motor power (r = − 0.317, p = 0.02) and require longer hospital stay (r = 0.32, p = 0.0197).ConclusionsA single burr hole with irrigation and leaving a subdural drain is safe procedure in managing subdural hematoma. We did not experience major adverse events related to drain insertion and efficient evacuation of collection and no obvious increase in mortality or morbidity rates.

Minimally Invasive Endoscopic Interventions in the Treatment for Traumatic Intracranial Hematomas

Traumatic brain injuries are a global problem, with more than 50 million people suffering from brain injuries every year. A frequent consequence of severe traumatic brain injury is intracranial hematoma (ICH), causing mortality, disability, post-traumatic epilepsy. ICH has different clinical manifestations and physical characteristics. Standard treatment for ICH includes conservative monitoring for small volume hematomas or surgical evacuation of the hematoma. Craniotomy is often used to remove hematomas, because acute and subacute hematomas contain clots, and drainage of the hematoma cavity alone is not enough. In chronic hematomas, drainage through a hole is usually used, but this is effective only if the hematoma is represented by one cavity and its contents are completely liquid, which is not always the case. Thus, widely used techniques do not always meet modern requirements for effectiveness and low invasiveness of surgical treatment.The review considers endoscopic methods of surgical treatment for all variants of traumatic ICH; 31 publications have been found on this topic, mentioning 602 interventions. Differences in patient selection criteria make it difficult to compare the methods and outcomes. From the technical point of view, the procedures were also very diverse. The article analyzes the main features of different authors’ methods.None of the authors comes to the conclusion about outcome worsening after endoscopic intervention. With regard to acute and subacute hematomas, there are currently no reliable statistical data, but the results obtained can generally be assessed as positive.In acute and subacute hematomas, endoscopic intervention is perceived by the authors not as providing more opportunities, but only as a less invasive replacement for conventional craniotomy. In chronic hematomas, endoscopic intervention is considered to have more opportunities and advantages over the standard treatment.At present, the widespread use of endoscopic minimally invasive methods of surgical treatment for traumatic hematomas is hampered mainly by the lack of clear criteria for selecting patients and well-established methods of intervention. More high-quality research is needed to determine the role of these methods in general clinical practice.

Outcome of Nonoperative Management of Selected Cases of Acute Traumatic Intracranial Hematomas in a Rural Neurosurgical Service of a Developing Country

In resource-limited settings, the standard of care prescribed in developed countries for either operative or nonoperative management of traumatic intracranial hematomas (TICHs) frequently has to be adapted to the economic and infrastructural realities. This study aims to present the outcome of selected cases of TICHs managed nonoperatively without routine intensive care unit admission, repeated cranial computed tomography (CT) scan or intracranial pressure monitoring at a rural neurosurgical service in a developing country. This was a retrospective analysis of a cohort of our patients with cranial CT-confirmed TICHs selected for nonoperative treatment from our prospective head injury (HI) register over a 42-month period. There were 67 patients (51 males) in this study with a mean age of 38.6 (standard deviation, 17.6) years, having mild HI in >half, (55.2%, 37/67) and anisocoria in 22.4% (15/67). Road traffic accident was the most common (50/67, 74.7%) trauma etiology. Isolated acute-subdural hematoma, intracerebral hemorrhage, and epidural hematoma occurred in 29.9%, 25.4%, and 22.4% of the patients respectively. Only 2 of 8 patients in whom intensive care unit admission was deemed necessary could afford admission. Repeat cranial CT scan was requested in 8 patients (8/67, 11.9%); only 5 of these could afford the investigation. The outcome of care was good in 82.1% patients (55/67). Increasing severity of the HI (P<0.01) and presence of pupillary abnormality (P=0.03) were significant predictors of poor outcome. In a Nigerian rural neurosurgery practice, nonoperative management of a well-selected cohort of TICHs was attended by acceptable level of favorable outcome.

