Delayed Posttraumatic Hemorrhage From (Stroke. 1995;26: ) © 1995 American Heart Association, Inc. Present by R2 Meng-Ting Wu

INTRODUCTION  Delayed posttraumatic hemorrhage (DPTH) is one of the causes of intracerebral hemorrhage (ICH). Most of the published series were reported before the advent of CT. Clinical characteristics and CT findings are described.

Subjects and Methods  Ten cases of CT-proven DPTH from a series of 216 patients (age range, 15 to 50 years) with ICH were evaluated.  Previous CT scans performed in the first 6 hours after head injury were normal in all patients.  Cerebral angiography showed no evidence of vascular disorders in any patient.

Results  DPTH was the fourth most common cause of ICH in our series. (after arterial hypertension, vascular malformations, and alcoholism)  The symptom-free interval after head injury ranged from 1 to 15 days.  Most hematomas were located deep in the hemisphere and were of small or medium size. Clinical course was good in the majority of cases; none of the patients died, and there was no recurrence.

Discussion

 The initial CT scan should be performed within the first 6 hours after the head injury and should show no signs of ICH.

Discussion  Fukamachi-- posttraumatic ICH may be classified into four types:  type I, hematomas visible on the initial CT scan;  type II, small or medium hematomas that progressively increase in size;  type III, hematomas developing in sites where the initial CT scan shows no hemorrhagic lesion;  type IV, hematomas forming in areas of contusion where the initial CT scan showed a "pepper and salt" image (areas of high density and isodensity).

Discussion  the symptom-free interval between injury and appearance of signs and symptoms varies between 24 hours and several weeks, or even months.  In our series, the interval ranged from 1 to 15 days, with an average of 5±5.23 days.

Discussion  The pathogenesis of DPTH has not been definitively established.

Discussion  The most important signs were appearance of a focal neurological deficit, slight impairment on the Glasgow Outcome Scale (drowsiness in one patient), and epileptic seizures in one patient.

Discussion  There were no deaths.  This may be due to our patients' relative youth, the absence of other concurrent intracranial bleeding or skull fracture, and the facts that none of the patients required neurosurgery because of the head injury and that none had coagulation disorders

Conclusion  No coagulation disorders or previous vascular abnormalities were detected.  None of our patients presented any other type of ICH or required neurosurgery.  Most head injuries causing DPTH are of low intensity, and initial clinical signs are mild.  Most DPTH are located deep in the hemispheres and are of small or medium size.  Prognosis in the short and long term is good.

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