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traumatic_intracranial_hemorrhage

Traumatic intracranial hemorrhage

Traumatic intracranial hemorrhage its studied within neurotraumatology

Types

Intracranial epidural hematoma

Traumatic subdural hematoma

Traumatic intracerebral hemorrhage

Traumatic parturitional intracranial hemorrhage

Traumatic posterior fossa hematoma….

A definitive consensus on the standardization of practice of a routine repeat head CT (RHCT) scan in patients with traumatic intracranial hemorrhage is lacking.

In a 3-year prospective cohort analysis of patients aged 18 years and older, without antiplatelet or anticoagulation therapy, presenting to a level 1 trauma center with intracranial hemorrhage on initial head CT and a follow-up RHCT. Neurosurgical intervention was defined by craniotomy/craniectomy. Neurologic deterioration was defined as altered mental status, focal neurologic deficits, and/or pupillary changes.

A total of 1,129 patients were included. Routine RHCT was performed in 1,099 patients. The progression rate was 19.7% (216 of 1,099), with subsequent neurosurgical intervention in 4 patients. Four patients had an abnormal neurologic examination, with a Glasgow Coma Scale (GCS) of ≤8 requiring intubation. Thirty patients had an RHCT secondary to neurologic deterioration; 53% (16 of 30) had progression on RHCT, of which 75% (12 of 16) required neurosurgical intervention. There was an association between deterioration in neurologic examination and need for neurosurgical intervention (odds ratio 3.98; 95% CI 1.7 to 9.1). The negative predictive value of a deteriorating neurologic examination in predicting the need for neurosurgical intervention was 100% in patients with GCS > 8.

Routine repeat head CT scan is not warranted in patients with normal neurologic examination. Routine repeat head CT scan does not supplement the need for neurologic examination for determining management in patients with traumatic brain injury 1).

Management

Emergency department (ED) management of mild traumatic brain injury (TBI) with any form of traumatic intracranial hemorrhage (ICH) is variable.

Since 2000, center's standard practice has been to obtain a repeat head computed tomography (CT) at least 6 hours after initial imaging. Patients are eligible for discharge if clinical and CT findings are stable. Whether this practice is safe is unknown 2).

Complications

No evidence is available on the risks of neurologically asymptomatic minimal traumatic intracranial hemorrhage (mTIH) in patients with traumatic brain injury (TBI) for posttraumatic headache (PTH).

Moderate-to-severe PTH can be expected after TBI in patients with mTIH and posttraumatic seizure. PTH occurs more frequently in patients with mTIH than in those without mTIH.

Progressive hemorrhagic injury (PHI)

Intracranial hemorrhage (ICH) after traumatic brain injury (TBI) commonly increases in size and coagulopathy has been implicated in such progression.

A meta-analysis to assess their relationship. Cochrane library, PubMed, and EMBASE were searched for literatures. Pooled effect sizes and 95% confidential intervals (CIs) were calculated using random-effects model. We included six studies, involving 1700 participants with 540 progressive hemorrhagic injuries (PHIs). Our findings indicate that PT, D-dimer level, and INR value are positively associated with the risk of PHI. Higher level of PLT and Fg seemed to suggest a lower risk of PHI. Among these parameters, higher D-dimer level and INR value would possess more powerful strength in predicting PHI. 3).

1)
Joseph B, Aziz H, Pandit V, Kulvatunyou N, Hashmi A, Tang A, Sadoun M, O'Keeffe T, Vercruysse G, Green DJ, Friese RS, Rhee P. A three-year prospective study of repeat head computed tomography in patients with traumatic brain injury. J Am Coll Surg. 2014 Jul;219(1):45-51. doi: 10.1016/j.jamcollsurg.2013.12.062. Epub 2014 Mar 1. PubMed PMID: 24745622.
2)
Kreitzer N, Lyons MS, Hart K, Lindsell CJ, Chung S, Yick A, Bonomo J. Repeat neuroimaging of mild traumatic brain-injured patients with acute traumatic intracranial hemorrhage: clinical outcomes and radiographic features. Acad Emerg Med. 2014 Oct;21(10):1083-91. doi: 10.1111/acem.12479. PubMed PMID: 25308130.
3)
Zhang D, Gong S, Jin H, Wang J, Sheng P, Zou W, Dong Y, Hou L. Coagulation Parameters and Risk of Progressive Hemorrhagic Injury after Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Biomed Res Int. 2015;2015:261825. Epub 2015 Sep 17. PubMed PMID: 26457298.
traumatic_intracranial_hemorrhage.txt · Last modified: 2019/06/14 19:12 by administrador