Traumatic intracerebral hematomas were classified by initial CT scan performed within 4 to 6 hours after injury and by repeated CT scan follow-up to establish correct treatment methods by the findings obtained.
Traumatic hematomas were classified into the following three types : primary hematoma resulting from traumatic vascular lesion; hematoma within contusion resulting from hemorrhagic contusion; and contusional hematoma formed by an entirely different mechanism which is not yet clear. Both contusional hematoma and hematoma within contusion are delayed traumatic intracerebral hematomas.
Of the 34 cases (31 patients), primary hematoma produced by traumatic damage of the intracerebral vessels could be diagnosed by oval or round high density areas with regular low density zone on initial CT scan in 20%.
Hematoma within contusion, produced by fusion of the hemorrhagic contusion on the second to 7th day after trauma, showing low density areas or several hemorrhagic spots in the low density area on initial CT scan was noted in 30%. The mechanism may be similar to the Scheinker theory.
Contusional hematoma, produced on the second to 7th day after injury or after removal of subdural or epidural hematoma by compressive craniectomy, showing normal density of the brain on the initial CT scan was noted in 50%. The mechanism is quite different from the Scheinker theory and may be related to hyperoxydation caused by local disturbance of cerebral circulation.
Classification of traumatic intracerebral hematoma into these three types by repeated CT scan is thus thought to be useful clinically to establish correct diagnosis and to obtain good results by enabling adequate treatment.
