Delayed traumatic intracerebral hemorrhage

Traumatic intracerebral hemorrhage (TICH) demonstrated in patients on imaging that was not evident on initial admitting CT scan. Incidence of DTICH in patients with GCS ≤ 8: ≈ 10% (reported incidence varies with resolution of CT scanner, timing of scan, and definition). Most DTICH occur within 72 hrs of the trauma.

Some patients seem to be doing well and then present with an apoplectic event (although DTICH accounted only for 12% of patients who “talk and deteriorate”).

Factors that contribute to formation of DTICH include local or systemic coagulopathy, hemorrhage into an area of necrotic brain softening, coalescence of extravasated microhematomas.

Treatment is the same as for TICH

Outcome for patients with DTICH described in the literature is generally poor, with a mortality ranging from 50–75%.