[Computerized tomography and craniocerebral trauma].

Abstract

Computed tomography (CT) is now the standard neuroradiological examination for patients with major head injuries, although conventional X-ray of the skull should not be neglected. Whereas the latter only shows such skull pathology as fractures or intracranial air following a basal fracture, CT clearly visualizes intracranial pathology. It allows differentiation between haematoma and contusion, between localized oedema and generalized brain swelling; CT is therefore indicated in every patient with disturbed consciousness, focal neurological signs, and/or secondary clinical impairment, and also in all drunken patients with head injury. In a patient with impaired consciousness and focal neurological deficit the probability of a pathologic CT is 85%. An extracerebral haematoma is often present, which needs urgent evacuation. A modern, non-expensive communications system using a standard telephone line enables hospitals without a neurosurgical unit to send CT pictures that are difficult to interpret to a neurosurgeon and to discuss them on-line by telephone. This system has now been in operation for over 2 years and has improved the care of patients with head injury in our region. It is highly efficient and reliable and improves cooperation between distant hospitals. It also helps to avoid unnecessary transfers, which are not only expensive but may even harm a critically ill patient.