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Cerebral Hemisphere Swelling in Severe Head Injury Patients

  • Conference paper
Proceedings of the 8th European Congress of Neurosurgery Barcelona, September 6–11, 1987

Part of the book series: Acta Neurochirurgica Supplementum 42 ((NEUROCHIRURGICA,volume 42))

Summary

The clinical course and the intracranial pressure (ICP) changes in 66 severe head injury patients presenting bulk enlargement of one cerebral hemisphere within a few hours of trauma have been analyzed. These patients represent 11% of a series of 589 severe head injury cases studied with computerized tomography (CT).

Cerebral hemisphere swelling, which was associated with an ipsilateral ubdural haematoma of variable extent in 58 patients (88%), or a large epidural haematoma in 5 patients (7%), and occurred as an isolated lesion in 3 patients (4%), carried the highest incidence of uncontrollable intracranial hypertension, the highest mortality rate and the shortest survival period after trauma in the authors’ severe head injury series.

The high incidence of arterial hypotension and/or hypoxaemia at admission (48% of cases), and the seventy of clinical presentation (82% of patients scored 5 patients or less in the Glasgow Coma Scale, 77% had uni- or bilateral mydriasis and 82% initial ICP above normal limits) correlated with the very poor final outcome (85% mortality). Only one of the 12 patients with normal initial ICP continued to have low pressure throughout the course. High dose thiopental failed to control severe intracranial hypertension in 29 patients (44%) who had a fulminant, malignant course. A transient decrease in ICP elevation was achieved in 17 patients (26%) and a definitive control in 12 patients (18%), among them the 10 survivors in this series. In the authors experience once ICP is controlled, and unless haemodynamic instability compells action to the contrary, barbiturate should not be discontinued until a control CT scan shows complete disappearance of the mass effect.

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Authors and Affiliations

  1. Service of Neurosurgery and Intensive Care Unit, Hospital 1° de Octubre and Faculty of Medicine, Madrid, Spain

    R. Sarabia, R. D. Lobato, J. J. Rivas, F. Cordobés, J. Rubio, A. Cabrera, P. Gomez, M. J. Muñoz & A. Madera

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  1. R. Sarabia
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  2. R. D. Lobato
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  3. J. J. Rivas
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  4. F. Cordobés
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  5. J. Rubio
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  6. A. Cabrera
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  7. P. Gomez
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  8. M. J. Muñoz
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  9. A. Madera
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Editor information

Editors and Affiliations

  1. Servicio de Neurocirugia, Hospital de Bellvitge, University of Barcelona, Spain

    Fabian Isamat

  2. Newport, Dyfed, UK

    Antony Jefferson

  3. Neurochirurgische Universitätsklinik, Homburg/Saar, Federal Republic of Germany

    Friedrich Loew

  4. Department of Neurological Surgery, Institute of Neurology, The National Hospital, London, UK

    Lindsay Symon TD, FRCS

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© 1988 Springer-Verlag/Wien

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Sarabia, R. et al. (1988). Cerebral Hemisphere Swelling in Severe Head Injury Patients. In: Isamat, F., Jefferson, A., Loew, F., Symon, L. (eds) Proceedings of the 8th European Congress of Neurosurgery Barcelona, September 6–11, 1987. Acta Neurochirurgica Supplementum 42, vol 42. Springer, Vienna. https://doi.org/10.1007/978-3-7091-8975-7_9

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  • DOI: https://doi.org/10.1007/978-3-7091-8975-7_9

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-8977-1

  • Online ISBN: 978-3-7091-8975-7

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