Details
Category: Volume 07 Issue 12 December 2019
Hits: 956

Title: Spectrum of Computerized Tomography (CT) Findings in Craniocerebral Trauma- A Clinicoradiological Evaluation

Authors: Dr Shyna Narang, Dr Pradeep Bansal, Dr BB Thukral, Dr Mukta Mital

 DOI: https://dx.doi.org/10.18535/jmscr/v7i12.100

Abstract

Objective: To assess the spectrum of computerized tomography (CT) findings in craniocerebral trauma by clinico-radiological evaluation.

Methods: This was a cross sectional study. After taking informed consent, the detailed clinical history was taken (including age, sex, date of injury, mode of injury and duration of LOC). General and systemic examination including detailed CNS examination (which included GCS score, higher mental function status, cranial nerve examination, motor and sensory function, meningeal signs) was done as per structured Performa. The patients presented with head injury referred for computed tomography of the head. After initial resuscitation, severity of the cranio-cerebral injury was graded with the help of "Glasgow Coma Scale" (GCS).

Results: About one third of patients were >50 years of age (33%). Majority of patients were males (76%). RTA was the most common mode of injury (56%). The commonest type of fractures associated with head injury were linear fractures (73%). Death was reported among 25 (25.0%) patients. Skull fracture were the commonest of all lesions accounting for 63.0% followed by contusions of brain (44.0%).Midline shift, contusion, Extradural Hematoma, Intra Cerebral Hematoma were significantly (p<0.05) associated with mortality.Patients with GCS score of <8 had a mortality of 54.5%. .There was significant (p<0.001) association of GCS with mortality.

Conclusion: Head injury higher among patients above 30 years of age. RTA was found to be most common cause of head injury in this study. Skull fracture was the commonest of all lesions accounting for 63.0% followed by contusions of brain (44.0%).

Keywords: Head injury, Road traffic accidents, Mortality, subdural hematoma, extradural hematoma, subarachnoid haemorrhage, intracerebral hematoma.

