Early computer tomography in patients with brain contusions
Abstract
Objective: To validate the critical approach to the results of early computed tomography in patients with focal traumatic brain injury in the acute period of TBI. Material and methods: Data of 109 patients in acute period of TBI with total number of 209 focal brain lesions were analyzed. The volume dynamics of the lesions was monitored in primary and follow-up CT-scans. The common estimation of CT images was conducted using the Marshall and Rotterdam classifications in comparison with dynamics of clinical signs. Results: It was revealed that the lesion volume increased due to hemorrhagic component of the traumatic lesions, which was the smaller as shorter was the time period from trauma to their detection on a primary brain CT scan. There was not found any correlation between the lesions progression and the clinical status, that may be due to different brain reactions on the injured zone enlargement. Conclusion: “Early” (15 minutes - 2 hours) computed tomography studies in acute period of TBI do not reflect the real severity of brain damage, the evolution of which is still going on and ends later. The usage of the special CT-scales in dynamics allows selecting “important” progression of traumatic lesions with mass-effect increasing and “unimportant” without it.
About the Authors
P. V. Smirnov
«Городская клиническая больница № 39» г. Нижнего Новгорода
Russian Federation
Russian Federation
L. Ya. Kravets
ФГБУ «Приволжский Федеральный Медицинский Исследовательский Центр» МЗ РФ
Russian Federation
Russian Federation
V. N. Yakimov
Национальный исследовательский Нижегородский государственный университет им. Н.И. Лобачевского
Russian Federation
Russian Federation
References
1. Oertel M., Kelly D.F., McArthur D., Boscardin W.J., Glenn T.C., Lee J.H. et al. Progressive hemorrhage after head trauma: Predictors and consequences of the evolving injury. J. Neurosurgery; 2002; 96 (1): 109-116.
2. Park H.K., Joo W.I. Chough C.K., Cho C.B., Lee K.J., Rha H.K. The clinical efficacy of repeat brain computed tomography in patients with traumatic intracranial hemorrhage within 24 hours after blunt head injury. Br J. Neurosurgery; 2009 Dec; 23(6): 617-621.
3. Fainardi E., Chieregato A., Antonelli V., Fagioli L., Servadei F. Time course of CT evolution in traumatic subarachno id haemorrhage: a study of 141 patients. Acta Neurochir. (Wien); 2004; 146(3): 257-63.
4. White C.L., Griffith S., Caron J.L. Early progression of tr aumatic cerebral contusions: characterization and risk factors. J. Trauma; 2009 Sep; 67(3): 508-14.
5. Yadav Y.R., Basoor A., Jain G., Nelson A. Expanding traumatic intracerebral contusion/hematoma. Neurol. India; 2006; 54: 377-81.
6. Homnick A., Sifri Z., Yonclas P., Mohr A., Livingston D. The temporal course of intracranial haemorrhage progression: how long is observation necessary? Injury; 2012 Dec; 43(12): 2122-5.
7. Lumenta C.B., Rocco C.Di., Haase J., Mooij J.J. A. European manual of medicine - Neurosurgery. Springer, Berlin; 2010: 642 pp.
8. Servadei F., Nanni A., Nasi M. T., Zappi D., Vergoni G., Giuliani G. et al. Evolving brain lesions in the first 12 hours after head injury: Analysis of 37 comatose patients. Neurosurgery; 1995; 37(5): 899-906.
9. Lobato R.D., Alen J.F., Perez-Nuсеz A., Alday R., Gуmez P.A., Pascual B. et al. Value of serial CT scanning and intracranial pressure monitoring for detecting new intracranial mass effect in severe head injury patients showing lesions type I-II in the initial CT scan. Neurocirugia (Astur); 2005; 16(3): 217-34.
10. Juratli T.A., Zang B., Litz R.J., Sitoci K.H., Aschenbrenner U., Gottschlich B. et al. Early hemorrhagic progression of traumatic brain contusions: frequency, correlation with coagulation disorders, and patient outcome: a prospective study. J. Neurotrauma; 2014; 31(17): 1521-7.
11. Kurland D., Hong C., Aarabi B., Gerzanich V., Simard J.M. Hemorrhagic progression of a contusion after traumatic brain injury: a review. Journal of Neurotrauma; 2012; 29(1): 19-31.
12. Sturiale C.L., De Bonis P., Rigante L., Calandrelli R., D’Arrigo S., Pompucci A. et al. Do traumatic brain contusions increase in size after decompressive craniectomy? J. Neurotrauma; 2012; 29(18): 2723-6.
13. Compagnone C., Murray G.D., Teasdale G.M., Maas A.I., Esposito D., Princi P. et al. The management of patients with intradural post-traumatic brain lesions: a multicenter survey of current approaches to surgical management in 729 patients coordinated be the European Brain Injury Consortium. Neurosurgery; 2005; 57(6): 1183-1192.
14. Kornienko V.N., Pronin I.N. Diagnostic Neuroradiology. Moscow; 2009; 3; 463 pp. (In Russian). (Корниенко В.Н., Пронин И.Н. Диагностическая нейрорадиология. Москва. - 2009; 3; 463 стр.)
15. Bullock M.R., Chestnut R., Ghajar J., Gordon D., Hartl R., Newell D.W. et al. Guidelines for the surgical management of traumatic brain injury. J. Neurosurgery; 2006; 3 (58): S2-1-S2-62.
16. Chang E.F., Meeker M.,, Holland M. C. Acute traumatic intraparenchymal hemorrhage: risk factors for progression in the early post-injury period. J. Neurosurgery; 2006; 4 (58): 647-656.
17. Marshall L.F., Marshall S.B., Klauber M.R. Van Berkum Clark M., Eisenberg H., Jane J. A. et al. A new classification of head injury based on computerized tomography. J. Neurotrauma; 1992; 9(1): 287-92.
18. Maas A.I., Hukkelhoven C.W., Marshall L.F., Steyerberg E.W. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery; 2005; 57(6): 1173-82.
19. Mata-Mbemba D., Mugikura S., Nakagawa A., Murata T., Ishii K., Li L. et al. Early CT findings to predict early death in patients with traumatic brain injury: Marshall and Rotterdam CT-scoring systems compared in the major academic tertiary care hospital in northeastern Japan. Acad. Radiol; 2014; 21(5): 605-11.
20. Лебедев В.В., Крылов В.В., Мартыненко A.È., Халчевский В.М. Клинико-компьютернотомографическая классификация ушибов головного мозга // Нейрохирургия. - 2001. - № 1. - С. 25-36
Review
For citations:
Smirnov P.V., Kravets L.Ya., Yakimov V.N. Early computer tomography in patients with brain contusions. Russian journal of neurosurgery. 2017;(2):21-28. (In Russ.)
Views:
1514
Email this article 