Outcome from severe head injury related to the type of intracranial lesion

A computerized tomography study

Ramiro D. LobatoDepartments of Neurosurgery, Neuroradiology, and Intensive Care Unit, Ciudad Sanitaria “1° de Octubre” and Faculty of Medicine, Universidad Complutense, Madrid, Spain

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Francisco CordobesDepartments of Neurosurgery, Neuroradiology, and Intensive Care Unit, Ciudad Sanitaria “1° de Octubre” and Faculty of Medicine, Universidad Complutense, Madrid, Spain

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Juan J. RivasDepartments of Neurosurgery, Neuroradiology, and Intensive Care Unit, Ciudad Sanitaria “1° de Octubre” and Faculty of Medicine, Universidad Complutense, Madrid, Spain

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Marina de la FuenteDepartments of Neurosurgery, Neuroradiology, and Intensive Care Unit, Ciudad Sanitaria “1° de Octubre” and Faculty of Medicine, Universidad Complutense, Madrid, Spain

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Angel MonteroDepartments of Neurosurgery, Neuroradiology, and Intensive Care Unit, Ciudad Sanitaria “1° de Octubre” and Faculty of Medicine, Universidad Complutense, Madrid, Spain

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Alejandro BarcenaDepartments of Neurosurgery, Neuroradiology, and Intensive Care Unit, Ciudad Sanitaria “1° de Octubre” and Faculty of Medicine, Universidad Complutense, Madrid, Spain

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Carlos PerezDepartments of Neurosurgery, Neuroradiology, and Intensive Care Unit, Ciudad Sanitaria “1° de Octubre” and Faculty of Medicine, Universidad Complutense, Madrid, Spain

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Antonio CabreraDepartments of Neurosurgery, Neuroradiology, and Intensive Care Unit, Ciudad Sanitaria “1° de Octubre” and Faculty of Medicine, Universidad Complutense, Madrid, Spain

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Eduardo LamasDepartments of Neurosurgery, Neuroradiology, and Intensive Care Unit, Ciudad Sanitaria “1° de Octubre” and Faculty of Medicine, Universidad Complutense, Madrid, Spain

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Page Range:
762–774
Volume/Issue:
Volume 59: Issue 5
DOI link:
https://doi.org/10.3171/jns.1983.59.5.0762
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✓ The influence of the type of intracranial lesion on the final outcome in a consecutive series of 277 severely head-injured patients was analyzed. Patients were studied with computerized tomograpy (CT) and underwent continuous measurement of intracranial pressure. They received identical treatment according to a standardized protocol. Outcome of patients with either epidural hematoma (38 cases), subdural hematoma (56 cases), brain contusion (87 cases), or diffuse brain damage (96 cases) was rather heterogeneous, and serial CT scanning allowed the authors to outline eight consistent anatomical patterns in the whole series which have stronger prognostic significance than the four major lesion categories mentioned above. Patients with pure extracerebral hematoma (19 cases), single brain contusion (45 cases), general brain swelling (41 cases), and normal CT scans (28 cases) had a significantly better outcome than patients developing acute hemispheric swelling after operation for a large extracerebral hematoma (27 cases), patients with multiple brain contusion, either unilateral or bilateral (74 cases), and patients with diffuse axonal injury (43 cases). These anatomical patterns are interesting because, in addition to having clinical and physiopathological significance, they provide useful prognostic information and facilitate improved therapeutic decision-making in severely head-injured patients.

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Contributor Notes

Address reprint requests to: Ramiro D. Lobato, M.D., Servicio de Neurocirugía, Ciudad Sanitaria “1° de Octubre,” C. Andalucia, Km 5.400, Madrid, Spain.
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