MR imaging as predictor of delayed posttraumatic cerebral hemorrhage.

The occurrence of delayed traumatic intracerebral hemorrhage or hematomas was predicted in four patients by T2-weighted magnetic resonance (MR) imaging. From June, 1986, through February, 1987, 42 patients with head injury were admitted to the Neurosurgical Service of the Seirei Mikatabara General Hospital. Cerebral contusion was suspected in six of these patients. Although the initial computerized tomography (CT) scans showed no cerebral parenchymal lesion, the initial symptoms were more serious than might have been expected from the initial CT findings and/or because their initial CT scans showed intracranial extracerebral hemorrhage. In all six, the initial CT scans were obtained within 2 hours after the injury and were followed by MR imaging. In four patients, T2-weighted MR images revealed areas of increased signal intensity in the cerebral parenchyma, where hemorrhagic changes were subsequently demonstrated by follow-up CT scans. In the remaining two, T2-weighted MR images showed no parenchymal lesion and subsequent CT scans confirmed the absence of hemorrhagic change; these two patients were discharged from the hospital without neurological deficits. It is concluded that MR imaging is useful in predicting delayed hemorrhages.