Computerized tomography (CT) in acute head trauma.

The retrospective evaluation of 100 cases of head trauma that were subjected to computerized tomography (CT) leads to the following conclusions: (1) Computerized tomography and plain skull survey, should be the first neuroradiological procedures to perform. (2) Angiography may be carried out after computerized tomography when necessary, but as proved by this series, it will be needed in a relatively small number of cases. These include patients with technically limited CT scans or those in whom the possibility of an associated vascular lesion of the cervical or intracranial vessel is clinically suspected. (3) It is essential to obtain CT scans of the best possible quality. Sedation will be required in many instances, but this is considered worth doing because a normal CT scan, without significant technical limitations, will exclude the presence of lesions requiring prompt surgical intervention. Those patients who require surgery will need general anesthesia under any circumstances. (4) There is generally a direct relationship between the severity of clinical presentation and the CT demonstration of the abnormality responsible for the clinical status. Seventy percent of the patients clinically diagnosed as contusion had positive CT scans, and for all practical purposes, 100 percent of patients having trauma more severe than our Group III (contusion) had abnormal CT scans. Likewise, the number and intensity of tissue abnormalities on CT scans increase proportionately with the severity of the clinical signs and symptons. (5) It is foreseen that, with the advent of faster computerized tomographic scanners, the usefulness of this method will increase further, owing to a reduction in the total examination time and the lessened requirement for sedation.