Acute Traumatic Intraparenchymal Hemorrhage: Risk Factors for Progression in the Early Post-injury Period

Neurosurgery ◽  
2006 ◽  
Vol 58 (4) ◽  
pp. 647-656 ◽  
Author(s):  
Edward F. Chang ◽  
Michele Meeker ◽  
Martin C. Holland
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Ct Scan ◽  
Subdural Hematoma ◽  
Outcome Variable ◽  
Trauma Patients ◽  
Post Injury ◽  
Initial Size ◽  
Head Ct ◽  
Surgical Evacuation

Abstract OBJECTIVE: To characterize the natural course of traumatic intraparenchymal contusions and hematomas (IPHs) and to identify risk factors for IPH progression in the acute post-injury period. METHODS: A retrospective analysis was performed on a prospective observational database containing 113 head trauma patients exhibiting 229 initially nonoperated acute IPHs. The main outcome variable was radiographic evidence of IPH progression on serially obtained head computed tomographic (CT) scans. Secondary outcomes included the actual amount of IPH growth and later surgical evacuation. Univariate and multivariate analyses (using a generalized estimate equation) were applied to both demographic and initial radiographic features to identify risk factors for IPH progression and surgery. RESULTS: Overall, 10 IPHs (4%) shrank, 133 (58%) remained unchanged, and 86 (38%) grew between the first and second head CT scan. IPH progression was independently associated with the presence of subarachnoid hemorrhage (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.12–2.3), presence of a subdural hematoma (OR, 1.94; 95% CI, 1.1–3.43), and initial size (OR, 1.11; 95% CI, 1.02–1.21, for each cm3 volume). Size of initial IPH proportionately correlated with the amount of subsequent growth (linear regression, P < 0.001). Worsened Glasgow Coma Score between initial and follow-up head CT scan (OR, 8.6; 95% CI, 1.5–50), IPH growth greater than 5 cm3 (OR, 7.3; 95% CI, 1.6–34), and effacement of basal cisterns on initial CT scan (OR, 9.0; 95% CI, 1.5–52) were strongly associated with late surgical evacuation. CONCLUSION: A large proportion of IPHs progress in the acute post-injury period. IPHs associated with subarachnoid hemorrhage, a subdural hematoma, or large initial size should be monitored carefully for progression with repeat head CT imaging. Effacement of cisterns on the initial head CT scan was strongly predictive of failure of nonoperative management, thereby leading to surgical evacuation. These findings should be important factors in the understanding and management of IPH.

scholarly journals Kernohan-Woltman notch phenomenon and intention tremors in case of chronic subdural hematoma

2014 ◽  
Vol 21 (1) ◽  
pp. 109-112
Author(s):  
P. Sasikala ◽  
Bindu Menon ◽  
Amit Agarwal
Keyword(s):  
Ct Scan ◽  
Movement Disorders ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
Midline Shift ◽  
Rare Presentation ◽  
Surgical Evacuation ◽  
Significant Mass Effect ◽  
Significant Mass

Abstract Movement disorders are atypical and rare presentation of chronic subdural hematomas. We report a case of 60 year man who presented with intention tremors and altered sensorium. The patient had Kernohan-Woltman notch phenomenon on clinical examination. CT scan brain showed a large left fronto-temporo-parietal chronic subdural hematoma with significant mass effect and midline shift. His symptoms relieved completely after surgical evacuation of the hematoma.

