Imaging of traumatic intracranial hemorrhage

Intracerebral hemorrhage (ICH) is a potential complication from traumatic brain injury, with a 30-day mortality rate of 35–52%. Rapid diagnosis allows for earlier treatment, which impacts patient outcomes. A trauma activation (TA) is called when injury severity meets institutional criteria. The patient is immediately roomed, and a multispecialty team is present. A trauma evaluation (TE) occurs when injuries are identified after standard triage processes.

Our aim was to determine whether TA patients with ICH were diagnosed and treated more rapidly than TE patients.

This was a retrospective study of patients presenting to trauma centers within a large hospital system diagnosed with traumatic ICH between January 2018 and December 2018. Patients were categorized as TA or TE patients. The time to diagnosis was compared between groups, and additional times were evaluated, including time to imaging, computed tomography interpretation, and treatment.

A total of 294 patients were included. Groups had similar demographic characteristics and medical history; there was no difference in head Abbreviated Injury Score, Injury Severity Score, or anticoagulant use. Time to diagnosis was decreased for TA patients compared with TE patients (p < 0.0001). In addition, TA patients received treatment sooner (median 107 min) than TE patients (184.5 min) (p < 0.0001).

Diagnosis and treatment times were significantly faster in TA patients than in TE patients. Given the similarities in injury severity between groups, the increased time to treatment may be detrimental for patients. Trauma activations are a resource-heavy process, but TE delays care. These data suggest that an intermediary process may be beneficial.

Imaging is an indispensable part of the initial assessment and subsequent management of patients with head trauma. Initially, it is important for diagnosing the extent of injury and the prompt recognition of treatable injuries to reduce mortality. Subsequently, imaging is useful in following the sequelae of trauma. In this chapter, we review indications for neuroimaging and typical computed tomography (CT) and magnetic resonance imaging (MRI) protocols used in the evaluation of a patient with head trauma. We review the role of CT), the imaging modality of choice in the acute setting, and the role of MRI in the evaluation of patients with head trauma. We describe an organized and consistent approach to the interpretation of imaging of these patients. Important topics in head trauma, including fundamental concepts related to skull fractures, intracranial hemorrhage, parenchymal injury, penetrating trauma, cerebrovascular injuries, and secondary effects of trauma, are reviewed. The chapter concludes with advanced neuroimaging techniques for the evaluation of traumatic brain injury, including use of diffusion tensor imaging (DTI), functional MRI (fMRI), and MR spectroscopy (MRS), techniques which are still under development.

Traumatic brain injury is expected to become the major cause of death and disability for children and young adults by the year 2020. One of the most frequent and most morbid pathologies resulted from a head trauma is acute subdural haematoma (ASDH). For nearly one third of the ASDH cases the etiopathology directly relates to a bridging vein (BV) rupture.

In the current study the bridging vein–superior sagittal sinus (BV–SSS) units were axially stretched until failure for strain rates ranging from 2.66 s⁻¹ to 185.61 s⁻¹, in order to investigate any strain rate dependency in their mechanical behaviour.

Results showed that up to 200 s⁻¹, the effect of the strain rate on veins' mechanical behaviour is outweighed by the large morphological intra- and inter-individual variations. Gender had a strong influence on the BVs geometrical description, but exerted no direct influence on the BV biomechanical parameters. Veins' dimensions had the strongest influence on the BV mechanical behaviour and on the failure mechanism.

The present study brings important contribution to the ASDH research, emphasising the importance of considering the BV–SSS complex as a whole when trying to describe the ASDH mechanopathology.