Samuel Galbraith

ACUTE TRAUMATIC INTRACRANIAL HÆMATOMA WITHOUT SKULL FRACTURE

307 cases of acute traumatic intracranial haematoma in patients admitted to the Institute of Neurological Sciences in Glasgow have been analysed for various presenting features. 57 (19%) had no fracture, and 14 had neither a fracture nor neurological symptoms and signs immediately after the injury. Apart from the children, immediate admission and observation of these 14 cases for a period of 24 hours rarely led to the early detection of a haematoma.

Acute Traumatic Intracranial Hematomas

Introduction 253 Importance of Traumatic Intracranial Hematoma 253 What Is a Hematoma and What Is a Significant Hematoma? 254 Classification 256 Incidence of Acute Traumatic Intracranial Hematoma 260 Clinical Picture 261 Signs and Symptoms 261 Posterior Fossa Hematoma 263 The Skull X-Ray 263 Probability of a Hematoma 264 Conscious Level and Focal Signs 264 Epilepsy 264 Skull Fracture 264 CT Scanning 265 CT Findings in Acute Traumatic Intracranial Hematoma 265 Reliability 269 Who and When to Scan 270 Techniques of Operation 272 Burr Holes for Head Injury 272 Craniotomy for Traumatic Intracranial Hematoma 273 When is Operation Unnecessary? 274 Results 276 Outcome Assessment 277 Prognostic Factors 278 Type of Hematoma and Outcome 278 Age and Outcome 279 State of Responsiveness before Operation and Outcome 280 Can Results be Improved? 283 References 286

Causes and Consequences of Raised Intracranial Pressure in Head Injuries

There is still disagreement about the value of monitoring and treating Intracranial Pressure (ICP) in severely head injured patients (Stuart et al. 1983). This reflects continuing uncertainties about what mechanisms are responsible for increased ICP, if these differ in different injuries, and also doubts about the relationship between ICP and brain damage. We review a range of investigations we have performed on severely injured adults in order to study changes in the volumes of the intracranial constituents that may indicate raised ICP after head injury. The results provide a basis for understanding the causes and consequences of traumatic intracranial hypertension.