Intracerebral Hematoma

Intracerebral hematoma after head injury represents a continuum of cerebral contusion consisting of predominantly disrupted, edematous brain tissue with a small amount of blood, to large, confluent hematomas within a contused cerebral hemisphere. Indications for open surgical evacuation by craniotomy vary between surgeons but include:

1. Local mass effect with associated focal neurological deficit. Because the deficit may be related to contusion of surrounding brain, hematoma evacuation will not always result in improvement.

2. Raised intracranial pressure.

3. Persistent seizures corresponding to the location of the hematoma.

4. Prevention of secondary injury cascade from thrombin and other hematoma products.

Figure 5. A) Acute and chronic subdural hematomas. Axial computed tomography demonstrates hypodense, subdural fluid collections in the frontal region and a hyperdense collection in the right occipital region. This infant also had long bone fractures and retinal hemorrhages, suggesting a diagnosis of nonaccidental trauma. The frontal collections represent proteinaceous subdural hygromas and the occipital collection represents an acute subdural hematoma. MR imaging is more sensitive in detecting this type of injury. B) Acute and chronic subdural hematomas. T1-weighted, axial MR imaging demonstrates mixed signal and presumably mixed age blood and proteinaceous fluid collections in the subdural space.

Figure 5. A) Acute and chronic subdural hematomas. Axial computed tomography demonstrates hypodense, subdural fluid collections in the frontal region and a hyperdense collection in the right occipital region. This infant also had long bone fractures and retinal hemorrhages, suggesting a diagnosis of nonaccidental trauma. The frontal collections represent proteinaceous subdural hygromas and the occipital collection represents an acute subdural hematoma. MR imaging is more sensitive in detecting this type of injury. B) Acute and chronic subdural hematomas. T1-weighted, axial MR imaging demonstrates mixed signal and presumably mixed age blood and proteinaceous fluid collections in the subdural space.

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