[Computed tomography in diagnosis and management of acute head injury--correlation between clinical symptoms and CT findings (author's transl)].

A series of 202 patients with acute head injuries was investigated in correlation with clinical signs and computed tomographical findings. Clinical signs were classified into four types according to ARAKI's grading. Ninety three cases of type I, 61 cases of type II, 41 cases of type III and 7 cases of type IV were included in this series. The youngest patient was 40 days old and the oldest was 83 years old and average age was 31.3 years old. Initial C.T. was carried out in 70.80% of this series within 2 days after injury. Conclusions were obtained as follows: 1) Intracranial hemorrhages were recognized in 5.4% of type I, 18.0% of type II, 68.3% of type III and 100% of type IV on C.T. 2) All of intracranial hemorrhage in type I and type II were small and limited ones and showed no mass effect on C.T. 3) In all of severe cases with deep coma, their C.T. demonstrated poor visualization of so-called pentagone, ambient cistern and quadrigeminal cistern. These findings especially that of quadrigeminal cistern image were considered to be signs of poor prognosis. 4) Incidence of visualization of Sylvian fissure decreased in order of type I, type II, type III and type IV on C.T. Poor visualization of Sylvian fissure may reflect of small lesion in or out of cortex near Sylvian fissure such as small intracerebral hemorrhage, localized brain edema, small epidural hematoma etc. 5) Incidence of visualization of sulci decreased in order of type I, type II, type III, and type IV. Poor visualization of sulci may reflect existence of small lesion in or out of cortex in vertex area. 6) False negative of false positive finding on C.T. can result from slice level or time of C.T. and/or age of patient. Repeated C.T. may be recommended when the patient has conflicting neurological signs for these C.T. findings.