Traumatic intracerebral hemorrhage outcome [Neurosurgery Wiki]

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====== Traumatic intracerebral hemorrhage outcome ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/10ksRz738wlgy7B_xHZUh0mETeHXV-Ku-Y1xnox3d7WUQp_EdG/?limit=15&utm_campaign=pubmed-2&fc=20230827070811}}
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[[Cerebral contusion]]s, are frequently associated with surrounding edematous-appearing tissue that exacerbates elevation of [[intracranial pressure]] (ICP). Half of all cerebral contusions enlarge in the first hours after injury, with perilesional hypodensity being a significant factor in prediction of expansion
((Beaumont A. Gennarelli T. CT prediction of contusion evolution after closed head injury: the role of pericontusional edema. Acta Neurochir. 2006;96(Suppl):30–32.)).
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The presence of [[Apolipoprotein E]], an elevated international normalized ratio, and a higher [[glucose]] level (≥ 10 mmol/L) are predictors of Progressive traumatic [[intracerebral hemorrhage]]. Additionally, APOE ε4 is not associated with traumatic coagulopathy and patient outcome
((Wan X, Gan C, You C, Fan T, Zhang S, Zhang H, Wang S, Shu K, Wang X, Lei T.
Association of APOE ε4 with progressive hemorrhagic injury in patients with
traumatic intracerebral hemorrhage. J Neurosurg. 2019 Jul 19:1-8. doi:
10.3171/2019.4.JNS183472. [Epub ahead of print] PubMed PMID: 31323634.
)).

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A survey of 729 patients with TBI by the TBI European Brain Injury Consortium found that cerebral contusions alone (44%) or in association with subdural haematoma (29%) were the most frequent causes for delayed surgical intervention
((Compagnone C, Murray GD, Teasdale GM, Maas AI, Esposito D, Princi P, et al. The management of patients with intradural post-traumatic mass lesions: A multicenter survey of current approaches to surgical management in 729 patients coordinated by the European Brain Injury Consortium. Neurosurgery. 2005;57(6):1183–1192.)).

===== Neutrophil to lymphocyte ratio =====

The [[Neutrophil to lymphocyte ratio]] is easily calculated and might predict the early growth of [[Traumatic intracerebral hemorrhage]] for patients suffering from [[TBI]]
((Zhuang D, Sheng J, Peng G, Li T, Cai S, Din F, Li L, Huang M, Tian F, Li K, Wang S, Chen W. Neutrophil to lymphocyte ratio predicts early growth of traumatic Intracerebral hemorrhage. Ann Clin Transl Neurol. 2021 Jun 24. doi: 10.1002/acn3.51409. Epub ahead of print. PMID: 34165245.)).

===== Outpatient follow-up =====
Repeat outpatient CT of asymptomatic patients after nonoperative cerebral contusion and tSAH is very unlikely to demonstrate significant new pathology. Given the cost and radiation exposure associated with CT, imaging should be reserved for patients with significant symptoms or focal findings on neurological examination
((Rubino S, Zaman RA, Sturge CR, Fried JG, Desai A, Simmons NE, Lollis SS.
Outpatient follow-up of nonoperative cerebral contusion and traumatic
subarachnoid hemorrhage: does repeat head CT alter clinical decision-making? J
Neurosurg. 2014 Oct;121(4):944-9. doi: 10.3171/2014.6.JNS132204. Epub 2014 Jul
25. PubMed PMID: 25061865.
)).

===== Complications =====

[[Intracerebral hemorrhage complications]].