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TRAUMATIC SUBARACHNOID HEMORRHAGE IN ACUTE SEVERE HEAD INJURY Shiro Kobayashi 1 , Shozo Nakazawa 1 , Hiroyuki Yokota 1 , Kazuo Isayama 1 , Masami Yano 2 , Toshibumi Otsuka 3 1Department of Neurosurgery, Nippon Medical School 2Anesthesiology, Nippon Medical School 3Critical Care Medicine, Nippon Medical School pp.1131-1135
Published Date 1988/12/1
DOI https://doi.org/10.11477/mf.1406206218
  • Abstract
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Traumatic subarachnoid hemorrhage (TSAH) is a frequent occurence resulting from acute severe head injury. Computerized tomography (CT) accu-rately identifies the region, extent and nature of TSAH following trauma. But, to our knowledge, there have been few series detailing the charac-teristics of TSAH in acute severe head injury. The purpose of this study is to describe the findings, nature and prognosis of TSAH.

Over a six and a half year period between April 1977 and September 1983, 414 severely head injured patients were examined by CT within 24 hours of the injury in the Department of Neurological Surgery and Critical Care Medi-cine, Nippon Medical School. Among them, 97 (23.4%) patients showed the appearance of TSAH in the Sylvian fissures, tentorium cerebelli, cor-tical sulci, basal cisterns and interhemispheric fissures. Conscious state on admission was defined using the Glasgow Coma Scale (GCS) and clinical outcome was defined using Glasgow Outcome Scale. There were 77 men and 20 women, ran-ging from 4 months to 83 years in age (means 44.3 years). TSAH therefore appears to be seen in all age groups, but especially in middle age groups. The GCS on admission was 8 or less in all cases ; the GCS was 8 in 10 cases, 7 in 7 cases, 6 in 15 cases, 5 in 16 cases, 4 in 23 cases, 3 in 26 cases. The lower GCS scores, the more frequently TSAH was identified, and 67% of the patients had a GCS of 6 or less. The distribution of TSAH by CT were as follows : 61.9% in the Sylvian fissures, 32% along the tentorium cerebelli, 27.8% in the basal cisterns, 22.7% in cortical sulci and 9. 3% in the interhemispheric fissures (n=97). Patients with isolated TSAH in the Sylvian fissures or along the tentorium cerebelli had a relatively good outcome ; on the other hand the patients presenting TSAH in the basal cisterns demonstrated a poor outcome. The wider the distribution of the TSAH, the worse the utcome (p<0.005 by the Kendall Rank Correla-tion Coefficient). Among those patients having TSAH in the three of the regions, there were no good outcomes. Associated CT findings most commonly were acute subdural hematoma (41.3%), cerebral contusion (37.6%) and diffuse cerebral swelling (23.7%). Concerning the Glasgow Out-come Scale of TSAH at three months after trauma, good recovery occurred in 12 cases (12.4%), mo-derate disability in 9 cases (9.3%), and severe disability was 7 cases (7.2%), persistent vegeta-tive state was 14 cases (14.4%) and dead was 55 cases (56.7%).

We conclude that TSAH in acute severe head injury appears to be an important risk factor indicating poor prognosis.


Copyright © 1988, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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