Near-infrared spectroscopic localization of intracranial hematomas

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✓ Near-infrared spectroscopy (NIRS) of the cerebral hemispheres, applied transcranially through the intact scalp and skull, was evaluated for its ability to detect the presence of an intracranial hematoma in 46 head-injured patients. In 40 patients intracranial hematomas (22 subdural, 10 epidural, eight intracerebral) were identified on computerized tomography (CT); in all 40 cases, NIRS demonstrated greater absorption of light at 760 nm on the side of the hematoma. The mean difference in optical density (OD) between the hemisphere with the hematoma and the normal hemisphere was 0.99 ± 0.30 for epidural hematomas, 0.87 ± 0.31 for subdural hematomas, but only 0.41 ± 0.11 for intracerebral hematomas. In 36 patients, the asymmetry in OD resolved after surgical evacuation of the hematoma or with spontaneous resorption of the hematoma. Four patients who developed postoperative or delayed hematomas exhibited persistence of the asymmetry in OD. Six patients had only diffuse injuries and exhibited only minor differences in OD between the hemispheres, similar to 10 patients in the control group with no head injury. It appears that NIRS is useful in the initial examination of the head-injured patient, as an adjunct to CT, and in following patients postoperatively in the intensive care unit.

Article Information

Address for Dr. Chance: Department of Biochemistry and Biophysics, University of Pennsylvania, Philadelphia, Pennsylvania.Address reprint requests to: Shankar P. Gopinath, M.D., Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030.

© AANS, except where prohibited by US copyright law.

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Figures

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    Diagram of the procedure used to measure the difference in optical density (ΔOD) between the hemispheres. The intensity of the unabsorbed or reflected light was measured by placing the near-infrared spectroscopy probe on each side of the head. The right and left values were similar in the control patients and the patients with diffuse injuries. In patients with intracranial hematomas, there was a marked reduction in the amount of unabsorbed light on the side of the hematoma.

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    Bar graph showing the mean difference in optical density (OD) in the four types of injuries examined. An asterisk indicates a significant difference (p < 0.05) in OD from the patients with diffuse brain injury (DBI). A cross indicates a significant difference (p < 0.05) in OD from the patients with intracerebral hematoma (ICH). SDH = subdural hematoma; EDH = epidural hematoma.

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    Scattergram showing the relationship between the difference in optical density (OD) and the thickness of the hematoma measured on computerized tomography scans in 32 patients with extracerebral hematomas (r = 0.45, p < 0.007).

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    Studies in a 20-year-old man admitted with an epidural hematoma in the right temporal region, which was surgically evacuated. Forty-eight hours later, the difference in optical density (ΔOD) was 0.94, highest in the left temporoparietal region on the side opposite the original hematoma. A contour map of the ΔOD was drawn (left), outlining the localized epidural hematoma which was found on the computerized tomography scan (right). Numbers denote brain areas studied.

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