Hostname: page-component-5c6d5d7d68-qks25 Total loading time: 0 Render date: 2024-08-10T00:49:09.564Z Has data issue: false hasContentIssue false

Intraparenchymal and Intraventricular Hemorrhage without Mass Effect in Traumatic Coma

Published online by Cambridge University Press:  18 September 2015

Jen-Pei Lee*
Affiliation:
Division of Neurosurgery, Department of Surgery, Chang Gung Medical College and Chang Gung Memorial Hospital, Taipei, Taiwan
*
Division of Neurosurgery, Taiwan Provincial Tao-Yuan General Hospital, 1492, Chung-Shan Road, Tao-Yuan Taiwan 33007 R.O.C.
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

A group of 57-head injured patients showing computerized tomographic (CT) findings compatible with “diffuse brain injury” or of the so called “diffuse axonal injury” is analyzed. Thirty-four patients showed intraparenchymal hemorrhage in the CT scan study, 8 intraventricular hemorrhage and 15 patients had both intraparenchymal and intraventricular hemorrhage. Forty percent (23/57) of those with these findings had associated intracranial focal lesions. The deep nuclei are the most common location of intraparenchymal hemorrhage. Signs of brain stem hemorrhage were seen in 9 patients. Forty-nine percent of patients in this series had a good outcome. Old age (>60), abnormal motor response, abnormal eye signs, associated with focal lesions, and evidence of brain stem hemorrhage are reliable prognostic parameters for a grave outcome.

Type
Articles
Copyright
Copyright © Canadian Neurological Sciences Federation 1991

