Ziechmann Robert, Pathak Sami M, Welch Jonathan, Villanueva Philip
Neurosurgery, Temple University Hospital, Philadelphia, USA.
Cureus. 2023 Aug 5;15(8):e42987. doi: 10.7759/cureus.42987. eCollection 2023 Aug.
Delayed traumatic intracerebral hematoma (DTICH) is a relatively common occurrence after a traumatic brain injury (TBI). Several case series have been performed to study DTICH, many of which offer different definitions of DTICH. Some definitions involve a delayed progression of an existing hemorrhage, and others involve a de novo intracerebral hematoma that was not evident on the initial trauma evaluation. We propose a classification system for DTICH that accounts for the subtleties in the clinical manifestation and pathophysiology of the different types of DTICH, with the ultimate goal of providing strategies to prevent and manage DTICH. Based on the senior author's clinical experience, we generated a classification system for DTICH, and each type of DTICH was illustrated with a case. We defined type 1A (case 1A), the classic presentation of DTICH as predominantly characterized in the literature, as an intracerebral hematoma unseen on initial computed tomography imaging that typically develops five days to one week following blunt or penetrating head trauma. We defined type 1B (case 1B) as a hematoma that forms after at least one week following trauma in areas of the brain initially hemorrhage-free. We defined type 2 (case 2) as a hematoma that develops rapidly following a surgical evacuation of a different hematoma. We defined type 3 (case 3) as a hematoma that develops after a traumatic head injury in areas of non-hemorrhagic contusion, usually frontal or temporal. A literature review was performed using select terms on PubMed to find articles related to DTICH, excluding articles describing DTICH from an underlying vascular injury. After performing the literature review and screening articles by title and/or abstract, a total of 79 articles were found to meet the inclusion and exclusion criteria. We recorded which type of DTICH from our classification system best correlated with the articles in our literature review. Taken together with results from the literature, the proposed classification system is based on the senior author's clinical experience. Overall, DTICH is a relatively common occurrence after head trauma, and our pathophysiologic classification has the potential to help outline future studies to recognize and prevent the development of DTICH.
迟发性创伤性脑内血肿（DTICH）是创伤性脑损伤（TBI）后相对常见的情况。已经进行了多个病例系列研究来探讨DTICH，其中许多对DTICH给出了不同的定义。一些定义涉及现有出血的延迟进展，另一些定义涉及在初始创伤评估时不明显的新发脑内血肿。我们提出了一种DTICH分类系统，该系统考虑了不同类型DTICH临床表现和病理生理学的细微差别，最终目标是提供预防和管理DTICH的策略。基于资深作者的临床经验，我们生成了一种DTICH分类系统，每种类型的DTICH都配有一个病例说明。我们将1A型（病例1A）定义为文献中主要描述的DTICH的典型表现，即初始计算机断层扫描成像未见的脑内血肿，通常在钝性或穿透性头部创伤后5天至1周出现。我们将1B型（病例1B）定义为创伤后至少1周在最初无出血的脑区形成的血肿。我们将2型（病例2）定义为在另一个血肿手术清除后迅速形成的血肿。我们将3型（病例3）定义为在非出血性挫伤区域（通常为额叶或颞叶）头部创伤后形成的血肿。使用PubMed上的特定术语进行文献综述，以查找与DTICH相关的文章，排除描述由潜在血管损伤导致的DTICH的文章。在进行文献综述并通过标题和/或摘要筛选文章后，共发现79篇文章符合纳入和排除标准。我们记录了我们分类系统中的哪种DTICH类型与文献综述中的文章最相关。结合文献结果，所提出的分类系统基于资深作者的临床经验。总体而言，DTICH是头部创伤后相对常见的情况，我们的病理生理分类有可能有助于勾勒未来的研究，以识别和预防DTICH的发生。
