Initial CT findings in 753 patients with severe head injury

A report from the NIH Traumatic Coma Data Bank

Restricted access

✓ In this prospective multicenter study, the authors have examined data derived from the initial computerized tomography (CT) scans of 753 patients with severe head injury. When the CT findings were related to abnormal intracranial pressure and to death, the most important characteristics of the scans were: midline shift; compression or obliteration of the mesencephalic cisterns; and the presence of subarachnoid blood. Diffuse hemispheric swelling was also found to be associated with an early episode of either hypoxia or hypotension.

Article Information

Contributor Notes

Address for Dr. Foulkes: Biometry and Field Studies Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.Address for Dr. Jane: Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.Address for Drs. Marmarou and Young: Division of Neurosurgery, Medical College of Virginia, Richmond, Virginia.Address for Dr. Marshall: Division of Neurosurgery, University of California, San Diego, California.Address reprint requests to: Howard M. Eisenberg, M.D., Division of Neurosurgery E-17, The University of Texas Medical Branch, Galveston, Texas 77550.
Headings
References
  • 1.

    Alberico AMWard JDChoi SCet al: Outcome after severe head injury. Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients. J Neurosurg 67:6486561987Alberico AM Ward JD Choi SC et al: Outcome after severe head injury. Relationship to mass lesions diffuse injury and ICP course in pediatric and adult patients. J Neurosurg 67:648–656 1987

    • Search Google Scholar
    • Export Citation
  • 2.

    Becker DP: Selecting patients for intracranial pressure monitoring in severe head injury in Ishii SNagai HBrock M (eds): Intracranial Pressure V. New York: Springer-Verlag1983 pp 512516Becker DP: Selecting patients for intracranial pressure monitoring in severe head injury in Ishii S Nagai H Brock M (eds): Intracranial Pressure V. New York: Springer-Verlag 1983 pp 512–516

    • Search Google Scholar
    • Export Citation
  • 3.

    Beltramello APasut MLBricolo A: Early intracranial changes in severe head injury. A serial CT study. Neuroradiology 22:2702711982 (Abstract)Beltramello A Pasut ML Bricolo A: Early intracranial changes in severe head injury. A serial CT study. Neuroradiology 22:270–271 1982 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 4.

    Clifton GLGrossman RGMakela MEet al: Neurological course and correlated computerized tomography findings after severe closed head injury. J Neurosurg 52:6116241980Clifton GL Grossman RG Makela ME et al: Neurological course and correlated computerized tomography findings after severe closed head injury. J Neurosurg 52:611–624 1980

    • Search Google Scholar
    • Export Citation
  • 5.

    Columella FDelzanno GBGaist Get al: Angiography in traumatic cerebral lacerations with special regard to some less common aspects. Acta Radiol (Diagn) 1:2392471963Columella F Delzanno GB Gaist G et al: Angiography in traumatic cerebral lacerations with special regard to some less common aspects. Acta Radiol (Diagn) 1:239–247 1963

    • Search Google Scholar
    • Export Citation
  • 6.

    Cusmano FBertolino GCPichezzi Pet al: Computed tomography in severe head trauma. Acta Neurol 7:14201985Cusmano F Bertolino GC Pichezzi P et al: Computed tomography in severe head trauma. Acta Neurol 7:14–20 1985

    • Search Google Scholar
    • Export Citation
  • 7.

    Dublin ABFrench BNRenick JM: Computed tomography in head trauma. Radiology 122:3653691977Dublin AB French BN Renick JM: Computed tomography in head trauma. Radiology 122:365–369 1977

    • Search Google Scholar
    • Export Citation
  • 8.

    Falsetti HLMoody RA: Electrocardiographic changes in head injuries. Dis Chest 49:4204241966Falsetti HL Moody RA: Electrocardiographic changes in head injuries. Dis Chest 49:420–424 1966

    • Search Google Scholar
    • Export Citation
  • 9.

    French BNDublin AB: The value of computerized tomography in the management of 1000 consecutive head injuries. Surg Neurol 7:1711831983French BN Dublin AB: The value of computerized tomography in the management of 1000 consecutive head injuries. Surg Neurol 7:171–183 1983

    • Search Google Scholar
    • Export Citation
  • 10.

