抄録
Eighteen patients of delayed traumatic intracerebral hematoma (DTICH) were experienced among 268 head injured patients seen over a 32 month period. The interval from the admission computerized tomography (CT) to CT diagnosis of DTICH varied from eight hours to 13 days. All patients were comatose on admission. Three had acute epidural hematoma (EDH), one brain prolapse, and 17 exhibited acute subdural hematoma. Thirteen patients, including three EDH cases received evacuation of hematoma and craniectomy (external decompression) while the remaining five were not operated on but were treated with barbiturates to prevent or reduce intracranial hypertension.
All the patients had laboratory studies for disseminated intravascular coagulation (DIC) over 7 days. The parameters were platelet counts (PC), active partial thromboplastin time (APTT), prothrombin time (PT), serum fibrinogen, fibrin degradation products (FDP), and protamine sulphate test (PS-test). All the patients showed severe hypofibrinogenemia during the first 24 hours which recovered abruptly to beyond the normal range within the next 24 hours. Hyperfibrinogenemia continued for at least seven days after trauma. PC's were almost normal on admission but decreased promptly within 24 hours and remained low for the following four days. All cases revealed low or borderline level PT throughout the monitoring period, while APTT revealed no abnormalities. These and serum FDP and PS-tests revealed no statistically significant difference between DTICH cases and controls.
DTICH was found either in coup or contre-coup lesions along the extension line of impact, and the initial CT demonstrated abnormal densities in 14 (low, or salt & pepper) and normal in four. It was concluded that DIC was not responsible for the development of DTICH while primary direct contusion was a major factor in its evolution.
