[Pathogenesis and management of secondary neural damage in head trauma patients: analysis of patients who talk and deteriorate "fulminantly"].

To clarify the pathogenesis and management of secondary neural damage after head trauma, we characterized the clinical features and CT findings in nine patients who talked and deteriorated "fulminantly". The patient who talks and deteriorates "fulminantly" is defined as a patient who talks (verbal score of Glasgow Coma Scale > or = 4) on admission, and subsequently shows a rapid neurological deterioration to develop an anisocoria and/or a decerebrated posture within 24 hours after trauma. Nine (8%) out of 118 patients with severe head trauma satisfied the definition mentioned above. The mechanism of injury was a fall in 5 patients and a road traffic accident in 4. Plain skull X-ray manifested a linear skull fracture in 8 out of 9 (89%). Although they were almost alert and talked on admission, all of these 9 patients developed an anisocoria within 6 hours after trauma. Prior to the rapid neurological deterioration, in spite of their good consciousness, they characteristically showed a variety of CT abnormalities including subdural hematoma (SDH), intracerebral hematoma (ICH) and subarachnoid hemorrhage. Following the rapid neurological deterioration, 7 out of 9 patients underwent surgical treatment for hematoma evacuation using a large decompressive craniectomy. Clinical outcomes were 2 good recoveries, 1 moderate disability, and 6 deaths. Causes of the rapid neurological deterioration determined by CT and surgery were: 1) an enlarged SDH in 6 patients, 2) an enlarged ICH in 4 patients, and 3) a worsened brain swelling associated with SDH in 3 cases.(ABSTRACT TRUNCATED AT 250 WORDS)