Delayed Traumatic Intracranial Hemorrhage (DTICH) Ri 林鴻錡 History Böllinger1 described in 1891:four patients died from ICH occurred 2 weeks after they suffered head injury ("Traumatische Spät- Apoplexie"). Traumatische Spät-Apoplexie A definite history of the minor head trauma and young age An asymptomatic interval longer than 24 h An apoplectic event Absence of vascular disease Present Criteria evolved since the advent of CT Lipper et al : initial CT shows no lesions or if any lesion measures less than 1 cm and subsequent scans show high-density parenchymatous lesions Fukamachi et al: established that the initial CT scan must be performed within 6 hours after injury to allow DPTH to be distinguished from ICH of other causes Delayed Posttraumatic Hemorrhage "Spät-Apoplexie" José Álvarez-Sabín, MD; Antoni Turon; Manuel Lozano-Sánchez; José Vázquez, MD; Agustí Codina, MD Stroke 1995 Sep Vol:26(9) P1531-1535 Method Ten cases of CT-proven DPTH from a series of 216 patients (age range, 15 to 50 years) with ICH Previous CT in the first 6 hours after head injury were normal in all patients Cerebral angiography showed no evidence of vascular disorders in any patient. Result(1) Incidence: 4.5% (10patients of 216 ICH) PTICH: the fourth ICH cause after arterial hypertension, vascular malformations, and alcoholism Gender: M/F 7/3 Age:15-50 Cause: T/A:3 Fall:2 F-E:2 Bump:2 Work:2 Result(2) Underline: Alcoholics:2 Smoker2 HTN:1 DM:1 Initial symptoms:concussion(6), confusion(1), headache(1), confusion and headache(1) Interval:1-15 days, average:5.23 days Result(3) Hematoma location:capsule-basal ganglia(6), the frontal lobe(3), and pons(1). The hematoma volume:ranged from 0.3 to 19.6 mL, with an average of 9.9±7.0 mL Severe neurological deficit (Oxford Handicap Scale score of 3) persists in one patient and one epilepsy Discussion Symptom-free interval: depending on the series, varies between 24 hours and several weeks, or even months Age:Baratham and Dennyson series, from 5 to 83 years, with the majority in their sixties, which is when the incidence of amyloid angiopathy as a cause of ICH should be considered. HTN induced ICH: basal ganglia location is normally attributed to a possible hypertensive etiology Mortality: Nil. 1.patients' relative youth, 2.the absence of other concurrent intracranial bleeding or skull fracture Hypotheses Initial injury would cause areas of necrosis in the cerebral parenchyma and walls of the small arteries due to vasospasm caused by the trauma release of free radicals, accumulation of lipid peroxidase Kaufman et al: Trauma=> the release of thrombogenic substances=> intravascular coagulation =>subsequent fibrinolysis Evans and Scheinker and Gudeman et al : dysautoregulation=>perivascular hemorrhage Conclusion DPTH is one of the causes of ICH in adult patients under 50 years of age. Most head injuries causing DPTH are of low intensity, and initial clinical signs are mild. Most DPTH are located deep in the hemispheres and are of small or medium size. Prognosis in the short and long term is good.