1984 Volume 24 Issue 8 Pages 615-621
Four hundred two cases of blunt head injury admitted to Chikamori Hospital during the period from January 1980 through May 1983 were examined by plain craniogram and computerized tomography (CT) scan on admission. Skull fracture was observed in 82 (62%) of 132 child cases and in 162 (60%) of 270 adult cases. Intracranial complications were observed in 29 (22%) child cases and in 135 (50%) adult cases. They were classified according to CT findings as follows: 1) epidural hematoma, 2) subdural hematoma, 3) intracerebral hematoma and brain contusion, 4) subarachnoid hemorrhage, and 5) diffuse cerebral swelling or normal.
Parenchymal lesions, which constituted the most important factor in predicting outcome, were observed in 15 (52%) of 29 child cases and in 107 (79%) of 135 adult cases. Brain contusion was observed as a coup lesion in most child cases, but diffuse parenchymal lesion, which was related to rotational acceleration, was demonstrated in severely injured cases. In adult cases, brain contusion was observed in the frontal base and the temporal tip with sagittal impact, and in the bilateral frontal base and temporal lobes with lateral impact. So-called delayed traumatic intracerebral hematoma appeared in the frontal and temporal lobes. Extraparenchymal hematoma was found on the side of impact in child cases, whereas subdural hematoma in adults was more frequent on the contralateral side.
In conclusion, skull fracture shows the point, direction, and amount of impact, suggesting the mechanical background of the injury and predicting the parenchymal lesion as well as extraparenchymal hematoma.