    Greitz TLindgren E: Intracranial traumatic changes in Abrams HL (ed): Angiography. Boston: Little, Brown & Co1961 Vol 1pp 95100Greitz T Lindgren E: Intracranial traumatic changes in Abrams HL (ed): Angiography. Boston: Little Brown & Co 1961 Vol 1pp 95–100

    • Search Google Scholar
    • Export Citation
  • 11.

    Grolimund PWeber MSeiler RWet al: Time course of cerebral vasospasm after severe head injury. Lancet 2:11731988 (Letter)Grolimund P Weber M Seiler RW et al: Time course of cerebral vasospasm after severe head injury. Lancet 2:1173 1988 (Letter)

    • Search Google Scholar
    • Export Citation
  • 12.

    Haar FLSadhu VKPinto RSet al: Can CT scan findings predict intracranial pressure in closed head injury patients? in Shulman KMarmarou AMiller JDet al (eds): Intracranial Pressure IV. New York: Springer-Verlag1980 pp 4853Haar FL Sadhu VK Pinto RS et al: Can CT scan findings predict intracranial pressure in closed head injury patients? in Shulman K Marmarou A Miller JD et al (eds): Intracranial Pressure IV. New York: Springer-Verlag 1980 pp 48–53

    • Search Google Scholar
    • Export Citation
  • 13.

    Holliday PO IIIKelly DL JrBall M: Normal computed tomograms in acute head injury: correlation of intracranial pressure, ventricular size, and outcome. Neurosurgery 10:25281982Holliday PO III Kelly DL Jr Ball M: Normal computed tomograms in acute head injury: correlation of intracranial pressure ventricular size and outcome. Neurosurgery 10:25–28 1982

    • Search Google Scholar
    • Export Citation
  • 14.

    Huber P: Posttraumatische Kaliberschwankungen der Hirngefässe im Angiogramm. Fortsch Geb Rontgenstra Nuklearmed 98:2923021963Huber P: Posttraumatische Kaliberschwankungen der Hirngefässe im Angiogramm. Fortsch Geb Rontgenstra Nuklearmed 98:292–302 1963

    • Search Google Scholar
    • Export Citation
  • 15.

    Jane JASteward OGennarelli T: Axonal degeneration induced by experimental noninvasive minor head injury. J Neurosurg 62:961001985Jane JA Steward O Gennarelli T: Axonal degeneration induced by experimental noninvasive minor head injury. J Neurosurg 62:96–100 1985

    • Search Google Scholar
    • Export Citation
  • 16.

    Kishore PRSLipper MHBecker DPet al: Significance of CT in head injury: correlation with intracranial pressure. AJNR 2:3073111981Kishore PRS Lipper MH Becker DP et al: Significance of CT in head injury: correlation with intracranial pressure. AJNR 2:307–311 1981

    • Search Google Scholar
    • Export Citation
  • 17.

    Koo AHLaRoque RL: Evaluation of head trauma by computed tomography. Radiology 123:3453501977Koo AH LaRoque RL: Evaluation of head trauma by computed tomography. Radiology 123:345–350 1977

    • Search Google Scholar
    • Export Citation
  • 18.

    Lanksch WGrumme TKazner E: Correlations between clinical symptoms and computerized tomography findings in closed head injuries. Adv Neurosurg 5:27301978Lanksch W Grumme T Kazner E: Correlations between clinical symptoms and computerized tomography findings in closed head injuries. Adv Neurosurg 5:27–30 1978

    • Search Google Scholar
    • Export Citation
  • 19.

    Leeds NEReid NDRosen LM: Angiographic changes in cerebral contusions and intracerebral hematomas. Acta Radiol (Diag) 5:3203271966Leeds NE Reid ND Rosen LM: Angiographic changes in cerebral contusions and intracerebral hematomas. Acta Radiol (Diag) 5:320–327 1966

    • Search Google Scholar
    • Export Citation
  • 20.

