PDF(Pubmed)
Abstract：
Delayed traumatic intracerebral hematoma (DTICH) is a relatively common occurrence after a traumatic brain injury (TBI). Several case series have been performed to study DTICH, many of which offer different definitions of DTICH. Some definitions involve a delayed progression of an existing hemorrhage, and others involve a de novo intracerebral hematoma that was not evident on the initial trauma evaluation. We propose a classification system for DTICH that accounts for the subtleties in the clinical manifestation and pathophysiology of the different types of DTICH, with the ultimate goal of providing strategies to prevent and manage DTICH. Based on the senior author\'s clinical experience, we generated a classification system for DTICH, and each type of DTICH was illustrated with a case. We defined type 1A (case 1A), the classic presentation of DTICH as predominantly characterized in the literature, as an intracerebral hematoma unseen on initial computed tomography imaging that typically develops five days to one week following blunt or penetrating head trauma. We defined type 1B (case 1B) as a hematoma that forms after at least one week following trauma in areas of the brain initially hemorrhage-free. We defined type 2 (case 2) as a hematoma that develops rapidly following a surgical evacuation of a different hematoma. We defined type 3 (case 3) as a hematoma that develops after a traumatic head injury in areas of non-hemorrhagic contusion, usually frontal or temporal. A literature review was performed using select terms on PubMed to find articles related to DTICH, excluding articles describing DTICH from an underlying vascular injury. After performing the literature review and screening articles by title and/or abstract, a total of 79 articles were found to meet the inclusion and exclusion criteria. We recorded which type of DTICH from our classification system best correlated with the articles in our literature review. Taken together with results from the literature, the proposed classification system is based on the senior author\'s clinical experience. Overall, DTICH is a relatively common occurrence after head trauma, and our pathophysiologic classification has the potential to help outline future studies to recognize and prevent the development of DTICH.
摘要：
迟发性创伤性脑内血肿（DTICH）是创伤性脑损伤（TBI）后相对常见的事件。已经进行了几个案例系列来研究DTICH，其中许多提供了不同的DTICH定义。一些定义涉及现有出血的延迟进展，和其他涉及新生脑内血肿，在最初的创伤评估中并不明显。我们提出了DTICH的分类系统，该系统解释了不同类型DTICH的临床表现和病理生理学的微妙之处，最终目标是提供预防和管理DTICH的策略。根据资深作者的临床经验，我们为DTICH生成了一个分类系统，每种类型的DTICH都用一个案例进行了说明。我们定义了类型1A(案例1A)，DTICH的经典表述在文献中占主导地位，作为最初的计算机断层扫描成像中未发现的脑内血肿，通常在钝性或穿透性头部创伤后五天至一周内发生。我们将1B型（病例1B）定义为血肿，在最初无出血的脑区创伤后至少一周后形成。我们将2型（病例2）定义为在手术清除不同血肿后迅速发展的血肿。我们将类型3（病例3）定义为非出血性挫伤区域的颅脑外伤后发展的血肿，通常额叶或颞叶。使用PubMed上的精选术语进行了文献综述，以查找与DTICH相关的文章，排除描述DTICH的潜在血管损伤的文章。在进行文献综述和按标题和/或摘要筛选文章之后，共有79篇文章符合纳入和排除标准。我们记录了分类系统中哪种类型的DTICH与文献综述中的文章最相关。结合文献的结果，提出的分类系统是基于资深作者的临床经验。总的来说,DTICH是头部创伤后相对常见的事件，我们的病理生理学分类有可能帮助概述未来的研究，以识别和预防DTICH的发展。
