J Korean Neurotraumatol Soc.  2008 Jun;4(1):8-13. 10.13004/jknts.2008.4.1.8.

Risk Factors Associated with Delayed Traumatic Intraparenchymal Hemorrhage

• Lee SR
• Chun HJ
• Yi HJ

• KMID: 1814436
• DOI: http://doi.org/10.13004/jknts.2008.4.1.8

Abstract

OBJECTIVE
Delayed hemorrhage progression is one of the most common causes of neurologic deterioration after traumatic brain injury (TBI). We herein analyzed the risk factors related to the delayed hemorrhage progression in traumatic intraparenchymal hemorrhage (IPH) or cerebral contusion.
METHODS
A retrospective investigation was performed on selected 105 TBI patients with IPH or cerebral contusion associated with other types of intracranial hematoma during the last 2 years. Clinical features regarding neurologic grade, time intervals from the initial injury to delayed traumatic IPH, and initial computed tomographic (CT) findings including midline shifting, cisternal effacement, and location were studied. For majority of patients, follow-up CT scans were checked at 8, 24, 72 hours after trauma, except patients with sudden neurologic deterioration.
RESULTS
Among 105 patients with traumatic IPH, 49 patients showed hemorrhage progression. Traumatic subarachnoid hemorrhage (SAH) is the most commonly accompanied hemorrhage with IPH patients. The most frequent location of hemorrhage progression was the frontal lobe, and time interval for identifying delayed IPH was within the first 8 hours in 31 patients (63%). There was statistically significant correlation between IPH progression and presence of SAH (p=0.03) and effacement of cisterns (p<0.0001).
CONCLUSION
We should closely observe traumatic IPH or cerebral contusion patients who have initial CT findings of traumatic SAH and cisternal effacement. It is primarily because hemorrhage progression is very likely to occur in this patient group. Although we could not draw conclusion regarding time for CT surveillance, bed-side clinical monitoring is of utmost importance.

Keyword

Cistern; Effacement; Intraparenchymal hemorrhage; Progression; Subarachnoid hemorrhage; Traumatic brain injury

MeSH Terms

Brain Injuries
Contusions
Follow-Up Studies
Frontal Lobe
Hematoma
Hemorrhage
Humans
Retrospective Studies
Risk Factors
Subarachnoid Hemorrhage
Subarachnoid Hemorrhage, Traumatic

Figure

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  FIGURE 1 A 49-year-old man is admitted for headache following slip down. Initial brain computed tomogram shows subarachnoid hemorrhage on the right sylvian fissure and minimal contusion on the right temporal area (A). A computed tomographic angiography do not disclose any vascular lesion (B). Twelve hours later, he became stuporous and follow-up computed tomography reveals huge (Intraparenchymal hemorrhage on the right temporal avea cc).

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  FIGURE 2 A 48-year-old man is admitted to our department after in-car collision accident. Initial computed tomography shows small contusion on the left sylvian and the frontal lobe. Prominent cisternal effacement is also noted on both sylvian fissures and basal cisterns (A). According to the designated schedule, follow-up brain CT is performed at 24 hours later and it shows minimally increased hemorrhage on the left sylvian area (B).

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