Diagnosis and management of delayed traumatic intracerebral haematomas.

In a retrospective study of 888 consecutive patients with traumatic intracranial haematomas, we identified 23 (2.6%) who had developed a delayed intracerebral haematoma after admission to hospital. The initial CT scan within 48 h of injury had been abnormal in all 23 cases; a haematoma had been evacuated in eight (35%) and intracranial pressure (ICP) had been monitored in 14 (61%). A delayed intracerebral haematoma had been diagnosed by repeat CT scan between 4 h and 10 days later, and nine of these had been evacuated on clinical grounds. Patients with persistently elevated ICP were rescanned more quickly than those who deteriorated clinically or failed to improve. Seven patients (30%) died, and the main cause of death was severe primary brain damage. Overall outcome was better in this series than in other reported series of delayed haematomas. We conclude that delayed haematomas occur only when the initial CT scan has been abnormal, and that clinically important ones are uncommon. ICP monitoring offers earlier diagnosis, but it remains to be established that this affects outcome.