Posttraumatic Intracerebral Hematoma

Intracerebral haemorrhage in closed head injury

“…Thomson (1963) depends mainly on the late arterial lateral film for differentiation. In agreement with others (Lofstrom, Webster, and Gurdjian, 1955;Hancock, 1961;Larson and Mittelpunkt, 1965), in some temporal lobe haematomas there is no correlation between the size of the clot and the degree of shift of the anterior cerebral artery. Therefore the degree of such shift should not influence the decision to operate if this is indicated by the clinical and other angiographic data (Figs.…”

“…The results in the present series compare favourably with other reports in some of which mortality varies from 25 to 50 per cent (Browder and Turney, 1942; Gurdjian and Webster, 1958; Larson and Mittelpunkt, 1965). No claim is made that certain of the patients in this series might not have survived without their operation, but there is little doubt that operation was a life-saving measure in some, and it is likely that the surgical evacuation of the clot led to a more rapid and a more complete recovery in others.…”

“…The incidence of an associated surface clot in this series is significantly lower than that reported in the literature (Browder and Turney, 1942;McLaurin and McBride, 1956;Larson and Mittelpunkt, 1965;Phillips and Azariah, 1965 haematoma but was present in 5 in the present tumour (Thomson, 1963;Harries, 1969). Precise series.…”

“…Even less common are reports of solitary intracerebral haematomas after closed head injury. Although some reports suggest an incidence of massive intracerebral haemorrhage in about I per cent of head injuries (Echlin, Sordillo, and Garvey, 1956;Gurdjian and Webster, 1958), others (McLaurin and McBride, 1956;Larson and Mittelpunkt, 1965) are of the opinion that the lesion is more common. Of the 21 cases in the present series, 18 had solitary lesions within the brain substance.…”

“…A small craniotomy under general anaesthesia with controlled ventilation enables evacuation of the clot under direct vision (McLaurin and McBride, 1956; Larson and Mittelpunkt, 1965; Phillips and Azariah, I 965), using a transcortical incision remote from the motor area. The advantages are: inspection of a large area of the brain surface, better choice of the site of the incision through the cortex, less brain retraction, complete evacuation of the solid part of the haematoma, thorough inspection of the wall of the cavity, thorough haemostatis, and more adequate surgical decompression if this is necessary.…”