212 Hydrocephalus in Pediatric Traumatic Brain Injury: National Incidence, Risk Factors, and Outcomes in 124,444 Patients

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 257-257
Author(s):  
Kavelin Rumalla ◽  
Vijay Letchuman ◽  
Bharadwaj Jilakara ◽  
Akhil Pulumati ◽  
Usiakimi Igbaseimokumo
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Subdural Hematoma ◽  
Multivariable Analysis ◽  
Wound Complications ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Incidence Risk

Abstract INTRODUCTION Hydrocephalus is a well-known and life-threatening sequel of traumatic brain injury (TBI) in adults, but is not as well characterized in children. We investigated the national incidence, risk factors, and outcomes associated with hydrocephalus in pediatric TBI. METHODS The Kids Inpatient Database (KID) is the largest pediatric hospital database in the U.S. and is sampled every 3 years. We queried the KID 2003, 2006, 2009, and 2012 using ICD-9-CM codes to identify all patients (age 0–20) with a primary diagnosis of TBI (850.xx 854.xx) and a secondary diagnosis code for hydrocephalus (331.3-331.5, excluding congenital hydrocephalus [742.3]. Variables included demographics, comorbidities, TBI severity (consciousness, type of wound) complications (medical or neurological), and discharge outcomes. Both univariate and multivariable analysis was utilized to identify factors associated with hydrocephalus and alpha was set at P < 0.05. RESULTS >In 124,444 patients hospitalized for TBI. The average rate of hydrocephalus was 1.0% but was affected by the type of TBI: subdural hematoma (2.4%), subarachnoid hemorrhage (1.4%), epidural hematoma (1.0%), cerebral laceration (0.9%), concussion (0.2%). The risk factors for hydrocephalus in multivariable analysis were age 0–5 (compared to other ages), Medicaid insurance, electrolyte disorder, chronic neurological condition, weight loss, subarachnoid hemorrhage, subdural hematoma, open wound, postoperative neurological complication, and septicemia (all P < 0.05). The likelihood of hydrocephalus was increased among surgically managed patients (6.0% vs. 0.5%) but decreased among those who underwent operation on admission day (0.8% vs. 4.1%) (both P < 0.05). The mortality rate for TBI patients without hydrocephalus was higher (5.4%) than those with hydrocephalus (1.1%). However, average LOS (25 vs. 5 days) and mean total hospital costs ($86,596 vs. $16,791) were greater among patients with hydrocephalus. CONCLUSION Hydrocephalus following TBI in children is relatively uncommon but is more likely in patients with certain demographics, pre-existing comorbidities, and injury patterns and attracts a higher total hospital cost.

scholarly journals Correlation between Head Computed Tomography Scan, Pre-operative Blood Lactate, and Pre-operative Glucose Level in Acute Traumatic Subdural Hematoma

2021 ◽  
Vol 53 (2) ◽  
Author(s):  
Jefri Henky ◽  
◽  
Ahmad Faried
Keyword(s):  
Blood Glucose ◽  
Ct Scan ◽  
Blood Lactate ◽  
Subdural Hematoma ◽  
Midline Shift ◽  
Head Ct ◽  
Positive Correlation ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Weak Positive Correlation

Acute traumatic subdural hematoma (SDH) is a focal brain injury resulting in alteration of cerebral perfusion and glucose metabolism, which would also results in hyperglicemia-induced-hyperlactatemia. A cross-sectional study was performed to analyze acute traumatic SDH patients by head CT scan and observe the effect on pre-operative blood lactate and blood glucose levels in 40 acute traumatic SDH patients at Dr. Hasan Sadikin Hospital, Bandung, Indonesia during the period of July-September 2013. Somers' D correlation were used in the analysis with a p-value of ≤0.05 considered as significant with 95% confidence interval. The mean values of pre-operative blood lactate and blood glucose levels were 3.16±1.49 mmol/L and 155.85±32.95 mg/dl, respectively with a strong positive correlation between the hematoma thickness and the increase in blood lactate (r= 0.656; p= 0.021) and a moderate positive correlation with increased blood glucose (r= 0.556; p= 0.025). In addition, the compressed cistern also had a very weak positive correlation with increase in blood lactate (r =0.156; p=0.043) and very weak positive correlation with increase in blood glucose (r= 0.139; p=0.056) while the midline shift had a weak positive correlation with increased blood lactate (r=0.353; p= 0.041) and a weak positive correlation with increased blood glucose (r = 0.333; p= 0.046). In conclusion, increased hematoma thickness, compressed cistern, and midline shift seen on head CT scan correlate with increasing blood lactate and glucose levels in acute traumatic SDH. Head CT scan, blood lactate level, and blood glucose level can be considered as one of the routine examinations to determine acute traumatic SDH severity at the macroscopic and cellular level.

