An Analysis of Treatment Outcome in Traumatic Intracranial Bleed with Midline Shift of More Than 5mm: A Tertiary Level Health Care Center Based Study
Authors/Creators
- 1. Senior Resident, Department of General Surgery, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
- 2. Assistant Professor Neurosurgery, Department of Neurosurgery, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
Description
Background: Traumatic intracranial bleed is an acute event with a pathophysiology that is dynamic. It has the potential of inducing progressive neurological deterioration either because of its continued expansion over initial few hours or subsequently by the combined effect of hematoma and edema. The hematoma and edema induced mass effect leads to midline shift (MLS) that may cause secondary damage to the delicately balanced architecture of brain between the two hemispheres, thus aggravating the neurological deficits or may even threaten the life. Influenced by a multitude of factors, the treatment and its outcome varies across centers. This signifies the need to identify factors that might possibly be modified to deliver a favorable outcome or prognosticate the patient in concern. Among the factors having bearing on the decision of medical or surgical treatment, midline shift and Glasgow Coma scale score (GCS) are the most important ones and inversely related among themselves. We conducted a prospective study to assess their impact in need of surgery and outcome of treatment on a short-term basis. Objectives: In patients of head injury having acute intracranial bleed and producing mass effect and midline shift of more than 5mm – to determine (1). The percentage of patients requiring surgery. (2). To determine the incidence of mortality. (3). To evaluate the functional recovery at 6 months post trauma Methods: 61 patients with traumatic intracranial bleed and MLS of 5mm or more were enrolled over a period of 3 years. Medical or surgical treatment as justified by clinico radiological parameters and standard guidelines were given. Analysis was carried out with the objectives of identifying -the need of surgery in study subjects, mortality and functional outcome at 6 months post injury. Results: 60% patient were less than 40 years of age. 50.8% patients were admitted with severe head injury (GCS<8). 73.8% patients (45/61) had a MLS between 5-10mm. 41 out of 61(66.7%) patients were treated by surgery. Overall, mortality was 37.7% (23/61). Of those who survived, 56.5% were functionally independent for activities of daily living at 6 months follow-up. Conclusions: Traumatic intracranial bleed associated mass effect and midline shift is associated with high mortality. Treatment benefit rapidly declines with increasing mass effect. Only half of the survivors achieve functional independence for activities of daily living at 6 months post trauma
Abstract (English)
Background: Traumatic intracranial bleed is an acute event with a pathophysiology that is dynamic. It has the potential of inducing progressive neurological deterioration either because of its continued expansion over initial few hours or subsequently by the combined effect of hematoma and edema. The hematoma and edema induced mass effect leads to midline shift (MLS) that may cause secondary damage to the delicately balanced architecture of brain between the two hemispheres, thus aggravating the neurological deficits or may even threaten the life. Influenced by a multitude of factors, the treatment and its outcome varies across centers. This signifies the need to identify factors that might possibly be modified to deliver a favorable outcome or prognosticate the patient in concern. Among the factors having bearing on the decision of medical or surgical treatment, midline shift and Glasgow Coma scale score (GCS) are the most important ones and inversely related among themselves. We conducted a prospective study to assess their impact in need of surgery and outcome of treatment on a short-term basis. Objectives: In patients of head injury having acute intracranial bleed and producing mass effect and midline shift of more than 5mm – to determine (1). The percentage of patients requiring surgery. (2). To determine the incidence of mortality. (3). To evaluate the functional recovery at 6 months post trauma Methods: 61 patients with traumatic intracranial bleed and MLS of 5mm or more were enrolled over a period of 3 years. Medical or surgical treatment as justified by clinico radiological parameters and standard guidelines were given. Analysis was carried out with the objectives of identifying -the need of surgery in study subjects, mortality and functional outcome at 6 months post injury. Results: 60% patient were less than 40 years of age. 50.8% patients were admitted with severe head injury (GCS<8). 73.8% patients (45/61) had a MLS between 5-10mm. 41 out of 61(66.7%) patients were treated by surgery. Overall, mortality was 37.7% (23/61). Of those who survived, 56.5% were functionally independent for activities of daily living at 6 months follow-up. Conclusions: Traumatic intracranial bleed associated mass effect and midline shift is associated with high mortality. Treatment benefit rapidly declines with increasing mass effect. Only half of the survivors achieve functional independence for activities of daily living at 6 months post trauma
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IJPCR,Vol15,Issue9,Article137.pdf
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Additional details
Dates
- Accepted
-
2023-08-29
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue9,Article137.pdf
- Development Status
- Active
References
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