A new classification of head injury based on computerized tomography

1991 ◽  
Vol 75 (Supplement) ◽  
pp. S14-S20 ◽  
Author(s):  
Lawrence F. Marshall ◽  
Sharon Bowers Marshall ◽  
Melville R. Klauber ◽  
Marjan van Berkum Clark ◽  
Howard M. Eisenberg ◽  
...  
Keyword(s):  
Head Injury ◽  
Mortality Rate ◽  
Ct Scan ◽  
Computerized Tomography ◽  
Head Injuries ◽  
Midline Shift ◽  
New Classification ◽  
Content Type ◽  
Diffuse Injury

✓ A new classification of head injury based primarily on information gleaned from the initial computerized tomography (CT) scan is described. It utilizes the status of the mesencephalic cisterns, the degree of midline shift in millimeters, and the presence or absence of one or more surgical masses. The term “diffuse head injury” is divided into four subgroups, defined as follows: Diffuse Injury I includes all diffuse head injuries where there is no visible pathology; Diffuse Injury II includes all diffuse injuries in which the cisterns are present, the midline shift is less than 5 mm, and/or there is no high- or mixed-density lesion of more than 25 cc; Diffuse Injury III includes diffuse injuries with swelling where the cisterns are compressed or absent and the midline shift is 0 to 5 mm with no high- or mixed-density lesion of more than 25 cc; and Diffuse Injury IV includes diffuse injuries with a midline shift of more than 5 mm and with no high- or mixed-density lesion of more than 25 cc. There is a direct relationship between these four diagnostic categories and the mortality rate. Patients suffering diffuse injury with no visible pathology (Diffuse Injury I) have the lowest mortality rate (10%), while the mortality rate in patients suffering diffuse injury with a midline shift (Diffuse Injury IV) is greater than 50%. When used in conjunction with the traditional division of intracranial hemorrhages (extradural, subdural, or intracerebral), this categorization allows a much better assessment of the risk of intracranial hypertension and of a fatal or nonfatal outcome. This more accurate categorization of diffuse head injury, based primarily on the result of the initial CT scan, permits specific subsets of patients to be targeted for specific types of therapy. Patients who would appear to be at low risk based on a clinical examination, but who are known from the CT scan diagnosis to be at high risk, can now be identified.

Neurological course and correlated computerized tomography findings after severe closed head injury

1980 ◽  
Vol 52 (5) ◽  
pp. 611-624 ◽  
Author(s):  
Guy L. Clifton ◽  
Robert G. Grossman ◽  
Merry E. Makela ◽  
Michael E. Miner ◽  
Stanley Handel ◽  
...  
Keyword(s):  
Ct Scan ◽  
Computerized Tomography ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Mass Effect ◽  
Neurological Deterioration ◽  
Content Type ◽  
Diffuse Brain Injury ◽  
Clinical Series ◽  
Closed Head

✓ This study includes 124 patients with closed head injuries and with Glasgow Coma Scale (GCS) scores of ≤ 8, who were admitted over a 7 1/2-month period. The time at which death occurred after injury was bimodal: deaths occurred either within 48 hours or after 7 days or longer after injury. Neurological deterioration, however, occurred with equal frequency on Days 2 to 7 after injury. Patients who survived the first 48 hours and then suffered neurological deterioration did not differ from the total population in age, sex, GCS scores on admission, or pupillary reactivity, but had a much higher incidence of intracranial hematomas of all types. Deterioration occurred three times more frequently in those with hematomas than in those with diffuse brain injury. Patients who deteriorated were rarely among the 35% of those who rapidly improved in the first 48 hours (4 points or more on the GCS). Computerized tomography (CT) scans of those deteriorating (24 patients) could be divided into four categories: 1) those without new mass effect (eight cases); 2) those with new or increased hemispheric edema (six cases); 3) those with generalized edema (two cases); and 4) those with focal or lobar areas of new edema or hemorrhage (eight cases). Of the patients in coma who deteriorated, 19% had large, delayed intracerebral hematomas. In 11 of 16 cases deteriorating with new mass effect, prior compression by overlying extracerebral hematoma, disruption of brain by intra-cerebral hematoma, or preexisting hemispheric edema preceded the brain swelling that caused deterioration. Areas of disruption or compression on CT scan typically developed decreased attenuation 2 to 7 days after injury, but did not cause deterioration unless new mass effect accompanied the lucency appearing on CT scan. A mortality rate of 29% was achieved for the 124 cases, which were managed with early evacuation of hematomas and control of intracranial pressure. Certain methods are suggested for evaluating therapy and for comparing clinical series.

Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injuries

1987 ◽  
Vol 66 (5) ◽  
pp. 706-713 ◽  
Author(s):  
Harvey S. Levin ◽  
Eugenio Amparo ◽  
Howard M. Eisenberg ◽  
David H. Williams ◽  
Walter M. High ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Head Injury ◽  
Magnetic Resonance ◽  
Computerized Tomography ◽  
Neuropsychological Testing ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Lesion Volume ◽  
Resonance Imaging ◽  
Content Type

✓ Twenty patients admitted for minor or moderate closed-head injury were studied to investigate the relationship between magnetic resonance imaging (MRI) and neurobehavioral sequelae. The MRI scans demonstrated 44 more intracranial lesions than did concurrent computerized tomography (CT) scans in 17 patients (85%); most of these lesions were located in the frontal and temporal regions. Estimates of lesion volume based on MRI were frequently greater than with CT; however, MRI disclosed no additional lesions that required surgical evacuation. Neuropsychological assessment during the initial hospitalization revealed deficits in frontal lobe functioning and memory that were related to the size and localization of the lesions as defined by MRI. Follow-up MRI and neuropsychological testing at 1 month (13 cases) and 3 months (six cases) disclosed marked reduction of lesion size paralleled by improvement in cognition and memory. These findings encourage further investigation of the prognostic utility of MRI for the clinical management and rehabilitation of mild or moderate head injury.

scholarly journals CT scan Positive Finding Pattern of Head Injury at the University of Gondar Hospital; North West Ethiopia

2014 ◽  
Vol 1 (2) ◽  
pp. 65-72
Author(s):  
Zerubabel Tegegne Desita ◽  
Wossen Mulugeta
Keyword(s):  
Head Injury ◽  
Ct Scan ◽  
Computerized Tomography ◽  
Head Injuries ◽  
Skull Fracture ◽  
Subdural Hemorrhage ◽  
Positive Finding ◽  
Cross Sectional ◽  
North West ◽  
The University

Background: Head injuries rank high among morbidities due to trauma. Computerized tomography is an important modality in the investigation of these cases. However, there is no literature on the importance of computerized tomography in the diagnosis of head injury in Ethiopia. This study therefore is aimed to document the computerized tomographic features of patients with head injury managed at the University of Gondar Teaching Hospital. Materials and Methods: A cross sectional study involving 96 patients with head injury who had CT scan of the head in the UOG hospital over a 12-month period. Results: Most of the patients were male (74%).  Majority (58%) were in the age range of 20 to 40 years with a mean age of 31yrs. The most common abnormal findings were skull fracture (52%) and intracerebral hemorrhage and contusions (51%). It is followed by subdural hemorrhage (33%) soft tissue swelling 32% and epidural hemorrhage 10%. Conclusion:  Skull fracture and intra cerebral hemorrhage were the most common abnormal findings. This study has demonstrated the importance of CT scan in the evaluation of head injury by giving visibility of intracranial post traumatic injuries in a high proportion of patients which would be difficult to reach in to diagnosis clinically or using skull radiography alone. This obviously will have a significant role in improving patient management. Taking this in to account expansion of CT scan service for moderate to severe head injury patients is recommended in Ethiopia.   

