Delayed or enlarged lesioins in head injury are potentially preventable events which worsen overall prognosis. We investigated the incidence and risk factors of these lesions in 240 head injured patients examined by repeated computerized
tomographic
(CT) scans from January 1989 to December 1990.
Overall, delayed or enlarged lesions were found in 95 patients (39.6%) Intracerebral hemorhage was the most common lesion (37 cases) : Subdural (17 cases), epildural hematoma (16 cases), subdural hygroma (15 cases), cerebral swelling (6 cses),
hydrocephalus (4 cases), and infarction (2 cases) followed in that order.
These lesions occurred 3 days of initial scan in 64 patients (67.4%). Predictors were a low Glasgow Coma Scale score, abnormal pu;illary response, low or high blood pressure, hypoxia and previous infusion of large amounts of mannitol. Acute
subdural
hematoma was the most common initial lesion, heralding delayed or enlarged lesions in 50% of cases. Intracerebral hemtomas or contusion followed by next most common lesions. Incidence of delayed or enlarged lesions also differed according to
therapy :
decompressive craniectomy with these lesions in 82.8%. Mortality rate in patients who had delayed or enlarged lesions (35.5%) was 5.6 times higher than patient who did not have such lesions (6.3%)
Delayed or enlarged lesions are relatively common. Patients with risk factors for dleayed or enlaryged lesions should be adequately monitored before overt clinical deterioration.
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