A prognostic appraisal in acute stage of severe head injury

207 cases (total group) of severely head-injured, who showed a loweing level of consciousness less than ''not obeying commands'' and ''not uttering any reconizable words'', were classified into the following 8 types according to their CT findings.FOut of the total group, there were 147 cases (study group) who had precise clinical recordings with the sequential scores of GCS and the corresponding serial CT examination in the acute stage.FThe study group was divided into two groups according to the survey of their outcome. Group A who had apparently good outcome after surgical and medical treatment. They showed no relation to the GCS score in the acute stage. On the other hand, the cases of Group B had various grades of outcomes.FClinical implication of the disappearance of the quadrigeminal and the ambient cisterns were also investigated. In Group A, the disappearance of these cisterns was noted in 10 cases within 6 hours after the accident and only one case died (10%). 3 cases showed it in the period of 7 to 24 hours after the accident and all recovered well. in Group B, the disappearance of the cisterns was noted in 43 cases within 6 hours after the accident and 35 cases (81%) were dead. 19 cases showed it in 7 to 24 hours after the accident and 15 cases were dead (78%). 15 cases showed it in 24 or more hours later and 4 cases (27%) were dead.FAs a conclusion for this study, a combined judgement of repeated CT and sequential evaluation of the GCS for severe head-injured cases may lead us to a more accurate prognostic appraisal in the very early acute stage, at least, at the time of 24 hours after the accident. And the disappearance of the quadrigeminal and the ambient cisterns may have different values between Group A and B, and also according to the timing of it's appearance. (J.P.N.)