Quantitative pupillometry, a new technology: normative data and preliminary observations in patients with acute head injury

2003 ◽  
Vol 98 (1) ◽  
pp. 205-213 ◽  
Author(s):  
William R. Taylor ◽  
Jeff W. Chen ◽  
Hal Meltzer ◽  
Thomas A. Gennarelli ◽  
Cynthia Kelbch ◽  
...  
Keyword(s):  
Head Injury ◽  
Healthy Volunteers ◽  
New Technology ◽  
Head Injuries ◽  
Mass Effect ◽  
Midline Shift ◽  
Content Type ◽  
Cardiology Clinic ◽  
Diffuse Brain Swelling ◽  
Fine Print

✓ The authors prospectively used a new hand-held point-and-shoot pupillometer to assess pupillary function quantitatively. Repetitive measurements were initially made in more than 300 healthy volunteers ranging in age from 1 to 87 years, providing a total of 2432 paired (alternative right eye, left eye) measurements under varying light conditions. The authors studied 17 patients undergoing a variety of nonintracranial, nonophthalmological, endoscopic, or surgical procedures and 20 seniors in a cardiology clinic to learn more about the effects of a variety of drugs. Additionally, the authors carried out detailed studies in 26 adults with acute severe head injury in whom intracranial pressure (ICP) was continuously monitored. Finally, five patients suffering from subarachnoid hemorrhage were also studied. Quantitative pupillary measurements could be reliably replicated in the study participants. In healthy volunteers the resting pupillary aperture averaged 4.1 mm and the minimal aperture after stimulation was 2.7 mm, resulting in a 34% change in pupil size. Constriction velocity averaged 1.48 ± 0.33 mm/second. Pupillary symmetry was striking in both healthy volunteers and patients without intracranial or uncorrected visual acuity disorders. In the 2432 paired measurements in healthy volunteers, constriction velocity was noted to fall below 0.85 mm/second on only 33 occasions and below 0.6 mm/second on eight occasions (< one in 310 observations). In outpatients, the reduction in constriction velocity was observed when either oral or intravenous narcotic agents and diazepam analogs were administered. These effects were transient and always symmetrical. Among the 26 patients with head injuries, eight were found to have elevations of ICP above 20 mm Hg and pupillary dynamics in each of these patients remained normal. In 13 patients with a midline shift greater than 3 mm, elevations of ICP above 20 mm Hg, when present for 15 minutes, were frequently associated with a reduction in constriction velocity on the side of the mass effect to below 0.6 mm/second (51% of 156 paired observations). In five patients with diffuse brain swelling but no midline shift, a reduction in constriction velocities did not generally occur until the ICP exceeded 30 mm Hg. Changes in the percentage of reduction from the resting state following stimulation were always greater than 10%, even in patients receiving large doses of morphine and propofol in whom the ICP was lower than 20 mm Hg. Asymmetry of pupillary size greater than 0.5 mm was observed infrequently (< 1%) in healthy volunteers and was rarely seen in head-injured patients unless the ICP exceeded 20 mm Hg. Pupillometry is a reliable technology capable of providing repetitive data on quantitative pupillary function in states of health and disease.

Prognostic value of early computerized tomography scanning following craniotomy for traumatic hematomas

1999 ◽  
Vol 91 (4) ◽  
pp. 581-587 ◽  
Author(s):  
Santiago Lubillo ◽  
José Bolaños ◽  
Luis Carreira ◽  
José Cardeñosa ◽  
Javier Arroyo ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Hospital Stay ◽  
Ct Scan ◽  
Computerized Tomography ◽  
Ct Scanning ◽  
Unfavorable Outcome ◽  
Content Type ◽  
Gcs Score ◽  
Fine Print