scholarly journals Diagnostic Yield and Outcomes of Computed Tomography of the Head in Critically Ill Nontrauma Patients

2017 ◽  
Vol 34 (11-12) ◽  
pp. 955-966
Author(s):  
Fabian Finkelmeier ◽  
Sophie Walter ◽  
Kai-Henrik Peiffer ◽  
Anjali Cremer ◽  
Andrea Tal ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Independent Predictor ◽  
Diagnostic Yield ◽  
Pathological Finding ◽  
Trauma Patients ◽  
Head Ct ◽  
Therapeutic Consequences ◽  
Altered Mental State ◽  
New Finding

Background: Computed tomography of the head (HCT) is a widely used diagnostic tool, especially for emergency and trauma patients. However, the diagnostic yield and outcomes of HCT for patients on medical intensive care units (MICUs) are largely unknown. Methods: We retrospectively evaluated all head CTs from patients admitted to a single-center MICU during a 5-year period for CT indications, diagnostic yield, and therapeutic consequences. Uni- and multivariate analyses for the evaluation of risk factors for positive head CT were conducted. Results: Six hundred ninety (18.8%) of all patients during a 5-year period underwent HCT; 78.7% had negative CT results, while 21.3% of all patients had at least 1 new pathological finding. The main indication for acquiring CT scan of the head was an altered mental state (AMS) in 23.5%, followed by a new focal neurology in 20.7% and an inadequate wake up after stopping sedation in 14.9% of all patients. The most common new finding was intracerebral bleeding in 6.4%. In 6.7%, the CT scan itself led to a change of therapy of any kind. Admission after resuscitation or a new focal neurology were independent predictors of a positive CT. Psychic alteration and AMS were both independent predictors of a higher chance of a negative head CT. Positive HCT during MICU is an independent predictor of lower survival. Conclusions: New onset of focal neurologic deficit seems to be a good predictor for a positive CT, while AMS and psychic alterations seem to be very poor predictors. A positive head CT is an independent predictor of death for MICU patients.

Utilizing clinical factors to reduce head CT scan ordering for minor head trauma patients

1997 ◽  
Vol 15 (4) ◽  
pp. 453-457 ◽  
Author(s):  
Erik C. Miller ◽  
James F. Holmes ◽  
Robert W. Derlet
Keyword(s):  
Ct Scan ◽  
Head Trauma ◽  
Trauma Patients ◽  
Minor Head Trauma ◽  
Clinical Factors ◽  
Head Ct

RISK FACTORS OF HIGH INTRACRANIAL PRESSURE AND THE RELATED OUTCOMES IN SUBJECTS WITH SEVERE HEAD INJURY IN SANGLAH GENERAL HOSPITAL DENPASAR

2018 ◽  
Vol 1 (3) ◽  
Author(s):  
Wayan Niryana
Keyword(s):  
Risk Factors ◽  
Head Injury ◽  
Intracranial Pressure ◽  
Ct Scan ◽  
Severe Head Injury ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Secondary Brain Injury ◽  
Unfavourable Outcome ◽  
Head Ct

