Severe Traumatic Brain Injury Diagnosis [Neurosurgery Wiki]

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====== Severe Traumatic Brain Injury Diagnosis ======

===== Head computed tomography =====

see [[Head computed tomography for traumatic brain injury]].

First cCT

The timing of the second cCT scan is not standardized. Recommendations range from 6 to 48 hours after the first scan
((Chesnut RM, Temkin N, Carney N, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. The New England Journal of Medicine. 2012;367:2471–2481.))
((Cope DN, Date ES, Mar EY. Serial computerized tomographic evaluations in traumatic head injury. Archives of Physical Medicine and Rehabilitation. 1988;69(7):483–486.))
((Servadei F, Nanni A, Nasi MT, et al. Evolving brain lesions in the first 12 hours after head injury: analysis of 37 comatose patients. Neurosurgery. 1995;37(5):899–907.))
((Stein SC, Spettell CM. Delayed and progressive brain injury in children and adolescents with head trauma. Pediatric Neurosurgery. 1995;23(6):299–304.)).
Over the years the time from accident to the first cCT immediately after admission has decreased continuously. Therefore initial cCT scans might be unremarkable despite intracranial trauma sequel
((Servadei F, Nanni A, Nasi MT, et al. Evolving brain lesions in the first 12 hours after head injury: analysis of 37 comatose patients. Neurosurgery. 1995;37(5):899–907.))
((Maas AIR, Dearden M, Servadei F, Stocchetti N, Unterberg A. Current recommendations for neurotrauma. Current Opinion in Critical Care. 2000;6(4):281–292.)).
. For that reason some trauma centres schedule the second scan 6 to 24 hours after the admission scan in order to detect early progression of brain injury 
((Servadei F, Nanni A, Nasi MT, et al. Evolving brain lesions in the first 12 hours after head injury: analysis of 37 comatose patients. Neurosurgery. 1995;37(5):899–907.))
((Muakkassa FF, Marley RA, Paranjape C, Horattas E, Salvator A, Muakkassa K. Predictors of new findings on repeat head CT scan in blunt trauma patients with an initially negative head CT scan. Journal of the American College of Surgeons. 2012;214:965–972.))
((Lee TT, Aldana PR, Kirton OC, Green BA. Follow-up Computerized Tomography (CT) scans in moderate and severe head injuries: correlation with Glasgow Coma Scores (GCS), and complication rate. Acta Neurochirurgica. 1997;139(11):1042–1048.))
((Stein SC, Spettell C, Young G, Ross SE, Kaufman HH, Marshall LF. Delayed and progressive brain injury in closed-head trauma: radiological demonstration. Neurosurgery. 1993;32(1):25–31.)).