Object. Patients with head injuries traditionally were categorized on the basis of whether their lesions appeared to be diffuse, focal, or mass lesions on admission computerized tomography (CT) scanning. In the classification of Marshall, et al., the presence of a hematoma (evacuated or not evacuated) is more significant than any diffuse injury (DI). The CT scan appearance after evacuation of a mass lesion has not been analyzed previously in relation to outcome. The authors have investigated the importance of: 1) neurological assessment at hospital admission; 2) the status of the basal cisterns and associated intracranial lesions on the admission CT scan; and 3) the degree of DI on the early CT scan obtained after craniotomy to identify patients at risk for development of raised intracranial pressure (ICP) and lowered cerebral perfusion pressure (CPP) and to discover the influence of the postoperative CT appearance of the lesion on patient outcome.Methods. The authors prospectively studied 82 patients with isolated, severe closed head injury (Glasgow Coma Scale [GCS] score ≤ 8), all of whom had intracranial hematoma. Both ICP and CPP were continuously monitored, and a CT scan was obtained within 2 to 12 hours after craniotomy. The CT images were categorized according to the classification of Marshall, et al.The mortality rate during the hospital stay was 37%, and 50% of the patients achieved a favorable outcome. Compression of the basal cistern on the admission (preoperative) CT scan was associated with raised ICP and a CPP of less than 70 mm Hg but not with any other features or with poor patient outcome. In 53 patients the postoperative CT scan revealed DIs III or IV and 29 patients had DIs I or II. The percentages of time during the hospital stay in which ICP was higher than 20 mm Hg and CPP was lower than 70 mm Hg as well as unfavorable outcome were higher in the group of patients in whom DI III or IV was present (p < 0.001). Raised ICP, CPP lower than 70 mm Hg, DI III or IV, and unfavorable outcome were more frequently observed in patients who presented with a motor (m)GCS score of 3 or less, bilateral unreactive pupils, associated intracranial injuries, and hypotension (p < 0.001). When logistic regression analysis was performed, an mGCS score of 3 or less (p = 0.0013, odds ratio [OR] 10.8), bilateral unreactive pupils (p = 0.0047, OR 31.8), and DI III or IV observed on CT scanning after surgery (p = 0.015, OR 8.9) were independently associated with poor outcome.Conclusions. Features on CT scans obtained shortly after craniotomy constitute an independent predictor of outcome in patients with traumatic hematoma. Patients in whom DI III or IV appears on postoperative CT scanning, who often present with an mGCS score of 3 or less and nonreactive pupils, are at high risk for the development of raised ICP and lowered CPP.

Head injury mortality in two centers with different emergency medical services and intensive care

1989 ◽  
Vol 71 (2) ◽  
pp. 202-207 ◽  
Author(s):  
Austin R. T. Colohan ◽  
Wayne M. Alves ◽  
Cynthia R. Gross ◽  
James C. Torner ◽  
V. S. Mehta ◽  
...  
Keyword(s):  
Head Injury ◽  
Mortality Rate ◽  
Head Injuries ◽  
Mortality Rates ◽  
Striking Similarity ◽  
Prehospital Emergency Care ◽  
New Delhi ◽  
Severe Injuries ◽  
Content Type ◽  
Severity Of Injury

✓ The authors report data collected prospectively on 551 cases of head injury in New Delhi, India, and 822 cases in Charlottesville, Virginia. The mortality rate, adjusted for initial severity of injury, was 11.0% in New Delhi versus 7.2% in Charlottesville (p < 0.02). There was a striking similarity in mortality rates at both centers when comparing patients with the least severe head injuries and those with the most severe injuries according to the motor score of the Glasgow Coma Scale (GCS M). However, in the group with an abnormal but purposeful motor response (GCS M = 5), the mortality rate was 12.5% in New Delhi versus 4.8% in Charlottesville (p < 0.01). The relative absence of prehospital emergency care and the delay in admission after head injury in New Delhi are cited as two possible causes for the differences in mortality rates in this subgroup of patients with “moderate” head injuries.

scholarly journals Outcome Prediction in Patients of Traumatic Brain Injury Based on Midline Shift on CT Scan of Brain

2021 ◽  
Author(s):  
Shrikant Govindrao Palekar ◽  
Manish Jaiswal ◽  
Mandar Patil ◽  
Vijay Malpathak
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Ct Scan ◽  
Treatment Protocol ◽  
Emergency Setting ◽  
Midline Shift ◽  
Ct Head ◽  
Clinical Tools ◽  
Gcs Score

