Summary
The authors analysed the serial computerized tomography (CT) findings in a large series of severely head injured patients in order to assess the variability in gross intracranial pathology through the acute posttraumatic period and determine the most common patterns of CT change. A second aim was to compare the prognostic significance of the different CT diagnostic categories used in the study (Traumatic Coma Data Bank CT pathological classification) when gleaned either from the initial (postadmission) or the control CT scans, and determine the extent to which having a second CT scan provides more prognostic information than only one scan.
92 patients (13.3% of the total population) died soon after injury. Of the 587 who survived long enough to have at least one control CT scan 23.6% developed new diffuse brain swelling, and 20.9% new focal mass lesions most of which had to be evacuated. The relative risk for requiring a delayed operation as related to the diagnostic category established by using the initial CT scans was by decreasing order: diffuse injury IV (30.7%), diffuse injury III (30.5%), non evacuated mass (20%), evacuated mass (20.2%), diffuse injury II (12.1%), and diffuse injury I (8.6%).
Overall, 51.2% of the patients developed significant CT changes (for worse or better) occurring either spontaneously or following surgery, and their final outcomes were more closely related to the control than to the initial CT diagnoses. In fact, the final outcome was more accurately predicted by using the control CT scans (81.2% of the cases) than by using the initial CT scans (71.5% of the cases only). Since the majority of relevant CT changes developed within 48 hours after injury a pathological categorization made by using an early control CT scan seems to be most useful for prognostic purposes.
Prognosis associated with the CT pathological categories used in the study was similar independently of the moment of the acute posttraumatic period at which diagnoses were made.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bullock R, Golek J, Blake G (1989) Traumatic intracerebral hematoma — which patients should undergo surgical evacuation? CT scan features and ICP monitoring as a basis for decision making. Surg Neurol 32: 181–187
Bullock R, Hannemann CO, Murray L, Teasdale GM (1990) Recurrent hematomas following craniotomy for traumatic intracranial mass. J Neurosurg 72: 9–14
Clifton GL, Grossman RG, Makela ME, Miner ME, Handel S, Sadhu V (1980) Neurological course and correlated computerized tomography findings after severe closed head injury. J Neurosurg 52: 611–624
Cooper PR, Maravilla K, Moody S, Clark WK (1979) Serial computerized tomographic scanning and the prognosis of severe head injury. Neurosurgery 5: 566–569
Eisenberg HM, Gary HE, Aldrich EF, Saydjari C, Turner B, Foulkes MA, Jane JA, Marmarou A, Marshall LF, Young HF (1990) Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg 73: 688–698
Gennarelli TA, Speilman GM, Langfitt TW, Gildenberg PL, Harrington T, Jane JA, Marshall LF, Miller JD, Pitts LH (1982) Influence of the type of intracranial lesion on outcome from severe head injury. J Neurosurg 56: 26–32
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1: 480–484
Kobayashi S, Nakazawa S, Otsuka T (1983) Clinical value of serial computed tomography with severe head injury. Surg Neurol 20: 25–29
Lobato RD, Sarabia R, Cordobes F, Rivas JJ, Adrados A, Cabrera A, Gomez P, Madera A, Lamas E (1988) Posttraumatic cerebral hemisphere swelling. Analysis of 55 cases studied with computerized tomography. J Neurosurg 68: 417–423
Lobato RD, Cordobes F, Rivas JJ, de la Fuente M, Montero A, Barcena A, Perez C, Cabrera A, Lamas E (1983) Outcome from severe head injury related to the type of intracranial lesion. A computerized tomography study. J Neurosurg 59: 762–774
Lobato RD, Rivas JJ, Cordobes F, Alted E, Perez C, Sarabia R, Cabrera A, Diez I, Gomez P, Lamas E (1988) Acute epidural hematoma: an analysis of factors influencing the outcome of patients undergoing surgery in coma. J Neurosurg 68: 48–57
Lobato RD, Sarabia R, Rivas JJ, Cordobes F, Castro S, Muñoz MJ, Cabrera A, Barcena A, Lamas E (1986) Normal computerized tomography scans in severe head injury. Prognostic and clinical mangement implications. J Neurosurg 65: 784–789
Marshall LF, Bowers SA, Klauber MR, Clark MvB, Eisenberg HM, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1991) A new classification of head injury based on computerized tomography. J Neurosurg 75 [Suppl]: S14-S20
Marshall LF, Gautille T, Klauber MR, Eisenberg HM, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1991) The outcome of severe closed head injury. J Neurosurg 75 [Suppl]: S28-S36
Roberson FC, Kishore PRS, Miller JD, Lipper MH, Becker DP (1979) The value of serial computerized tomography in the management of severe head injury. Surg Neurol 12: 161–167
Sautreaux JL, Binnert D, Thierry A, Pelikan MC, Ordas M, Couaillier JF (1982) La scanographie en traumatologie cránienne. Etude critique de 500 cas. Neurochirurgie 28: 263–270
Servadei F, Nanni A, Nasi MT, Zappi D, Vergoni G, Giuliani G, Arista A (1995) Evolving brain lesions in the first 12 hours after head injury: analysis of 37 comatose patients. Neurosurgery 37: 899–907
Stein SC, Spettell C, Young G, Ross SE (1993) Delayed and progressive brain injury in closed-head trauma: radiological demonstration. Neurosurgery 32: 25–31
Teasdale E, Cardoso E, Galbraith S, Teasdale G (1984) CT scan in severe head diffuse injury: physiological and clinical correlations. J Neurol Neurosurg Psychiatry 47: 600–603
Teasdale G, Jennett B (1984) Assessment of coma and impaired consciousness. A practical scale. Lancet 2: 81–84
Turazzi S, Bricolo A, Pasut L, Formenton A (1987) Changes produced by CT scanning in the outlook of severe head injury. Acta Neurochir (Wien) 85: 87–95
van Dongen KJ, Braakman R, Gelpke GJ (1983) The prognostic value of computerized tomography in comatose head injury patients. J Neurosurg 59: 951–957
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lobato, R.D., Gomez, P.A., Alday, R. et al. Sequential computerized tomography changes and related final outcome in severe head injury patients. Acta neurochir 139, 385–391 (1997). https://doi.org/10.1007/BF01808871
Issue Date:
DOI: https://doi.org/10.1007/BF01808871