Risk factors associated with delayed traumatic intraparenchymal hemorrhage

초록

PURPOSE : Delayed hemorrhage progression is one of the most common causes of neurologic deterioration after traumatic brain injury(TBI). We herein analyzed the risk factors related to the delayed hemorrhage progression in traumatic intraparenchymal hemorrhage(IPH) or cerebral contusion. MATERIALS AND METHODS : A retrospective investigation was performed on selected 105 TBI patients with IPH or cerebral contusion associated with other types of intracranial hematoma during the last 2 years. Clinical features regarding neurologic grade, time intervals from the initial injury to delayed traumatic IPH, and initial computed tomographic(CT) findings including midline shifting, cisternal effacement, and location were studied. For majority of patients, follow-up CT scans were checked at 8, 24, 72 hours after trauma, except patients with sudden neurologic deterioration. RESULTS : Among 105 patients with traumatic IPH, 49 patients showed hemorrhage progression. Traumatic subarachnoid hemorrhage (SAH) is the most commonly accompanied hemorrhage with IPH patients. The most frequent location of hemorrhage progression was the frontal lobe, and time interval for identifying delayed IPH was within the first 8 hours in 31 patients(63%). There was statistically significant correlation between IPH progression and presence of SAH(p=0.03) and effacement of cisterns(p<0.0001). CONCLUSION : We should closely observe traumatic IPH or cerebral contusion patients who have initial CT findings of traumatic SAH and cisternal effacement. It is primarily because hemorrhage progression is very likely to occur in this patient group. Although we could not draw conclusion regarding time for CT surveillance, bed-side clinical monitoring is of utmost importance.