Prognostic value of CT in head injuries

Five hundred cases of acute head injury were analyzed on the basis of clinical severity, CT findings and outcome. Parenchymal lesions, which were the most important information in predicting the outcome, were classified into six categories: Isodensity WITHOUT Mass Effect, Isodensity WITH Mass Effect, High Density, High and Low Density Complex, Low Density, and Acute Diffuse Cerebral Swelling. Isodensity WITH Mass Effect was related to the worst outcome (59% mortality and 24% functional recovery). This finding was obtained 2 and a half hours following trauma and High and Low Density Complex eventually appeared in repeated CT. Epidural hematoma was associated with parenchumal lesions in only six (40%) out of 15 cases and acute subdural hematoma was accompanied by parenchymal lesions in 21 (84%) out of 25 cases. The remarkable differences in the outcome of those two extracerebral hematomas were entirely dependent on the associated parenchymal lesions. In the minor head injury group, parenchumal lesions were not rare (8.5%) in patients with a loss of consciousness even for a brief period. To follow the rapid dynamic changes in parenchymal lesions, the importance of repeated CT was emphasized. (author)