Abstract Background Clinicians treating patients with head injury often take decisions based on their assessment of prognosis. Assessment of prognosis could help communication with a patient and the family. One of the most widely used clinical tools for such prediction is the Glasgow coma scale (GCS); however, the tool has a limitation with regard to its use in patients who are under sedation, are intubated, or under the influence of alcohol or psychoactive drugs. CT scan findings such as status of basal cistern, midline shift, associated traumatic subarachnoid hemorrhage (SAH), and intraventricular hemorrhage are useful indicators in predicting outcome and also considered as valid options for prognostication of the patients with traumatic brain injury (TBI), especially in emergency setting. Materials and Methods 108 patients of head injury were assessed at admission with clinical examination, history, and CT scan of brain. CT findings were classified according to type of lesion and midline shift correlated to GCS score at admission. All the subjects in this study were managed with an identical treatment protocol. Outcome of these patients were assessed on GCS score at discharge. Result Among patients with severe GCS, 51% had midline shift. The degree of midline shift in CT head was a statistically significant determinant of outcome (p = 0.023). Seventeen out of 48 patients (35.4%) with midline shift had poor outcome as compared with 8 out of 60 patients (13.3%) with no midline shift. Conclusion In patients with TBI, the degree of midline shift on CT scan was significantly related to the severity of head injury and resulted in poor clinical outcome.

Preliminary experience with Brown-Roberts-Wells (BRW) computerized tomography stereotaxic guidance system

1983 ◽  
Vol 59 (2) ◽  
pp. 217-222 ◽  
Author(s):  
M. Peter Heilbrun ◽  
Theodore S. Roberts ◽  
Michael L. J. Apuzzo ◽  
Trent H. Wells ◽  
James K. Sabshin
Keyword(s):  
Ct Scan ◽  
Computerized Tomography ◽  
Guidance System ◽  
Production Model ◽  
Ct Scanner ◽  
Content Type ◽  
Ct Scanners ◽  
Guidance Systems ◽  
Fine Print

✓ The production model of the Brown-Roberts-Wells (BRW) computerized tomography (CT) stereotaxic guidance system is described. Hardware and software modifications to the original prototype now allow the system to be used independently of the CT scanner after an initial scan with the localizing components fixed to the skull. The system is simple and efficient, can be used universally with all CT scanners, and includes a phantom simulator system for target verification. Preliminary experience with 74 patients at two institutions is described. It is concluded that CT stereotaxic guidance systems will become important tools in the neurosurgical armamentarium, as they allow accurate approach to any target identifiable on the CT scan.

CT infusion scanning for the detection of cerebral aneurysms

1989 ◽  
Vol 71 (2) ◽  
pp. 175-179 ◽  
Author(s):  
David W. Newell ◽  
Peter D. LeRoux ◽  
Ralph G. Dacey ◽  
Gary K. Stimac ◽  
H. Richard Winn
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Computerized Tomography ◽  
Cerebral Aneurysms ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Spontaneous Hemorrhage ◽  
Fine Print

✓ Computerized tomography (CT) infusion scanning can confirm the presence or absence of an aneurysm as a cause of spontaneous intracerebral hemorrhage. Eight patients who presented with spontaneous hemorrhage were examined using this technique. In five patients the CT scan showed an aneurysm which was later confirmed by angiography or surgery; angiography confirmed the absence of an aneurysm in the remaining three patients. This method is an easy effective way to detect whether an aneurysm is the cause of spontaneous intracerebral hemorrhage.

Prophylactic phenytoin in severe head injuries

1979 ◽  
Vol 51 (4) ◽  
pp. 507-509 ◽  
Author(s):  
Richard N. W. Wohns ◽  
Allen R. Wyler
Keyword(s):  
Retrospective Study ◽  
Head Injury ◽  
High Probability ◽  
Late Onset ◽  
Head Injuries ◽  
Content Type ◽  
Posttraumatic Epilepsy ◽  
Fine Print

✓ We are reporting a retrospective study of 62 patients whose head injury was sufficiently severe to cause a high probability of posttraumatic epilepsy. Of 50 patients treated with phenytoin, 10% developed epilepsy of late onset. Twelve patients not treated with phenytoin but who had head injuries of equal magnitude had a 50% incidence of epilepsy. These data from a highly selected group of patients with severe head injuries confirm the bias that treatment with phenytoin decreases the incidence of posttraumatic epilepsy.

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