Neurosurgical Review

, Volume 12, Issue 2, pp 133–140 | Cite as

Traumatic brain swelling studied by computerized tomography and densitometry

  • László Rózsa
  • Ernst H. Grote
  • Patric Egan
Original articles


Two-hundred and fifty-two computerized tomography (CT) scans of 107 patients with head injuries were analyzed. The most frequent consequence of trauma was a diffuse swelling of the brain in 91% of the cases. The severity of brain swelling and its course can be estimated by the compression of (or absence of) the intracranial cerebrospinal fluid space. These observations may be of prognostic value as well.

By measurement of theHounsfield units (HU) in 52 cases the blood or water content in the brain tissues was assessed. An increase in blood content of the tissues (hyperaemia) can account for an increase in Hounsfield values. A decrease in HU suggests brain edema.

The density measurements showed that in the first hours and days following head injury, the diffuse brain swelling was caused by severe cerebrovascular congestion in the majority (53%) of the cases. Immediate brain edema without a preceeding hyperaemic phase occurs less frequently (32%).

Between the 1st and 4th day after injury, edema started to prevail, and between the 5th and 8th day the edematous type of brain swelling was present almost exclusively.


Brain edema brain swelling CT-densitometry head injury hyperaemia 


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  1. [1]
    Bruce DA, A Alavi, L Bilaniuk, C Dolinkas, W Obrist, B Uzzel: Diffuse cerebral swelling following injuries in children: the syndrome of “malignant brain edema”. J Neurosurg 54 (1981) 170–178Google Scholar
  2. [2]
    Bullock R, R Smith, J Favier, M Dutrevou, G Blake: Brain specific gravity and CT scan density measurement after human head injury. J Neurosurg 63 (1985) 64–68Google Scholar
  3. [3]
    Evans JP, IM Scheinker: Histologic studies of the brain following head trauma. I. Post-traumatic cerebral swelling and edema. J Neurosurg 2 (1945) 306–314Google Scholar
  4. [4]
    Ito U, H Tomita, S Yamazaki: Brain swelling and brain oedema in acute head injury. Acta Neurochir 79 (1986) 120–124Google Scholar
  5. [5]
    Johansson BB: Brain edema. Acta Neurochir Suppl 36 (1986) 137–141Google Scholar
  6. [6]
    Kobrine AI, E Timmins, RK Rajjoub, HV Rizzoli, DO Davis: Demonstration of massive traumatic brain swelling within 20 minutes after injury. Case report. J Neurosurg 46 (1977) 256–258Google Scholar
  7. [7]
    Langfitt TW, HM Tannanbaum, NF Kessel: The etiology of acute brain swelling following experimental head injury. J Neurosurg 24 (1966) 47–56Google Scholar
  8. [8]
    Lanksch W, T Grumme, E Kazner (eds): Computed tomography in head injuries. Springer-Verlag, Berlin, Heidelberg, New York 1979Google Scholar
  9. [9]
    Lassen NA: The luxury perfusion syndrome and its possible relation to acute metabolic acidosis localized within the brain. Lancet 2 (1966) 1113–1115Google Scholar
  10. [10]
    Obrist W, TW Langfitt, JL Jaggi, J Cruz, TA Gennarelli: Cerebral blood flow and metabolism in comatose patients with acute head injury. J Neurosurg 61 (1984) 241–253Google Scholar
  11. [11]
    Rieth KG, K Fujiwara, G Dichiro, J Klatze, RA Brooks, GS Johnston, CM O'Connor, LG Mitschell: Serial measurements of CT attenuation and specific gravity in experimental cerebral edema. Radiology 135 (1980) 343–348Google Scholar
  12. [12]
    Rózsa L, EH Grote, PJ Egan, J Gawlowski: Computed tomographic and densitometric evaluation of the traumatic brain swelling. Magyar Radiol 60 (1986) 332–344Google Scholar
  13. [13]
    Saunders ML, JD Miller, D Stablein, G Allen: The effects of graded experimental trauma on cerebral blood flow and responsiveness to CO2. J Neurosurg 51 (1979) 18–26Google Scholar
  14. [14]
    Schröder JM, W Wechsler: Ödem and Nekrose in der grauen und weißen Substanz beim experimentellen Hirntrauma. Acta Neuropath 5 (1965) 81–111Google Scholar
  15. [15]
    Sweet RC, JC Miller, M Lipper, PRS Kishore, DP Becker: Significance of bilateral abnormalities on the CT scan in patients with severe head injury. J Neurosurg 63 (1985) 830–839Google Scholar
  16. [16]
    Yoshino E, T Yamaki, T Higuchi, Y Horikawa, K Hirakowa: Acute brain edema in fatal head injury: analysis by dynamic CT scanning. J Neurosurg 63 (1985) 830–839Google Scholar
  17. [17]
    Zimmerman RA, LT Bilaniuk, D Bruce, C Dolinskas, W Obrist, D Kuhl: Computed tomography of pediatric head trauma: acute general cerebral swelling. Radiology 126 (1978) 403–408Google Scholar

Copyright information

© Walter de Gruyter & Co 1989

Authors and Affiliations

  • László Rózsa
    • 1
    • 3
  • Ernst H. Grote
    • 1
  • Patric Egan
    • 2
  1. 1.Neurosurgical Department of the University of TübingenTübingenWest Germany
  2. 2.Neuroradiological Department of the University of TübingenTübingenWest Germany
  3. 3.Neurosurgical Department of the University of DebrecenDebrecenHungary

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