References

  1. Vadhanan S, Bhatoe HS. Understanding Head injury :A prelude. Indian Journal of Neurotrauma 2010;7:101-06.
  2. Butcher I, McHugh GS, Lu J, Steyerberg EW, Hernández AV, Mushkudiani N, Maas AI, Marmarou A, Murray GD. Prognostic value of cause of injury in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007;24(2):281-6.
  3. Fearnside MR, Cook RJ, McDougall P, McNeil RJ. The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables. Br J Neurosurg. 1993;7(3):267-79.
  4. MacDorman MF, Minino AM, Strobino DM, Guyer B. Annual summary of vital statistics–2001. Pediatrics. 2002;110(6):1037–52.
  5. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81-4.
  6. Farahvar A, Gerber LM, Chiu YL, Carney N, Härtl R, Ghajar J. Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring. J Neurosurg. 2012;117(4):729-34.
  7. Roberts I, Yates D, Sandercock P, Farrell B, Wasserberg J, Lomas G, Cottingham R, et al. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial. Lancet. 2004;364(9442):1321-8.
  8. Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J, McHugh GS, et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med. 2008;5(8):e165.
  9. Stiell IG, Clement CM, Rowe BH, Schull MJ, Brison R, Cass D, Eisenhauer MA, et al. Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury. JAMA. 2005;294(12):1511-8.
  10. Masson F, Thicoipe M, Aye P, Mokni T, Senjean P, Schmitt V, Dessalles PH, Cazaugade M, Labadens P; Aquitaine Group for Severe Brain Injuries Study. Epidemiology of severe brain injuries: a prospective population-based study. J Trauma. 2001;51(3):481-9.
  11. Wintermark M, van Melle G, Schnyder P, Revelly JP, Porchet F, Regli L, et al. Admission perfusion CT: Prognostic value in patients with severe head trauma. Radiology. 2004;232(1):211‑
  12. Puvanachandra P, Hyder AA. The burden of traumatic brain injury in Asia: a call for research. Pak J Neurol Sci. 2009;4(1):27-32.
  13. Mutch CA, Talbott JF, Gean A. Imaging Evaluation of Acute Traumatic Brain Injury. Neurosurg Clin N Am. 2016;27(4):409-39.
  14. Rastogi D, Meena S, Sharma V, Singh GK. Epidemiology of patients admitted to a major trauma centre in Northern India. Chin J Traumatol. 2014;17(2):103-7.88
  15. Zimmerman RA, Bilaniuk LT, Genneralli T, Bruce D, Dolinskas C, Uzzell B. Cranial computed tomography in the diagnosis and management of acute head trauma. AJR Am J Roentgenol. 1978;131(1):27-34.
  16. Holmes JF, Hendey GW, Oman JA, Norton VC, Lazarenko G, Ross SE, Hoffman JR, Mower WR; NEXUS group. Epidemiology of blunt head injury victims undergoing ED cranial computed tomographic scanning. Am J Emerg Med. 2006;24(2):167-73.
  17. Saboori M, Ahmadi J, Farajzadegan Z. Indications for brain CT scan in patients with minor head injury. Clinical Neurology and Neurosurgery. 2007;109(5):399-405.
  18. Ogunseyinde AO, Obajimi MO, Ogundare SM. Radiological evaluation of head trauma by computed tomography in Ibadan, Nigeria. West Ar J Med. 1999;18(1):33-8.
  19. Khan F, Baguley IJ, Cameron ID. Rehabilitation after traumatic head injury. Med J Aust. 2003;178(6):290-3.
  20. Bindu TS, Vyas S, Khandelwal N, Bhatia V, Dhandapani S, Kumar A, et al. Role of whole‑brain computed tomography perfusion in head injury patients to predict outcome. Indian J Radiol Imaging. 2017;27(3):268-73.
  21. Igun GO. Predictive indices in traumatic intracranial haematomas. East Afr Med J. 2000;77(1):9-12.
  22. Lloyd DA, Carty H, Patterson M, Butcher CK, Roe D. Predictive value of skull radiography for intracranial injury in children with blunt head injury. Lancet. 1997;349(9055):821-4.
  23. Prasad et al. Role of Computerized Tomography in Craniocerebral Trauma. JMSCR. 2017; 5(3):18540-6.
  24. Dambatta AH, Sidi M. Computed tomographic evaluation of pediatric head injury in Aminu Kano Teaching Hospital, Kano, Nigeria. Niger J Basic Clin Sci. 2019;16(1):5-8.
  25. Tomar SS, Bhargava A, Reddy N. Significance of computed tomography scans in head injury. Open Journal of Clinical Diagnostics.2013;3(3):109-14.
  26. Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, McKnight RD, Verbeek R, Brison R, Cass D, Eisenhauer ME, Greenberg G, Worthington J. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357(9266):1391-6.
  27. Dublin AB, French BN, Rennick JM. Computed Tomography in head trauma. Radiology. 1977;122: 365-9.
  28. Cooper PR. Head Injury: Post traumatic intracranial mass lesions. 2nd Ed. Baltimore MD: Williams and Wilkins; 1987: pp 108-24.
  29. Bricolo AP, Pasut LM. Extradural hematoma; toward zero mortality. Neurosurgery. 1984;14(1):8-12.
  30. Smith HK, Miller JD. The danger of an ultra early computed tomographic scan in a patient with an evolving acute epidural hematoma. Neurosurgery. 1991;29(2):258-60.
  31. Stuart G, Yelland JDN, Balderson G. 3000 head injuries: a prospective study of patients admitted to Brisbane neurosurgical units. J Clin Neurosci. 1998;5(4):402-5.

Corresponding Author

Dr Pradeep Bansal

Associate Professor, Department of Radiodiagnosis, Subharti Medical College, Swami Vivekanand Subharti University, Meerut (U.P)