• H G Imhof, J Wacker, K Käch, A Platz, and O Trentz.
• Klinik für Unfallchirurgie, Universitätsspital Zürich.
• Helv Chir Acta. 1993 Sep 1; 60 (1-2): 195-200.

AbstractBecause of methodological reasons, within the first day after a head trauma, CT scan often does not demonstrate all the pathological consequences of brain injury. Additionally, secondary sequelae are frequent events. In our series of 129 patients the findings on subsequent CT scans done during the posttraumatic course were worse compared to the initial CT in 45% of patients. This deterioration on the CT scan was seen irrespective of the initial GCS score and the initial diagnosis of circumscribed or diffuse injury. The event observed most often was bleeding into a preexisting contusion or even bleeding into a region which had looked normal on the first CT scan. In the vast majority of cases, this happened within the first 2 weeks after the initial trauma. We conclude that an initially pathological CT should be repeated early in the posttraumatic period even in patients with mild to moderate head injury. In particular, we recommend that patients having sustained diffuse brain injuries should be transferred to neurotraumatology units for specialised management, even when there may not be immediately obvious indications for surgical intervention.

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