    Lin JPTChase NEKricheff IIet al: Microangiographic changes in the traumatized brain. Acta Radiol (Diagn) 5:3413511966Lin JPT Chase NE Kricheff II et al: Microangiographic changes in the traumatized brain. Acta Radiol (Diagn) 5:341–351 1966

    • Search Google Scholar
    • Export Citation
  • 21.

    Lipper MHKishore PRSEnas GGet al: Computed tomography in the prediction of outcome in head injury. AJR 144:4834861985Lipper MH Kishore PRS Enas GG et al: Computed tomography in the prediction of outcome in head injury. AJR 144:483–486 1985

    • Search Google Scholar
    • Export Citation
  • 22.

    Lobato RDCordobes FRivas JJet al: Outcome from severe head injury related to the type of intracranial lesion. A computerized tomography study. J Neurosurg 59:7627741983Lobato RD Cordobes F Rivas JJ et al: Outcome from severe head injury related to the type of intracranial lesion. A computerized tomography study. J Neurosurg 59:762–774 1983

    • Search Google Scholar
    • Export Citation
  • 23.

    Lobato RDSarabia RRivas JJet al: Normal computerized tomography scans in severe head injury. Prognostic and clinical management implications. J Neurosurg 65:7847891986Lobato RD Sarabia R Rivas JJ et al: Normal computerized tomography scans in severe head injury. Prognostic and clinical management implications. J Neurosurg 65:784–789 1986

    • Search Google Scholar
    • Export Citation
  • 24.

    Mantel NHaensel W: Statistical aspects of the analysis of data from retrospective studies of disease. JNCI 22:7197481959Mantel N Haensel W: Statistical aspects of the analysis of data from retrospective studies of disease. JNCI 22:719–7481959

    • Search Google Scholar
    • Export Citation
  • 25.

    Merindo-de Villasante JTavares JM: Computerized tomography (CT) in acute head trauma. AJR 126:7657781976Merindo-de Villasante J Tavares JM: Computerized tomography (CT) in acute head trauma. AJR 126:765–778 1976

    • Search Google Scholar
    • Export Citation
  • 26.

    Miller JDBecker DPWard JDet al: Significance of intracranial hypertension in severe head injury. J Neurosurg 47:5035161977Miller JD Becker DP Ward JD et al: Significance of intracranial hypertension in severe head injury. J Neurosurg 47:503–516 1977

    • Search Google Scholar
    • Export Citation
  • 27.

    Miller JDGudeman SKKishore PRSet al: CT scan, ICP and early neurological evaluation in the prognosis of severe head injury. Acta Neurochir 28:86881979Miller JD Gudeman SK Kishore PRS et al: CT scan ICP and early neurological evaluation in the prognosis of severe head injury. Acta Neurochir 28:86–88 1979

    • Search Google Scholar
    • Export Citation
  • 28.

    Murphy ATeasdale EMatheson Met al: Relationship between CT indices of brain swelling and intracranial pressure after head injury in Ishii SNagai HBrock M (eds): Intracranial Pressure V. New York: Springer-Verlag1983 pp 562565Murphy A Teasdale E Matheson M et al: Relationship between CT indices of brain swelling and intracranial pressure after head injury in Ishii S Nagai H Brock M (eds): Intracranial Pressure V. New York: Springer-Verlag 1983 pp 562–565

    • Search Google Scholar
    • Export Citation
  • 29.

    Narayan RKGreenberg RPMiller JDet al: Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure. J Neurosurg 54:7517621981Narayan RK Greenberg RP Miller JD et al: Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination multimodality evoked potentials CT scanning and intracranial pressure. J Neurosurg 54:751–762 1981

    • Search Google Scholar
    • Export Citation
  • 30.

    Paxton RAmbrose J: The EMI scanner. A brief review of the first 650 patients. Br J Radiol 47:5305651974Paxton R Ambrose J: The EMI scanner. A brief review of the first 650 patients. Br J Radiol 47:530–565 1974

    • Search Google Scholar
    • Export Citation
  • 31.

