HAEMORRHAGIC CONTUSIONS OF BRAIN : PREDICTORS OF OUTCOME AND RELATIONSHIP BETWEEN CLINICAL AND RADIOLOGICAL EVOLUTION

The most common sequelae of traumatic brain injuries (TBIs) are traumatic parenchymal mass lesions, accounts ~ 13 % of all TBI cases and 13%?35% of severe TBI cases, and for up to 20% of surgical intracranial lesions. The relationship between clinical and radiological evolution of haemorrhagic progression of brain contusions do exists with controversies. Aim:To identify predictors of unfavourable outcome, analyse haemorrhagic progression brain contusions and evaluate specific indications for surgery. Methods:A retrospective study, in which patients with brain contusions were identified in separate patient cohorts from Coimbatore medical college hospital, over a period of 1 year ( August 2017 ? July 2018). Clinical data & its parameters and course of the contusion were collected. Radiological parameters were registered using CT images during hospital admission and at subsequent follow-up. Patients who underwent surgical procedures were identified. Glasgow Outcome Scale-Extended used to evaluate the outcome 6 months after trauma. Results:Multivariate analysis revealed the following reliable predictors of unfavourable outcome: 1) increased patient age, 2) lower Glasgow Coma Scale score at first evaluation, 3) clinical deterioration in the first hours after trauma, and 4) onset or increase of midline shift on follow-up CT images. Further multivariate analysis identified the following as statistically significant predictors of clinical deterioration during the first hours after trauma: 1) onset of or increase in midline shift on follow-up CT images (p < 0.001) and 2) increased effacement of basal cisterns on follow-up CT images (p < 0.001). Conclusion :The onset of clinical deterioration is associated with the onset or increase of midline shift and worsened status of basal cisterns but not with increase in hematoma or oedema volume. The most reasonable indicator of surgery is the combination of clinical deterioration and increased midline shift/basal cistern compression.