J Korean Neurotraumatol Soc.  2006 Jun;2(1):43-51. 10.13004/jknts.2006.2.1.43.

Progression of Frontal Intraparenchymal Hematomas in the Early Post-Injury Period

• Choi JW
• Lee JK
• Moon KS
• Joo SP
• Kim JH
• Kim SH

• KMID: 2192333
• DOI: http://doi.org/10.13004/jknts.2006.2.1.43

Abstract

OBJECTIVE
The purpose of this study was to characterize risk factors for progression and estimate the clinical consequences of traumatic frontal intraparenchymal hematoma (IPH) in the early post-injury period.
METHODS
A retrospective chart and computed tomography (CT) review was conducted on 64 patients with traumatic frontal IPH, 35 in progressive and 29 in non-progressive group, meeting inclusion criteria between January 1997 and December 2004: ① non-penetrating head trauma, ② absence of major traumatic injury in other organs, ③ absence of other intracranial lesions should be operated on initial CT, ④ initial CT checked within 3 hrs after trauma, ⑤ IPH detected within 24 hrs after trauma. Univariate and multivariate analysis were performed to determine significant association between various potential factors and IPH progression in early post-injury period.
RESULTS
Progression of frontal IPH without neurological exacerbation was observed in 18 cases (51.4% in progression group). Mutivariate analysis demonstrated that time from injury to first CT scan was independently associated with progression of frontal IPH (p=0.045). Although there was no statistically significance, older age, subarachnoid hemorrhage on initial CT, deteriorated mental status and prolonged prothrombin time (PT) on admission could predict a progression of frontal IPH. Of the 35 patients who underwent operation for hematoma evacuation, 27 patients (77.1%, p=0.000) showed hematoma progression. The unfavorable rate of GOS at 6 months after injury in progression group was significantly higher than non-progression group (31.4% vs 3.4%, p=0.008).
CONCLUSIONS
Early progression occurs in 55% of the patients with frontal IPH who undergo CT scans within 3 hours of injury. Even though the patient neurologically unchange, the time from injury to first CT scan, older age, subarachnoid hemorrhage on initial CT, deteriorated mental status and prolonged PT on admission should be reminded as key determinants of hematoma progression. Considering high rates of progression without neurological deterioration and good results after operation, a repeated CT scans and aggressive surgical evacuation should be performed for patients with frontal traumatic IPH.

Keyword

Computed tomography; Frontal lobe; Intraparenchymal hematoma; Progressive hemorrhagic injury; Traumatic brain injury

MeSH Terms

Brain Injuries
Craniocerebral Trauma
Frontal Lobe
Hematoma*
Humans
Multivariate Analysis
Prothrombin Time
Retrospective Studies
Risk Factors
Subarachnoid Hemorrhage
Tomography, X-Ray Computed