References

REFERENCES

1.Strich, SJ.Diffuse degeneration of the cerebral white matter in severe dementia following head injury. J Neurol Neurosurg Psychiatry 1956; 19: 163185.CrossRefGoogle ScholarPubMed
2.Adams, JH, Mitchell, DE,Graham, DI, et al. Diffuse brain damage of immediate impact type, its relationship to “primary brain-stem damage” in head injury. Brain 1977; 100: 489502.CrossRefGoogle ScholarPubMed
3.Adams, JH, Graham, DI, Murray, LS, et al. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases. Ann Neurol 1982; 12: 557563.CrossRefGoogle ScholarPubMed
4.Adams, JH, Doyle, DI, et al. Diffuse axonal injury in head injuries caused by a fall. Lancet 1984; 2: 14201422.CrossRefGoogle ScholarPubMed
5.Gennarelli, TA.Head injury in man and experimental animals: clinical aspects. Acta Neurochir (Wien) 1983; (suppl 32): 113.Google ScholarPubMed
6.Gennarelli, TA, Thibault, LE, Adams, JH, et al. Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 1982; 12: 564574.CrossRefGoogle ScholarPubMed
7.Snoek, J, Jennett, B, Adams, JH, et al. Computerized tomography after recent severe head injury in patients without acute intracranial hematoma. J Neurol Neurosurg Psychiatry 1979; 42: 215225.CrossRefGoogle Scholar
8.Zimmerman, RA, Bilaniuk, LT, Gennarelli, T.Computed tomography of shearing injuries of the cerebral white matter. Radiology 1979; 127: 393396.CrossRefGoogle Scholar
9.Teasdale, G, Jennett, B.Assessment of coma and impaired consciousness: a practical scale. Lancet 1979; 2: 8184.Google Scholar
10.Jennett, B, Bond, M.Assessment of outcome after severe brain damage: a practical scale. Lancet 1975; 1: 480484.CrossRefGoogle Scholar
11.Adams, JH, Graham, DI, Scott, G, et al. Brain damage in fatal nonmissile head injury. J Clin Pathol 1980; 33: 11321145.CrossRefGoogle Scholar
12.Peerless, SJ, Rewcastly, NB.Shear injuries of the brain. Can Med Assoc 1967; 5: 577582.Google Scholar
13.Holbourn, AHS.Mechanics of head injuries. Lancet 1943; 2: 438441.CrossRefGoogle Scholar
14.Gennarelli, TA, Thibault, LE.Biomechanics of acute subdural hematoma. J Trauma 1982; 33: 680686.CrossRefGoogle Scholar
15.Becker, DP, Miller, JD, Ward, JD, et al. The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 1977; 491502.CrossRefGoogle ScholarPubMed
16.Gennarelli, TA, Spielman, GM, Langfitt, TW, et al. Influence of the type of intracranial lesion as outcome from severe head injury. A multicenter study using a new classification system. J Neurosurg 1982; 56: 2632.CrossRefGoogle Scholar
17.Lobato, RD, Lordobes, F, Rivas, JJ, et al. Outcome from severe head injury related to the type of intracranial lesion. A computerized tomography study. J Neurosurg 1983; 59: 762774.CrossRefGoogle Scholar
18.Papo, L, Caruselli, G, Scarpelli, M, et al. Intracranial hypertension in severe head injuries. Acta Neurochir(Wien) 1980; 52: 249263.CrossRefGoogle ScholarPubMed
19.Sweet, RC, Miller, JD, Lipper, M, et al. Significance of bilateral abnormalities on the CT scan in patients with severe head injury. Neurosurgery 1978; 3: 1621.CrossRefGoogle ScholarPubMed
20.Zimmerman, RA, Bilaniuk, LT.Computed tomography in diffuse traumatic cerebral injury. In: Popp, AJ, Bourke, RS, Nelson, LR, Kimelberg, HK,eds.New York: Raven Press, 1977; 253262.Google Scholar
21.Pilz, P.Axonal injury in head injury. Acta Neurochir (Wien) 1983; 32: 119123.Google ScholarPubMed
22.Gennarelli, TA, Adams, JH, Graham, DI.Acceleration induced head injury in the monkey. I. The model, its mechanical and physiological correlate. Acta Neuropathol (Berl) 1981;(suppl) 7: 2325.Google Scholar
23.Denny-Brown, D, Russell, WR.Experimental cerebral concussion. Brain 194; 64: 93164.Google Scholar
24.Pagni, CA.The prognosis of head-injured patients in a state of coma with decerebrated posture. J Neurol Sci 1973; 17: 289295.Google Scholar
25.Stewart, WA, Litten, SP, Sheehe, PR.A prognostic model for brain stem injury. Surg Neurol 1973; 1: 303310.Google ScholarPubMed
26.Jennett, B, Teasdale, G, Braakman, R, et al. Prognosis of patients with severe head injury. Neurosurgery 1979; 4: 283289.CrossRefGoogle ScholarPubMed
27.Carlsson, CA, Vonessen, C, Lofaren, L.Fractors affecting the clinical course of patients with severe head trauma. Part 1: influence of biological factors. Part 2: significance of post-traumatic coma. J Neurosurg 1968; 29: 248251.CrossRefGoogle Scholar
28.Gutterman, P, Shenkin, HA.Prognostic feature in recovery from traumatic decerebration. J Neurosurg 1970; 32: 330335.CrossRefGoogle ScholarPubMed
29.Richards, T, Hoff, J.Factors affecting survival from acute subdural hematoma. Surgery 1974; 75: 253258.Google Scholar
30.Sahuquillo, BJ, Lamarca, CJ, Vilalta, CJ, et al. Epidural hematoma and diffuse axonal injury. Neurosurgery 1985; 17: 378379.Google Scholar
31.Sahuquillo, BJ, Lamarca, CJ, Vilalta, CJ, et al. Acute subdural hematoma and diffuse axonal injury after severe head trauma. J Neurosurg 1988; 68: 894900.CrossRefGoogle Scholar
32.Crompton, MR.Brain stem lesions due to closed head injury. Lancet 1971; 1: 669673.CrossRefGoogle ScholarPubMed
33.George, B, Thorel, C, Pierron, D, et al. Frequency of primary brain stem lesions after head injuries, a CT scan analysis from 186 cases of severe head trauma. Acta Neurochir (Wien) 1981; 59: 3543.CrossRefGoogle Scholar
34.Tsai, FY, Teal, JS, Quinn, MF, et al. CT of brain stem injury. Am J Neuroradiol 1980; 1: 2329.Google Scholar