Management of a Patient With Multiple Traumatic Intracranial Hematomas in a Neurosurgical Clinic: Literature Review and Clinical Case

Multiple traumatic intracranial hematomas are one of the types of severe TBI, which are distinguished by high mortality and lead to disability. The article describes in detail the pathogenesis of TBI, the features of the clinical picture, outlines the basic principles of treatment and provides clinical examples of complex treatment of multiple intracranial hematomas. Timely treatment of secondary damage mechanisms in TBI will lead to a significant reduction in mortality and severe disabling consequences. Drug therapy is represented by a number of groups of drugs: calcium channel blockers, antioxidants and antihypoxants, NMDA receptor antagonists, inflammatory and immune response blockers, cell membrane stabilizers that improve synaptic transmission, apoptosis blockers, drugs with neuron-specific neurotrophic action, immunosuppressors, inhibitors of the renin-angiotensin-aldosterone system.

Excellent Outcome Following Very Severe Traumatic Brain Injury with Bilateral Acute Traumatic Intracranial Hematomas: A Case Report

Traumatic Brain Injury (TBI) is a significant global burden in terms of mortality and disability. The Glasgow Coma Scale (GCS) is used to determine the severity of TBI, categorizing cases as mild (GCS 13-15), moderate (GCS 8-12), or severe (GCS 3-7)

Use of anticoagulants in patients with traumatic brain injury and intracranial hematomas with the novel coronavirus infection as a concomitant pathology

Anticoagulant therapy is an integral part in the treatment and prevention of diseases and symptoms associated with pathological thrombosis in the human body. Anticoagulant therapy is traditionally not used in traumatic brain injury and hemorrhagic strokes with the formation of intracranial hematomas, intracerebral hematomas, and contusion hemorrhagic foci. However, in such diseases as the novel coronavirus infection, anticoagulant therapy is life-saving, since there is a high risk of developing various thromboses. The article considers the indications for the prescription of anticoagulants in the combination of these pathologies. The article discusses the possibility of using anticoagulants in patients with the novel coronavirus infection and intracranial hematomas, when there are two life-threatening diseases, in which anticoagulants are vital in one case and contraindicated in the other one. It is necessary to understand the complex mechanisms of hemostasis and weigh the risks and benefits in each case.

Clinical Diagnosis and Management of Traumatic Acute Intracranial Subdural Hematoma: Review Article

Traumatic brain injury (TBI) is the leading cause of death and disabling conditions in persons. The frequency and severity of head injuries have both decreased as a result of numerous industrial safety improvements, the installation of airbags in automobiles, and the enforcement of speed restrictions. TBI survivorship has increased due to advancements in emergency response times and acute care, but this has also increased the need for accurate ways to detect individuals at risk of subsequent diseases. Pupil reactivity, the Glasgow Coma Scale, and head computed tomography are currently the main clinical signs indicating the existence of brain damage. The current review will cover the clinical presentation, diagnosis, and treatment of TBI,

Assessment of Treatment Outcomes for Traumatic Intracranial Hematomas During Early Traumatic Brain Injury

The main objective of this research study was to examine the treatment outcomes of traumatic intracranial hematomas through the application of algorithms for complex diagnosis and differentiated tactics for treating various types of traumatic hematomas. Between 2014 and 2019, a total of 635 patients with traumatic intracranial hematomas were evaluated and treated at the Republican Specialized Scientific and Practical Medical Center of Neurosurgery. In addressing indications for surgical or conservative treatment, a unique approach was adopted based on the principles of urgency, complexity, and interconnection at all stages of treatment in the hospital. The results of the treatment of traumatic intracranial hematomas, both surgical and conservative, significantly varied not only in different periods and phases of the course of traumatic brain injury but also depending on the patient's age, type, location, and prevalence of the hematoma. The application of algorithms for complex diagnosis and differentiated treatment was found to be beneficial.

Performance of a new portable near-infrared spectroscopy device for detection of traumatic intracranial hematoma

