The post-traumatic diffuse cerebral lesions. A clinico-radiological study

This study includes clinical evolution of 100 patients selected among 1468 head injuries admitted to the Neurosurgical Institute of the University of Milan over the period 1981-1984. Criteria of selection were immediate coma Glasgow Coma Score (GCS <6) lasting more than 24 h and the presence of diffuse lesion documented at CT. Diffuse lesion was classified as follow: a) normal CT (33 cases), b) shearing injury (13 cases), c) diffuse brain swelling (54 cases). The best results were obtained with the first group (mortality rate: 15%). The appearance of deep hemorrhages on CT (indicative of wider extension of axonal damage from hemispheres to the brain stem) leads to a greater neurological impairment and a higher mortality rate (23%). Secondary vascular involvement and the following vasoparesis (due to hypoxemia, anemia and other unknown causes) producing a diffuse brain swelling plays an important role due to its frequency (54%) and to its high mortality rate (63%). The aim of this paper is to emphasize the clinical relevance of diffuse brain lesion.