Neurological Surgery No Shinkei Geka Volume 21, Issue 2 (February 1993)

Pathogenesis and Management of Secondary Neural Damage in Head Trauma Patients—Analysis of patients who talk and deteriorate“fulminantly” Iwao YAMAKAMI 1 , Akira YAMAURA 1 , Katsumi ISOBE 2 1Department of Neurosurgery, Chiba University School of Medicine 2Department of Neurosurgery, Kimitsu Central Hospital Keyword: Head trauma , Deterioration , Intracranial hematoma , Computerized tomography pp.129-133
Published Date 1993/2/10
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To clarify the pathogenesis and management of secondary neural damage after head trauma, we char-acterized the clinical features and CT findings in nine patients who talked and deteriorated “fulminantly”. The patient who talks and deteriorates “fulminantly” is defined as a patient who talks (verbal score of Glas-gow Coma Scale 4) on admission, and subsequently shows a rapid neurological deterioration to develop an anisocoria and/or a decerebrated posture within 24 hours after trauma. Nine (8%) out of 118 patients with severe head trauma satisfied the definition mentioned above.

The mechanism of injury was a fall in 5 patients and a road traffic accident in 4. Plain skull X-ray manifested a linear skull fracture in 8 out of 9 (89%) . Although they were almost alert and talked on admission, all of these 9 patients developed an anisocoria within 6 hours after trauma. Prior to the rapid neurological deteriora-tion, in spite of their good consciousness, they charac-teristically showed a variety of CT abnormalities in-cluding subdural hematoma (SDH), intracerebral hema-toma (ICH) and subarachnoid hemorrhage. Following the rapid neurological deterioration, 7 out of 9 patients underwent surgical treatment for hematoma evacuation using a large decompressive craniectomy. Clinical out-comes were 2 good recoveries, 1 moderate disability, and 6 deaths. Causes of the rapid neurological de-terioration determined by CT and surgery were 1) an enlarged SDH in 6 patients, 2) an enlarged ICH in 4 patients, and 3) a worsened brain swelling associated with SDH in 3 cases.

In a patient who talks and deteriorates “fulminantly”, a rapid neurological deterioration (secondary neural damage) occurs within the six hours after trauma, and is caused by an enlargement of the lesion occupying the intracranial space and associated with focal masses such as SDH and ICH. To salvage a patient who talks and deteriorates “fulminantly”, careful observation and repeated CT examinations within six hours after trauma should be performed in an alert patient with skull fracture and various CT abnormalities.

Copyright © 1993, Igaku-Shoin Ltd. All rights reserved.


Neurological Surgery 脳神経外科
21巻2号 (1993年2月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院