J Korean Neurotraumatol Soc.  2009 Dec;5(2):62-67. 10.13004/jknts.2009.5.2.62.

Progression of Intracranial Hemorrhage after Acute Head Injury

• Seong HS
• Rim BC
• Min KS
• Lee MS
• Kim YG
• Kim DH

• KMID: 1427359
• DOI: http://doi.org/10.13004/jknts.2009.5.2.62

Abstract

OBJECTIVE
The purpose of this study was to evaluate the risk factors for the development of progressive intracranial hemorrhage (PIH) after acute head injury.
METHODS
175 (one hundred and seventy-five) head trauma patients who visited our hospital and had computerized tomography (CT) scan from January 2005 to December 2006 were investigated. Their medical records, radiological images and readings were analyzed retrospectively.
RESULTS
Of the total 175 patients, 64 (64/175=36.6%) presented PIH. PIH was found in 54 patients (48.6%) of the 111 patient who obtained CT scans within 3 hours after trauma, whereas it was found in 10 (15.7%) of 64 patients who obtained CT more than 3 hours after head trauma. In 64 patients having PIH, the mean time interval between first and second CT scans was 13.8 hours. The risk factors for the development of PIH were cause of trauma, hemorrhagic lesion type, initial Glasow Coma Scale, first CT scan time after trauma.
CONCLUSION
If initial CT scan taken early after trauma shows hemorrhage, continuous supervision of mental status and changes in intracranial pressure, and early follow-up CT scan within 5 to 6 hours is necessary. In addition, because progression of hemorrhage may continue in a patient with hyperacute intracranial hemorrhage who are preparing for surgery, it is recommended to have a CT scan again right before the operation.

Keyword

Progressive intracranial hemorrhage; Head trauma; Computed tomography

MeSH Terms

Coma
Craniocerebral Trauma
Follow-Up Studies
Head
Hemorrhage
Humans
Intracranial Hemorrhages
Intracranial Pressure
Medical Records
Organization and Administration
Reading
Risk Factors

Figure

• 

  FIGURE 1 Illustration of Case 1, progression of intracranial hemorrhage in 2 hours. A, B: Initial CT scans obtained 30 minutes postinjury, demonstrating multiple small contusion and small amount of subdural hematoma in the left frontotemporal area. C, D: Second CT scans obtained 2 hours postinjury, revealing hemorrhagic progression.

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  FIGURE 2 Illustration of Case 2, progression of EDH in 5 hours. A, B: Initial CT scans obtained 1 hour postinjury, demonstrating minimal EDH in right temporal lobe. C, D: Second CT scans obtained 6 hours postinjury, revealing large amount of EDH. EDH: epidural hemorrhage.

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  FIGURE 3 Case 3, non progreiion of subdural hemorrhage. A, B: Initial CT scans obtained about 1 day postinjury, demonstrating SDH in the left frontal convexity and multiple contusions. C, D: Second CT scans obtained about 2 days postinjury, revealing no increment of hematoma. SDH: subdural hemorrhage.

• 

  FIGURE 4 Time interval between first and second CT in 64 cases with progressive intracranial hemorrhage.

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