IntroductionWe report results of a newly developed portable near-infrared spectroscopy (NIRS) based point-of-care device CEREBO® to detect traumatic intracranial hematoma (TICH). Materials and methodsPatients with alleged history of head injury visiting emergency room were enrolled. They were examined consecutively for the presence of TICH using CEREBO® and computed tomography (CT) scans. ResultsA total of 158 participants and 944 lobes were scanned, and 18% of lobes were found to have TICH on imaging with computed tomography of the head. 33.9% of the lobes could not be scanned due to scalp lacerations. The mean depth of hematoma was 0.8 (SD 0.5) cm and the mean volume of the hematoma was 7.8 (11.3) cc. The overall sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of CEREBO® to classify subjects as hemorrhagic or non-hemorrhagic were 96% (CI 90 - 99%), 85% (CI 73 - 93%), 92% (CI 86 - 96%), 91% (CI 84 - 96%) and 93% (CI 82 - 98%) whereas to classify the lobes as hemorrhagic and non-hemorrhagic, the sensitivity, specificity, accuracy, PPV and NPV were 93% (CI 88 - 96%), 90% (CI 87 - 92%), 90% (CI 88 - 92%), 66% (CI 61 - 73%), and 98% (CI 97 - 99%) respectively. The sensitivity was highest at 100% (CI 92 - 100%) for the detection of extradural and subdural hematoma. The sensitivity for detecting intracranial hematoma including epidural, subdural, intracerebral and subarachnoid hematomas, of more than 2 cc was 97% (CI 93 - 99%) and the NPV was 100% (CI 99 - 100%). The sensitivity dropped for hematomas less than 2cc in volume to 84% (CI 71 - 92%) and the NPV was 99% (CI 98 - 99%). The sensitivity to detect bilateral hematomas was 94% (CI 74 - 99%). ConclusionThe performance of currently tested NIRS device for detection of TICH was good and can be considered for triaging a patient requiring a CT scan of the head after injury. The NIRS device can efficiently detect traumatic unilateral hematomas as well as those bilateral hematomas where the volumetric difference is greater than 2cc.

Mortality And Prognostic Factors In Patients Operated For Acute Epidural Hematoma.

Epidural hematoma is one of the most common surgical emergencies encountered in neurosurgery. This study was conducted to determine the mortality and prognostic factors in patients operated for traumatic intracranial epidural hematoma in a resource-constrained setting from a developing country. This retrospective study was conducted in the Department of Neurosurgery at Ayub Teaching Hospital Abbottabad from 1st January 2019 to 31st Dec 2021. Inclusion and exclusion criteria were created. The medical record of 116 patients admitted and operated on for traumatic extradural hematoma was retrospectively reviewed. Information was recorded using a standardized structured questionnaire. The outcome was measured in terms of the Glasgow coma outcome score. Out of 116 patients, 93 were male and 23 were female.19 (16.4%) patients were in the age range 0-5 years, 42 (36.2%) were in the age range 6-15, 35(31.0%) were in the age range 16-30, 11 (9.5%) were in the age range 31-45 years, 7 (6.0%) were in the age range 46-60 years while only one patient included in this study was above 60 years. Overall mortality was 4.3%. Mortality was higher in females and in those aged less than 5 years (3.4%). 4 out of 16 patients died with GCS less than 8, while none of the patients died when GCS was above 12. Mortality was significantly higher in the presence of associated lesions (4.4% vs. 0%) and anisocoria (2.6% vs.1.7%). Patients who operated within 6 hours of trauma resulted in better outcomes with a mortality rate of 0.0% and functional recovery of 57.8 % while for those who operated after 6 hours, mortality was significantly higher (4.3%) and functional recovery was significantly low (15.5%). Good surgical outcomes can be achieved with early operative intervention if indicated. Female gender, low preoperative GCS score, presence of pupillary dilatation, presence of associated lesions, delayed surgical intervention and age less than 5 years are significant predictors for poor outcomes.

Evaluation of the Results of Differentiated Treatment of Traumatic Intracranial Hematomas in the Early Period of Traumatic Brain Injury

The purpose of this study was to study the results of the treatment of traumatic intracranial hematomas after the application of algorithms for complex diagnostics and differentiated tactics for the treatment of various types of traumatic hematomas. From 2014 to 2019, 635 patients with traumatic intracranial hematomas were examined and treated at the Republican Specialized Scientific and Practical Medical Center of Neurosurgery. In a hospital, questions of indications for surgical or conservative treatment required a unique approach based on the principles of urgency, complexity, and interconnection at all stages of treatment. The outcomes of treatment of traumatic intracranial hematomas, both surgical and conservative treatment, differ significantly not only in different periods and phases of the course of traumatic brain injury but also in the age, type of hematoma, its localization and prevalence. Application of algorithms of complex diagnostics and differentiated treatment.

Risk factors of deterioration in patients of head injury with non-operative management on first neurosurgical consultation.

