REHABILITATION OF MODERATE TO SEVERE TBI: NEUROLOGICAL DISORDERS: INTRACRANIAL COMPLICATIONS: LATE INTRACRANIAL MASS LESIONS  

  1. Chronic Subdural Hematoma, the most common late-presenting mass lesion 3 weeks or more postinjury, differs from the acute or subacute (3-20 days) types.
    • Occur: Usually peak in the 7th and 8th decade, in men, and with a parietal location
    • Signs: Headaches are accompanied by hemiparesis, personality or intellectual change, and/or increased intracranial pressure
    • Diagnosis: CT scans show decreased density; MRI shows increased signal and an outer membrane
    • Etiology: Due in part to low intracranial pressure, ongoing fluid generation/blood leakage, and a disordered local hemostatic mechanism
    • Treatment includes:
      • Burr holes to remove fluid
      • Craniotomy for sizable clots or loculation
      • Postoperative drainage and irrigation for brain reexpansion and reduced recurrence
      • Corticosteroids for small or recurrent chronic subdural hematoma
    • Prognosis is favorable, but may involve deficits in personality and memory

  2. Subdural Hygroma (Hydroma) is a collection of CSF
    • May be due to a tear in the arachnoid that allows CSF into the subdural space and prevents fluid from escaping
    • CT scans show low density, usually lower than subdural hematomas as well; MRI scans show less intensity than subdural hematomas
    • Surgical drainage is more positive when ICP is elevated
    • May not exert mass effect, may be managed conservatively, and may resolve spontaneously

  3. Epidural Hematoma
    • May present > 5 days or as late as 2-3 weeks postinjury
    • Usually is visible on CRT scan done immediately after admission, but, if first visible on a later scan, is called delayed epidural hematoma (EDH) (Domenicucci, et al 1995)
    • Usually occur in the temporal fossa, but delayed presentation usually results in extratemporal locations, such as the frontal fossa or, rarely, the posterior fossa
    • Signs include clouding or decreased level of consciousness and may be vague
    • Surgery is indicated for acute epidural hematoma; the associated brain injury and best motor response are the optimal set of 2 prognostic indicants for functional outcome (Lee, et al 1998)

  4. Delayed Traumatic Intracerebral Hemorrhage
    • Not visualized on initial CT, but seen in follow-up study
    • Usually occur within 24-48 hours postinjury
    • If located in the temporal lobe, may be increased risk of herniation

Based on information in Medical Rehabilitation of Traumatic Brain Injury, L.J. Horn and N.D. Zasler, eds. St. Louis, MO, Mosby, 1996, except for information where other papers are cited.