Traumatic intracerebral hematoma with stable neurological deficit.

The possibility of an intracerebral hematoma may be overlooked in the presence of a "fixed" neurologic deficit. The clinical complex that is emphasized is composed of (a) ipsilateral cranial trauma, (b) early development of focal neurological deficit, (c) a plateau in the subsequent course of the disease, (d) the delayed appearance of a positive radioactive isotope scan, and (e) a focal area of distorted vessels in angiographic studies. The availability of the computer tomographic scan has made the diagnosis of intracerebral hematomas more certain but it is important that the possibility of a hematoma be considered and pertinent investigations be performed. Even after diagnosis, an operative procedure may be delayed in patients who are neurologically stable. In the five cases presented, the diagnosis of cerebral contusion led to a delay in operative evacuation which was associated with improvement in the previously stable neurological deficit.