EARLY DETECTION OF DELAYED TRAUMATIC INTRACRANIAL HEMATOMAS USING NEAR-INFRARED SPECTROSCOPY

Delayed intracranial hematomas are an important treatable cause of sec ondary brain injury in patients with head trauma. Early identification and treatment of these lesions, which appear or enlarge after the ini tial computerized tomography (CT) scan, may improve neurological outco me. Serial examinations using near-infrared spectroscopy (NIRS) to det ect the development of delayed hematomas were performed in 167 patient s. The difference in absorbance of light (Delta OD) at 760 nm between the normal and the hematoma side was measured serially during the firs t 3 days after injury. Twenty-seven (16%) of the patients developed a type of late hematoma: intracerebral hematoma in eight, extracerebral hematoma in six, and postoperative hematoma in 13 patients. Eighteen o f the delayed hematomas caused significant mass effect and required su rgical evacuation. The hematomas appeared between 2 and 72 hours after admission. In 24 of the 27 patients, a significant increase (> 0.3) i n the Delta OD occurred prior to an increase in intracranial pressure, a change in the neurological examination, or a change on CT scan. A f avorable outcome occurred in 67% of the patients with delayed hematoma s, which suggests that early diagnosis using NIRS may allow early trea tment and reduce secondary injury caused by delayed hematomas.