Background: Severe head injury management target is to prevent the secondary brain injury characterized by deterioration in the outcome. High intracranial pressure (ICP) and low cerebral perfusion pressure (CPP) could cause unfavourable outcomes which is influenced by many factors, such as hypoxia and haemorrhage lesions pictured on head CT scan. This study analyzes various risk factors that can lead to increased ICP and the influence of high ICP on the outcome.Methods: This study is a prospective cohort, involving 42 consecutive subjects with severe head injury patients from June to October 2016. The subjects underwent examination for blood pressure, blood gas analysis, and head CT scan. ICP monitoring was then performed and the outcome was assessed using the Glasgow Outcome Scale score when the patient was discharged. In this study, risk factors such as hypoxia, hypotension, and subarachnoid haemorrhage (SAH) were analyzed. Statistical analysis was performed with SPSS 27 with a confdence interval of 95%.Result: There were two risk factors that signifcantly influenced the increase of ICP, which were hypotension (RR 0.27; 95CI 0.095-0.775; p<0.001) and hypoxia (RR 0.125; 95CI 0.034-0.457; p<0.001). High ICP value ≥ 20 mmHg was associated with an unfavourable outcome(RR 2.28; 95CI 1.31-3.98; p<0.001).Conclusion: Hypoxia and hypotension were two risk factors that signifcantly influenced the increase of ICP, where high ICP caused the unfavourable outcome.

Predictors of New Findings on Repeat Head CT Scan in Blunt Trauma Patients with an Initially Negative Head CT Scan

2012 ◽  
Vol 214 (6) ◽  
pp. 965-972 ◽  
Author(s):  
Farid F. Muakkassa ◽  
Robert A. Marley ◽  
Charudutt Paranjape ◽  
Elya Horattas ◽  
Ann Salvator ◽  
...  
Keyword(s):  
Ct Scan ◽  
Blunt Trauma ◽  
Trauma Patients ◽  
Head Ct ◽  
New Findings

Repeat Head CT Scan in Blunt Trauma Patients

2012 ◽  
Vol 215 (6) ◽  
pp. 897
Author(s):  
Matthew Garrett ◽  
Nader Pouratian
Keyword(s):  
Ct Scan ◽  
Blunt Trauma ◽  
Trauma Patients ◽  
Head Ct

Emergent Intubation and CT Scan Pathology of Blunt Trauma Patients with Glasgow Coma Scale Scores of 3–13

1993 ◽  
Vol 8 (3) ◽  
pp. 229-236 ◽  
Author(s):  
Albert K. Hsiao ◽  
Stuart P. Michelson ◽  
Jerris R. Hedges
Keyword(s):  
Emergency Department ◽  
Glasgow Coma Scale ◽  
Ct Scan ◽  
Blunt Trauma ◽  
Trauma Patients ◽  
Head Ct ◽  
Coma Scale ◽  
Number Of Patients ◽  
Gcs Score ◽  
Pharmacologic Agents

AbstractIntroduction:Widely accepted guidelines for use of pharmacologic agents for prehospital intubation have not been fully developed. Toward the goal of formulating specific guidelines, this study sought to determine how well the Glasgow Coma Scale (GCS) score stratifies the need for emergent intubation (within 30 minutes of emergency department arrival or in the prehospital setting).Methods:A one-year, retrospective review of the charts of blunt trauma patients with presumed head injury who presented to the emergency department of a Level 1 trauma center with a GCS score of ≤13 was performed. A total of 120 patients met the inclusion and exclusion criteria.Results:A significant number of patients presenting with a GCS score of ≤9 required emergent intubation. A significant minority of patients presenting with a GCS score of 10–13 required emergent intubation (20%) or had intracranial pathology on head CT scan (23%), and the majority of patients from this subgroup did not require subsequent intubation. Alcohol or substance intoxication and communication barriers such as deafness and language difficulties limited the clinical examination.Conclusion:Patients with a presenting GCS score of ≤9 represent candidates for the use of pharmacologic agents to facilitate aggressive airway control by well-trained and supervised emergency medical technicians (EMTs). Emergent intubation of patients with a GCS score of 10–13 is problematic. Patients with a presenting GCS score of 10–13 must be evaluated individually and closely monitored. In the emergency department, head CT scans coupled with serial evaluations generally are warranted to assess underlying pathology in patients with a presenting GCS score of 10–13.

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