Acute Traumatic Intraparenchymal Hemorrhage: Risk Factors for Progression in the Early Post-injury Period

Abstract

A large proportion of IPHs progress in the acute post-injury period. IPHs associated with subarachnoid hemorrhage, a subdural hematoma, or large initial size should be monitored carefully for progression with repeat head CT imaging. Effacement of cisterns on the initial head CT scan was strongly predictive of failure of nonoperative management, thereby leading to surgical evacuation. These findings should be important factors in the understanding and management of IPH.

Traumatic Intracranial Hematomas: Prognostic Value of Contrast Extravasation

“…32 Initial hematoma volume 2,3,6,9,42,43 and midline shift 35,36,[42][43][44] are potent predictors of intracranial hematoma progression and poor outcome but have also been shown to be collinear. 42,45 Contrast extravasation could, therefore, potentially offer additional information not provided by NCCT, though this would need to be assessed by directly comparing NCCT with CTA/PCCT.…”

“…It has previously been shown in large trauma studies that small traumatic intracerebral hematomas are less at risk of expansion and show a smaller magnitude of expansion than larger hematomas. 2,3,6,7 We did not specifically examine the role of extravasation in individual hematoma subtypes due to sample size restrictions. The relationship of CE and vasogenic edema prediction was also not evaluated but is known to be an important cause of secondary injury 56 and seems to be associated with the presence of contrast extravasation.…”

“…In the presence of acute intracranial hematomas, management options include emergent surgical evacuation or close observation including imaging surveillance. Sixteen percent to 65% of the patients in the latter group will show hematoma progression, [2][3][4][5][6][7][8] and 13%-19% will require delayed surgery [2][3][4] ; hematoma expansion is also associated with increased morbidity and mortality. 6,7 Despite previous identification of multiple NCCT predictors of hematoma expansion, 2,3,5,6,9 this modality remains inherently limited for the detection of active hemorrhage.…”

Clinical Trials in Traumatic Brain Injury: Past Experience and Current Developments

“…4 Contusional brain injury is different from diffuse axonal injury, with a much larger component of inflammatory response, and this is often characterized by lesion progression. Approximately 25 to 45% of cerebral contusions will enlarge significantly, 6,7 and even higher occurrences are reported if the initial computed tomographic scan is performed within 2 h of injury. 8 The more frequent use of anticoagulant medication and platelet aggregation inhibitors in older patients may further increase the risk of lesion progression.…”

Prognostic value of the Marshall computed tomography classification for traumatic subarachnoid hemorrhage

“…Whether the relationship of tSAH with poor outcome in TBI is merely an epiphenomenon or the result of some direct cause is unclear. Some investigators believe that tSAH is merely a part of an otherwise severe TBI [12], while others argue that it directly causes additional independent adverse reactions such as vasospasm and ischemia [13]. Chieregato et al [14] evaluated 141 patients with a CT diagnosis of tSAH to determine whether the amount of subarachnoid blood and the presence of associated parenchymal damage are powerful independent factors associated with poor outcomes.…”