In most of the emergency trauma intensive care units (ICUs) of India, neurosurgical opinion is sought for patients presenting with head trauma after earliest possible resuscitation to determine the further line of management. This study aimed to identify common risk factors, leading to neurological deterioration in conservatively managed patients of traumatic brain injury (TBI). This retrospective study analyzed patients admitted with acute TBI and traumatic intracranial hematoma under emergency trauma care ICU who did not require neurosurgical operation within 48 h of trauma. The recorded data were analyzed to determine the predictors of neurological deterioration using univariate and binary logistic regression analysis in SPSS-16 software. Medical records of consecutive 275 patients of acute TBI presenting to the emergency department were studied. One hundred and ninety-three patients were afflicted with mild TBI (70.18%), 49 patients had moderate TBI (17.81%), and 33 had severe TBI (12%). In the outcome, 74.54% of patients were discharged, and operative decision was made on 6.18% of patients and 19.27% died. Severe TBI is the independent predictor of neurological deterioration during their stay in ICU. Progressive hemorrhagic injury (PHI) showed neurological deterioration in 86.5% of patients. Systemic inflammatory response syndrome (SIRS) was present in 93.5% of patients who had deteriorated neurologically. Dyselectrolytemia was the biochemical derangements seen in 24.36% of cases. This study revealed severe TBI, PHI, and SIRS to be strong and independent risk factors of neurological deterioration.

Predictive Factors for Delayed Surgical Intervention in Children With Epidural Hematomas.

Optimal treatment of children with traumatic intracranial epidural hematomas (EDHs) is unknown. We sought to identify clinical and radiographic predictors of delayed surgical intervention among children with EDH admitted for observation. We retrospectively identified patients younger than 15 years with acute traumatic EDHs evaluated at our level 1 pediatric trauma center. We excluded patients with penetrating head injuries, recent surgical evacuation of EDH, or depressed skull fracture requiring surgical repair and assigned the remaining subjects to the immediate surgery group if they underwent immediate surgical evacuation, to the supportive-therapy-only group if they underwent observation only, and to the delayed surgery group if they underwent surgery after observation. We abstracted clinical and laboratory findings, surgical interventions, and neurological outcome and measured EDH dimensions and volumes, adjusting for cranial size. We compared clinical and radiographic characteristics among groups and performed receiver-operator characteristic analyses of predictors of delayed surgery. Of 172 patients with EDH, 103 patients met the inclusion criteria, with 6 (6%) in the immediate surgery group, 87 (84%) in the supportive-therapy-only group, and 10 (10%) in the delayed surgery group. Headache, prothrombin time of >14 seconds, EDH maximal thickness of ≥1.1 cm, volume of ≥14 mL, EDH thickness/cranial width index of ≥0.08 and EDH volume/cranial volume index of ≥0.18, and mass effect were associated with delayed surgical intervention. There was no difference in length of stay or functional impairment between the immediate and delayed surgery groups. However, patients in delayed surgery group were more likely to have subjective symptoms at discharge than those in immediate surgery group. Among patients with EDH admitted for observation, larger EDH, mass effect, headaches, and prothrombin time of >14 seconds were associated with delayed surgical intervention. A larger-scale study is warranted to identify independent predictors of delayed surgery in children under observation for EDH.

Time Course and Clinical Significance of Hematoma Expansion in Moderate-to-Severe Traumatic Brain Injury: An Observational Cohort Study

BackgroundPreventing intracranial hematoma expansion has been advertised as a possible treatment opportunity in traumatic brain injury (TBI). However, the time course of hematoma expansion, and whether the expansion affects outcome, remains poorly understood. In light of this, the aim of this study was to use 3D volume rendering to determine how traumatic intracranial hematomas expand over time and evaluate its impact on outcome.MethodsSingle-center, population-based, observational cohort study of adults with moderate-to-severe TBI. Hematoma expansion was defined as the change in hematoma volume from the baseline computed tomography scan until the lesion had stopped progressing. Volumes were calculated by using semiautomated volumetric segmentation. Functional outcome was measured by using the 12 month Glasgow outcome scale (GOS).ResultsIn total, 643 patients were included. The mean baseline hematoma volume was 4.2 ml, and the subsequent mean hematoma expansion was 3.8 ml. Overall, 33% of hematomas had stopped progressing within 3 h, and 94% of hematomas had stopped progressing within 24 h of injury. Contusions expanded significantly more, and for a longer period of time, than extra-axial hematomas. There was a significant dose–response relationship between hematoma expansion and 12 month GOS, even after adjusting for known outcome predictors, with every 1-ml increase in hematoma volume associated with a 6% increased risk of 1-point GOS deduction.ConclusionsHematoma expansion is a driver of unfavorable outcome in TBI, with small changes in hematoma volume also impacting functional outcome. This study also proposes a wider window of opportunity to prevent lesion progression than what has previously been suggested.

