Conservative management of extra-axial hematomas diagnosed by CT

Our purpose was to assess the role of serial CT in recently traumatized pat ients with clinically stable extra-axial intracranial hematomas (EACH) and a midline shift of less than 0.5 cm. A retrospective review of 91 imaging s tudies in 41 patients (with 45 EACH) was done to assess the time between tr auma and CT; the presence and type of skull fracture; the volume, type, and location of the EACH; the presence of associated edema and/or contusion. O ver a 19-day followup, 11% of the dense EACH increased in volume and 27% de creased. An adjacent skull fracture was seen most frequently in patients wi th a decrease in EACH volume. Clinical data remain the key to determining t he need for neurosurgical intervention in patients with EACH. Follow-up CT afforded no data which altered the medical management of these patients. Ho wever, it may be said to have alerted the clinician to an increase in the s ize of the EACH in 11% of cases, which could mandate close observation of t his group.