Diffuse cerebral swelling.

By means of computerized tomography (CT) diffuse cerebral swelling has been shown to exist in the early stages of severe acute head injury. But, to our knowledge, it has not been intensively studied in blunt head trauma. The purpose of this study is to elucidate the clinical features, pathogenesis and outcome of the patients with diffuse cerebral swelling occurring in the case of blunt head trauma. During the period of 5 years (April, 1977•`March, 1982) 288 patients with severe head injuries rated 8 or less on Glasgow Coma Scale had been examined by CT within 24 hours after incurring the trauma. These examinations were performed at Department of Neurosurgery and Critical Care Medicine of Nippon Medical School, Sendagi, Tokyo, Japan. In 45 cases of these patients, occurred diffuse cerebral swelling which caused compression or obliteration of the lateral and third ventricles, as well as of the perimesencephalic cistern. Besides the initial CT which was done using an EMI CT 1010 scanner with a 160•~160 matrix, the authors performed contrast enhanced CT carried out by intravenous injection of 50 ml of meglumine amidotrizoate (65% Angiografin R) in adults or of 1 ml/kg weight of the same medium in children" and serial CT scanning. The patients' states on admission were graded according to Glasgow Coma Scales' and clinical results at the time of 3 months after the trauma were graded according to the Glasgow Outcome Scale. These patients ranged in age from one to 70 years old, the mean being 23.5 years; 31 were male and 14 female. The majority of the cases were under 30 years of age, most being approximately 20 years old. All the patients showed the Glasgow Coma Scale score of 8 or less (8 : 1 case, 7 : 2 cases, 6 : 10 cases, 5 : 7 cases, 4 : 12 cases, 3 : 13 cases) at the time of admission. There were 32 patients (71%) with a Glasgow Coma Scale score of 5 or less (showing the primary brain stem injury clinically). Most patients with diffuse cerebral swelling were examined by CT within 2 hours after trauma, the earliest being 40 minutes after the injury. This indicates that diffuse cerebral swelling can rapidly develop after the injury. In 22 (49%) of the 45 patients the initial CT showed the occurrence of other pathological changes. The most frequently occurring was subarachnoid hemorrhage (13 cases). There were also intraventricular hemorrhage (6 cases), scattered small hemorrhages in the deep white matter, corpus callosum and brain stem (6 cases) and