TRAUMATIC INTRACEREBRAL LESIONS WITHOUT EXTRACEREBRAL HEMATOMA IN 218PATIENTS

218 of the 852 patients in the HIT-2 study of head injury had intracer ebral lesions only. They were analysed to get more information on the optimal treatment of these severely injured patients. The initial CT s cans were reviewed to exclude patients with extra cerebral lesions, an d to make a radiological diagnosis of contusion, contusion under a dep ressed fracture, diffuse axonal injury, or intracerebral haematoma. De terioration after admission to hospital was seen in 71% of patients. P atients with contusions, and contusions from depressed fractures in pa rticular showed a worse outcome than expected, while patients with dif fuse injury had a tendency to improve rather than to deteriorate. Pati ents with intracerebral haematoma seemed to improve if the mass was ev acuated. Nimodipine had an impact only in patients with contusions. Ou r findings mandate surgical evacuation of contusions and intracerebral haematomas in patients with lesions larger than 20 ml who also have r adiological signs of a mass effect. Regardless of an apparently good c linical state in the early phase, intracerebral lesions larger than 50 ml seemed to benefit from surgery as compared to nonsurgical treatmen t. The findings indicated that a further refinement of diagnostic crit eria may enable individually tailored head injury treatment to interfe re with most important pathogenic mechanisms. More accurate-diagnoses will improve head injury treatment and outcome, and are a prerequisite for making successful pharmaceutical trials of head injury in the fut ure.