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Abstract
Traumatic brain injury (TBI) continues to be an enormous public health problem, even with modern medicine in the 21st century. Almost 100% of persons with severe head injury and as many as two thirds of those with moderate head injury will be permanently disabled and will not return to their premorbid level of function. Traumatic intracerebral hematomas are now more frequently encountered than in the past. They account for a percentage ranging from 25 to 42% of all head injuries admitted to hospitals in the Western countries. In Egypt, we do not have an accurate recording and filing system
for calculating their percentage. Detection of such hematomas however, is becoming more frequently encountered especially with the wide prevalence and use of the Computerized Tomography Scans.
This study was done on 50 cases having traumatic intracerebral hematomas. All patients were admitted to the Menoufiya University Hospital and were subjected to clinical and radiological evaluation. Also treatment whether medical or surgical was instituted. In this study, patients’ age were in the age group from 8 to 65 years with the mean age was 35.2 years; the highest % were present in the 4th&3rd decades as they are more prone to accidents, with significant relation between patient’s age and outcome where the old ages were associated with poor outcome. Among the studied group 75% were males, 25% were females, as males were more prone to
accidents and blows on the head than females. Road traffic accidents were the main causes of the hematoma formation accounting for 62% of
the cases. The clinical evaluation of these patients revealed that disturbance of the conscious level was the most common symptom (100%), and severely comatosed patients either had deep basal hematomas or huge lobar hematomas causing midline shift while patients presenting with mild to moderate disturbance of the conscious level, usually have mild to moderate sized hematomas not causing considerable or minimal midline shift. Patients with severe decrease in the IGCS showed significant higher rate of death. CT scan revealed in all the cases the site of the hematoma, its size and the mass effect it exerts where the most common site of the hematoma among the studied group was Parietal hematoma (38%),
while the least was occipital one (6%),the volume of hematoma was >/=30cc in (46%) & <30cc in
(54%), mostly there was no midline shift in (64%) of cases and associated injuries in (20%) of them. Patients with hematoma volume >/=30cc showed significant higher prevalence of poor outcome Plain X-Ray skull showed in some cases linear fractures and in one case a compound depressed fracture. Medical treatment of these patients was directed towards stabilizing the cardiopulmonary circulation, reducing the high intracranial tension together with prevention of possible complications. Surgical treatment (craniotomy, irrigation, suction, hemostasis) was done for (34%) of cases who had disturbance of the conscious level with CT brain showing ICH volume or= 30 cc and causing mass effect