Limitation of admission CT in acute head injury

We experienced three autopsy cases with acute head injury in which developing fatal intracranial lesions could not be predicted by the initial admission CT scans. We studied these cases in detail. From the studies of these cases, the following conclusions were drawn. First, in some patients with acute head injury, dynamic changes of the intracranial lesions cannot be predicted only by the admission CT scans. Secondly, cerebral angiography may be useful in prediction of the changes in such cases. And lastly, we have an impression that surgical decompression may contribute to development or enlargement of another intracranial hematoma. Furthermore, the literature was reviewed in regard to the traumatic intracerebral hematoma developed following removal of the extradural hematoma, the cerebellar contusion and the interhemispheric subdural hematoma. (J.P.N.)