CLINICAL SIGNIFICANCE OF PROGRESSIVE TRAUMATIC INTRACRANIAL HEMATOMAS IN ACUTE PERIOD OF TRAUMATIC BRAIN INJURY

This work is devoted to one of the topical issues of neurosurgery, namely, craniocerebral injuries, in particular, intracranial hematomas. Timely diagnosis of traumatic intracranial hematomas and the choice of a correct treatment strategy are the main factors of patient’s recovery.&#x0D; The purpose of the study was to monitor intracranial hematomas and their changes using neuroimaging of brain structures, and to evaluate brain CT and MRI efficacy in a hospital setting.&#x0D; Materials and Methods. The authors analyzed 2255 medical records of patients treated in the neurosurgical departments of Ulyanovsk Regional Clinical Center for Specialized Types of Medical Care named after E.M. Chuchkalov and Central City Clinical Hospital, 61 reports of forensic autopsies and 373 surgical reports. Surgical procedures were performed in 2015.&#x0D; Results. Intracranial hematomas were diagnosed in 198 patients (8.7 %). According to the time factor, the hematomas were distributed as follows: 150 acute (75.8 %); 35 subacute (17.7 %); 8 chronic (4.0 %). In five cases (2.5 %), the authors identified hematomas that were not registered in the existing classification. Such hematomas have not been adequately investigated yet. Such hematomas were called “progressive”, due to their increase in case follow-up.&#x0D; Conclusion. The peculiarities of “progressive” intracranial hematoma development necessitates clinical suspicion. In this regard, the pathology requires a more detailed study in order to create a system of clinical and neuroimaging monitoring and develop management guidelines.

Supraorbital Endoscopic Evacuation for Traumatic Intracerebral Hematomas in the Frontal Lobe.

Traumatic intracranial hematomas have been rarely evacuated by endoscopic surgery. The frontal lobe is the usual location for the traumatic intracerebral hematoma (TICH). Endoscopic evacuation for the frontal TICHs via an eyebrow incision is to be presented as minimally invasive surgery. Thirteen patients with frontal TICHs were managed with endoscopic hematoma evacuation via eyebrow incision. After making the incision in the lateral eyebrow, a small frontal craniotomy was made, and the hematoma was evacuated under direct visualization of a rigid endoscope. No catheter was placed. Orbital rim resection, hematoma evacuation rate, surgical complications, and outcome at discharge were analyzed. Men were 11 and the mean age was 54 years old (range, 27-86). Orbitotomy was performed in four patients, and no effect on the hematoma evacuation rate was observed. More than 80% of the hematoma volume was successfully removed in 10 cases. Hematoma configuration was not related to the hematoma evacuation rate. None of the patients underwent revision operation or decompressive craniectomy. Endoscopic evacuation of the TICHs with the supraorbital approach may be a good method to evacuate the hematoma located in the frontal base.

