Maurice H. Lipper

Delayed intracranial hematoma in patients with severe head injury.

Serial computed tomography was peformed on 119 consecutive patients suffering from severe head injury. The development of delayed intracranial hematomas, both intra- and extraaxial, was evaluated by comparing the initial scan with subsequent studies. Ten delayed intracerebral hematomas and nine delayed extracerebral collections were encountered. The occurrence of delayed intracerebral hemorrhage is more frequenct than previously reported and is associated with a poor outcome.

Significance of Bilateral Abnormalities on the CT Scan in Patients with Severe Head Injury

One hundred forty head injured patients, managed by a standardized protocol of early diagnosis, surgical decompression, and intensive therapy, had computerized tomographic (CT) scans within 1 hour or arrival in the emergency room. Ninety of these patients had serial scans during the subsequent week. On admission, 26 patients had normal scans, 75 had unilateral lesions, and 39 had bilateral lesions. Thirteen who had unilateral lesions on admission developed contralateral lesions during the first week for a total of 52 patients with bilateral lesions. These 52 patients could be separated into two distinct groups: (a) those with small ventricles and no change or a slight, homogeneous decrease in density of the brain parenchyma, who had better neurological status on admission, lower intracranial pressure (ICP), and better outcome; and (b) those with bilateral increased density lesions, who had poorer motor response on admission, higher ICP, and worse outcome. The value of CT scanning in management, prognosis, and outcome is emphasized.

Ventriculostomy for hydrocephalus in cerebellar hemorrhage.

In a matter of hours the neurologic status of two hypertensive patients deteriorated to coma. Cranial computed tomography (CT) showed mild to moderate cerebellar hemorrhage and secondary hydrocephalus. Ventriculostomy resulted in clinical improvement within 20 minutes and obviated the need for suboccipital craniectomy. Both patients made a very satisfactory recovery. Similar patients have occasionally been observed by others. Ventriculostomy should be considered for patients with cerebellar hemorrhage who have hydrocephalus by CT scan and undergo progressive neurologic deterioration. Because the frequency of improvement and the risk of upward cerebellar herniation following ventriculostomy is unknown, immediate surgical evacuation of the hemorrhage should be anticipated.

Craniopharyngioma: Unusual computed tomographic presentation.

Craniopharyngioma usually presents on a computed tomographic (CT) scan as a hypodense or isodense lesion, with calcification, in the suprasellar region. A case with atypical CT findings of a huge, homogeneous, high density, apparently solid, lobulated suprasellar mass is presented. An explanation for the appearance of the tumor is discussed based upon clinical analysis of the tumor contents.

Intraspinal metastases from retinoblastoma.

Cerebrospinal fluid seeding is a well-known mode of metastasis for intracranial neoplasms such as medulloblastoma, ependymoma, and glioblastoma; however, retinoblastoma is not usually considered. The route of spread appears to be by direct extension into the optic nerve from the retina and into the meningeal spaces by extension from the choroid, or along the central retinal vessels to the subarachnoid space. Four cases are presented.

Delayed sequelae of head injury

The evaluation of delayed sequelae of head injury is greatly facilitated by CT. This non-invasive technique provides us with the opportunity to evaluate the head trauma patients sequentially to detect the development and clinical significance of post-traumatic sequelae like delayed intracerebral hemorrhage, hydrocephalus, and post-traumatic atrophy.