Clinical Analysis of Diffuse Cerebral Swelling following Head Injuries

Akihito SAITO, Nobumasa KUWANA, Yasuhiko MOCHIMATSU, Naoki TANAKA, Toshiyuki YOSHIDA
1986 Neurologia medico-chirurgica  
Twenty-two cases of diffuse cerebral swelling (DCS) following head injuries , rated 14 or less on the Glasgow Coma Scale (GCS) at the time of admission, were investigated. In nine cases the GCS was greater than 8, and in the remaining cases the GCS was 8 or less. This study focused on clinical features, computed tomography (CT) findings and the patient outcomes. The patients studied were classified into three age groups: the child group; aged 15 or under (9 cases), the adolescent group; aged 16
more » ... cent group; aged 16 to 19 (7 cases), and the adult group; aged 20 or older (6 cases). The frequency of skull fracture was significantly higher in the adult group compared to the other two groups. Regarding the site of the impact, frontal impact was most common in the child and adolescent groups, but this tendency was not evident in the adult group. Diagnosis of DCS on CT was made within 6 hours following the injury in all cases. Initial CT findings of DCS were classified into 3 types: Type I; slightly compressed ventricular system without narrowing of the perimesencephalic (PMC) cistern (12 cases), Type II; moderately compressed ventricular system with narrowing of the PMC cistern (4 cases), and Type III; markedly compressed ventricular system with obliteration of the PMC cistern (6 cases). The average age of the cases belonging to Types I, II, and III was 11.0, 18.0, and 34.5, respectively. There were no deaths among Type I cases. On the other hand, all Type III cases died. As other CT findings associated with DCS , subarachnoid hemorrhage in the basal cisterns and intraventricular hemorrhage were critical findings which always signified primary brain stem injury. This study indicates that the degree of DCS on CT in children was far less than that in adults , and also the prognosis for children was obviously better than that for adults. It is the authors' impression that the differences between the two groups are based on two factors, i .e., strength and direction of impact.
doi:10.2176/nmc.26.296 pmid:2429206 fatcat:ggxuk66gnbd5doprvgnnlbrtza