Endoscopic Removal of Acute Traumatic Intracerebral Hemorrhage

ABSTRACT Nowadays surgical treatment of patients with traumatic intracranial hematoma (TICH) and injuries of the brain is a very actual problem in neurosurgery.The purpose of this work was to assess of the feasibility and safety of minimally invasive endoscopic removal of TICH.MATERIAL AND METHODS In the period of 2010–2019, 2734 operations were performed on patients with traumatic brain injury in the Sklifosovsky Research Institute. There were 334 patients with TICH and the CC/BC foci, that made 12.2% of all patients. The median of hematoma volume, that did not cause a loss of consciousness was 48 cm2, and in most of the patients the hematoma volume ranged 30–35 cm2. Local fibrinolysis of TICH was performed in 14 patients with the hematoma volume of 30–50 cm2 without brain dislocation and not causing the consciousness depression more severe than sopor.Endoscopic removal of TICH was performed in 4 men at mean age of 54.8 years within 18–36 hours after trauma. Three patients had depression of consciousness to obtundation (14 by Glasgow Outcome Scale (GCS)), and one patient was in clear consciousness. The volume of the dense part of the contusion foci in the pole-basal regions of the frontal and temporal lobes was 24–40 cm3.RESULTS Among patients with TICH operated on by using the traditional technique, postoperative lethality was 13%, good outcomes were seen in 41%, and 46% had neurological disorders of varying severity. While treating the patients with TICH by using the local fibrinolysis method, 1 patient died after surgery, a good outcome was seen in 8 of 14 patients, and neurological disorders persisted in 3 patients in the postoperative period.Radicality of surgery in patients operated on by using endoscopic technique averaged 76% ranging from 41% to 91%. There were no complications during surgery nor in post-operative period. Patients were discharged from hospital after 8-21 days.

Mobilising patients with severe acquired brain injury in intensive care (MAWERIC) – Protocol for a randomised cross-over trial

IntroductionIn the early phase after severe brain injury, patients are often bedridden in an attempt to control intracranial homeostasis; however, prolonged immobilisation may trigger complications. There is limited knowledge about the physiological effects of mobilisation in this early phase. ObjectiveTo investigate changes in brain tissue oxygen tension when patients are mobilised using a Sara Combilizer® in the early phase after severe brain injury, in a randomised cross-over design. MethodsPatients with traumatic brain injury, subarachnoid haemorrhage or intracranial haematoma, will be randomised to early mobilisation or rest (no mobilisation = control) on the first day that the patient is deemed to be fit for mobilisation, and the opposite on the next day. On both days, patients will undergo continuous multimodal monitoring measuring brain tissue oxygen tension (primary outcome), invasive blood pressure, heart rate, middle cerebral artery blood flow velocity by transcranial Doppler ultrasound, intracranial pressure, and microdialysis markers of cerebral oxidative metabolism. DiscussionIntensive care unit patients with acute brain injury are frequently immobilised in the early phase after the ictus. The optimal timing and intensity of mobilisation is unknown. The present study attempts to establish if early mobilisation is safe with respect to intracranial homeostasis.Protocol version 1.1.Date: 19.02.2022.Ethical registration: H-21002728; approved on August 11, 2021.GDPR registration: P-2021 − 105; approved on February 10, 2021.ClinicalTrials.govidentifier:NCT05038930; approved on September 8, 2021.Electronic case report file: REDCap-database; created on August 13, 2021.

FREQUENCY OF INTRACRANIAL HEMATOMAS RELATED TO TRAUMATIC SKULL OR FACIAL INJURIES EVALUATED ON COMPUTED TOMOGRAPHY

Patients sustaining maxillofacial fractures are at risk of accompanying traumatic intracranial hematomas, which are a major cause of morbidity and mortality. Prompt recognition of the clinical signs, followed by a neurosurgical inspection and diagnosis, is crucial for improving patient survival and recovery. Objective: To determine frequency of intracranial hematoma related to traumatic skull and facial injuries evaluated on Computed Tomography. Methods: This study was conducted on 195 patients from radiological department of Lahore General hospital who had road traffic accident. In this Cross-sectional study conduction advance 16 multislice CT device which shows advanced desire 3D and was used to assess intracranial hematoma in patients with skull and facial fractures. All patients with intracranial hematomas related to skull and facial injuries in trauma center and all age groups without any gender specificity were included in this study. All patients having bleeding disorders or using anti-coagulant were excluded. Results: Out of 195 patients in which 48 (24.6%) were females and 147 (75.4%) were males. 132 (67.7%) patients out of 195 patients had headache, 64 (32.8%) patients had nausea, 116 (59.5%) patients had vomiting, 149 (76.4%) patients had speaking difficulty, 71 (36.4%) patients had External bleeding and 133 (68.2%) had consciousness. Total number of 195 patients out of which 179 (91.8%) had Intracranial hematoma. Conclusion: On the basis of the results it was concluded that head and facial injury had increase prevalence rate in people with road traffic accident but no significant difference was observed between head and facial fracture cases with ICH.