Delayed or Enlarged Lesions in Head Injury: An Analysis of Risk Factors

Hyun, Dong Keun; Lee, Kyeong Seok; Doh, Jae Won; Bae, Hack Gun; Yun, Il Gyu; Byun, Bark Jang

Abstract

Delayed or enlarged lesions in head injury are potentially preventable events which worsen overall prognosis. We investigated the incidence and risk factors of these lesions in 240 head injured patients examined by repeated computerized tomographic(CT) scans from January 1989 to December 1990. Overall, delayed or enlarged lesions were found in 95 patients(39.6%) Intracerebral hemorrhage was the most common lesion(37 cases):Subdural(17 cases), epildural hematoma(16 cases), subdural hygroma(15 cases), cerebral swelling(6 cases), hydrocephalus(4 cases), and infarction(2 cases) followed in that order. These lesions occurred 3 days of initial scan in 64 patients(67.4%). Predictors were a low Glasgow Coma Scale score, abnormal papillary response, low or high blood pressure, hypoxia and previous infusion of large amounts of mannitol. Acute subdural hematoma was the most common initial lesion, heralding delayed or enlarged lesions in 50% of cases. Intracerebral hemtomas or contusion followed by next most common lesions. Incidence of delayed or enlarged lesions also differed according to therapy:decompressive craniectomy with these lesions in 82.8%. Mortality rate in patient who had delayed or enlarged lesions(35.5%) was 5.6 times higher than patient who did not have such lesions(6.3%). Delayed or enlarged lesions are relatively common. Patients with risk factors for delayed or enlarged lesions should be adequately monitored before overt clinical deterioration.