    Roberson FCKishore PRSMiller JDet al: The value of serial computerized tomography in the management of severe head injury. Surg Neurol 12:1611671979Roberson FC Kishore PRS Miller JD et al: The value of serial computerized tomography in the management of severe head injury. Surg Neurol 12:161–167 1979

    • Search Google Scholar
    • Export Citation
  • 32.

    Sadhu VKSampson JHaar FLet al: Correlation between computed tomography and intracranial pressure monitoring in acute head trauma patients. Radiology 133:5075091979Sadhu VK Sampson J Haar FL et al: Correlation between computed tomography and intracranial pressure monitoring in acute head trauma patients. Radiology 133:507–509 1979

    • Search Google Scholar
    • Export Citation
  • 33.

    Sautreaux JLBinnert DThierry Aet al: La scanographie en traumatologie crânienne. Étude critique de 500 cas. Neurochirurgie 28:2632701982Sautreaux JL Binnert D Thierry A et al: La scanographie en traumatologie crânienne. Étude critique de 500 cas. Neurochirurgie 28:263–270 1982

    • Search Google Scholar
    • Export Citation
  • 34.

    Suwanwela CSuwanwela N: Intracranial arterial narrowing and spasm in acute head injury. J Neurosurg 36:3143231972Suwanwela C Suwanwela N: Intracranial arterial narrowing and spasm in acute head injury. J Neurosurg 36:314–323 1972

    • Search Google Scholar
    • Export Citation
  • 35.

    Sweet RCMiller JDLipper Met al: Significance of bilateral abnormalities on the CT scan in patients with severe head injury. Neurosurgery 3:16211978Sweet RC Miller JD Lipper M et al: Significance of bilateral abnormalities on the CT scan in patients with severe head injury. Neurosurgery 3:16–21 1978

    • Search Google Scholar
    • Export Citation
  • 36.

    Tabaddor KDanziger AWisoff HS: Estimation of intracranial pressure by CT scan in closed head trauma. Surg Neurol 18:2122151982Tabaddor K Danziger A Wisoff HS: Estimation of intracranial pressure by CT scan in closed head trauma. Surg Neurol 18:212–215 1982

    • Search Google Scholar
    • Export Citation
  • 37.

    Teasdale GJennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81841974Teasdale G Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84 1974

    • Search Google Scholar
    • Export Citation
  • 38.

    Toutant SMKlauber MRMarshall LFet al: Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury. J Neurosurg 61:6916941984Toutant SM Klauber MR Marshall LF et al: Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury. J Neurosurg 61:691–694 1984

    • Search Google Scholar
    • Export Citation
  • 39.

    van Dongen KJBraakman RGelpke GJ: The prognostic value of computerized tomography in comatose head-injured patients. J Neurosurg 59:9519571983van Dongen KJ Braakman R Gelpke GJ: The prognostic value of computerized tomography in comatose head-injured patients. J Neurosurg 59:951–957 1983

    • Search Google Scholar
    • Export Citation
  • 40.

    Vilato RJLeBeau J: Le spasme des artès du cercle de Willis au cours des hémorragies traumatique ou anévrismales. Neurochirurgie 8:2172211962Vilato RJ LeBeau J: Le spasme des artès du cercle de Willis au cours des hémorragies traumatique ou anévrismales. Neurochirurgie 8:217–221 1962

    • Search Google Scholar
    • Export Citation
  • 41.

    Wilkins RHOdom GL: Intracranial arterial spasm associated with craniocerebral trauma. J Neurosurg 32:6266331970Wilkins RH Odom GL: Intracranial arterial spasm associated with craniocerebral trauma. J Neurosurg 32:626–633 1970

    • Search Google Scholar
    • Export Citation
  • 42.

    Zimmerman RABilaniuk LTGennarelli TA: Cranial computed tomography in diagnosis and management of acute head trauma. AJR 131:27341978Zimmerman RA Bilaniuk LT Gennarelli TA: Cranial computed tomography in diagnosis and management of acute head trauma. AJR 131:27–34 1978

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 991 970 31
Full Text Views 1883 472 5
PDF Downloads 171 73 4
EPUB Downloads 0 0 0
PubMed
Google Scholar