Ahead of Print: Delayed Neurologic Deterioration Following Mild Head Injury

Background: Mild head injury (MHI) complicated by an intracranial hemorrhage (ICH) is a common cause of hospital admission following head trauma. Most patients are treated non-operatively, remain neurologically stable, and are discharged uneventfully. However, a small percentage of patients suffer delayed neurologic deterioration (DND). Little is known about the characteristics of DND following a MHI complicated by ICH.

Objective: To identify the etiology, temporal course, and outcomes of patients who deteriorated neurologically after presenting with MHI and ICH.

Methods: A retrospective review was performed of all adult patients presenting over 54 consecutive months with MHI and ICH. Patients who were treated non-operatively after initial head CT and had a subsequent DND (GCS drop >= 2) were identified. Demographics, neurologic status, clinical course, radiographic findings, and outcome data were collected.

Results: Over 54 months, 757 patients with MHI + ICH were admitted for observation; of these, 31 (4.1%) experienced DND. Eighty-seven percent of patients deteriorated within 24 hours after admission. Twenty-one patients (68%) deteriorated due to progressive intracranial hemorrhage (PIH) and 10 patients (32%) deteriorated due to medical causes. Seven patients (23%) died. Variables significantly associated with mortality included age > 60, coagulopathy, and change in Marshall CT classification.

Conclusion: The incidence of delayed neurologic deterioration following MHI with ICH is low and usually occurs within 24 hours after admission. It results in significant morbidity and mortality if due to PIH. Further research is needed to identify risk factors that can allow for early detection and improve outcomes in these patients.

From: Delayed Neurologic Deterioration Following Mild Head Injury: Etiology, Temporal Course and Outcomes by Choudhry et al.

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