A case of delayed contusion intracerebral hematoma not detected by head CT 7 hours after injury

Abstract

[Introduction] Traumatic intracerebral hematoma can usually be confirmed by head CT scan soon after injury. We report a case of delayed traumatic intracerebral hematoma.

[Case] A 43-year-old man. He was driving a car when he collided with a truck. On arrival at our hospital, he was conscious and his vital signs were stable. A systemic examination revealed a right hemopneumothorax, right multiple rib fractures, left 4th rib fracture, right clavicle fracture, right acute subdural hematoma (ASDH), and traumatic subarachnoid hemorrhage (tSAH). The ASDH was approximately 5mm thick with no midline sift, so conservative treatment was recommended. A right thoracic drainage tube was inserted and the patient was admitted to the hospital. A head CT scan taken 7 hours after the injury showed no changes. 18 hours after the injury, the patient developed generalized convulsions, and a repeat head CT scan revealed an intracerebral hematoma in the right frontal lobe. The patient was discharged home on the 27th day after.

[Discussion and conclusion] Delayed development of contusive intracerebral hematomas that cannot be detected by head CT scans at the time of admission may occur. Repeated blood tests of the coagulation system and head CT scans are necessary.