Early diagnosis of delayed posttraumatic intracerebral hematomas

Nine cases of delayed posttraumatic intracerebral hematomas (DTICH) were found retrospectively among 656 patients with closed head injuries admitted to the Hennepin County Medical Center in a 12-mth period. All cases had severe head injuries sustained with the head in motion. The interval from cranial injury to diagnosis of DTICH by computerized tomography (CT) varied from 8 hr to 13 days. Eight patients were comatose on admission, 3 had focal seizures, and 3 had focal findings. The diagnosis was made on repeat CT scans obtained because of the development of focal findings in 4 cases, lack of improvement in 4 cases, and general neurological deterioration in 1 case. Four patients had initially negative CT scans. Four demonstrated only extracerebral hematomas on initial CT scan. One patient showed intracerebral hematoma on the initial scan followed by new hematomas on repeat study. The cases presented are discussed in light of pertinent literature.