Clinical and Neurological Features and Differentiated Treatment Strategy for Traumatic Intracerebral Hematomas | American Journal Of Biomedical Science & Pharmaceutical Innovation

Authors

Begaliev S.M.

Karakalpak Branch of the Republican Scientific Centre of Emergency Medical Care, Nukus, Republic of Uzbekistan Medical Institute of Karakalpakstan, Nukus, Republic of Uzbekistan
Mambetkarimov G.A.

Medical Institute of Karakalpakstan, Nukus, Republic of Uzbekistan
Tajibaeva Sh.A.

Medical Institute of Karakalpakstan, Nukus, Republic of Uzbekistan

DOI:

https://doi.org/10.37547/ajbspi/Volume06Issue06-03

Keywords:

Traumatic intracerebral haematoma traumatic brain injury neuroimaging

Abstract

Background. Traumatic intracerebral hematomas (TICH) represent one of the most severe forms of traumatic brain injury (TBI), associated with mortality rates of 35–72% and disability in more than 60% of survivors. The marked polymorphism of the clinical presentation, the complexity of treatment decision-making, and the high frequency of unfavourable outcomes underscore the importance of studying the clinical and neurological characteristics of TICH.

Objective. To investigate the clinical and neurological features of TICH in relation to haematoma location, volume, and level of consciousness impairment, and to establish criteria for differentiated selection between surgical and conservative treatment.

Materials and methods. The study included 154 patients: a primary cohort of 82 patients treated at the Republican Neurosurgery Scientific Centre (RNSC), Tashkent (1994–1999), and an additional cohort of 72 patients from the neurosurgical unit of the Medical Institute of Karakalpakstan (MIK), Nukus (2020–2024). Neurological severity was assessed using the Glasgow Coma Scale (GCS), and functional outcomes were evaluated with the Glasgow Outcome Scale Extended (GOSE) and Barthel Index. Neuroimaging included CT, MRI, and CT angiography. Neurophysiological methods comprised echoencephalography (Echo-EG), EEG, and transcranial Doppler ultrasonography (TCD). Patients in the primary cohort were divided into two groups: Group 1 — 43 patients who underwent surgical treatment; Group 2 — 39 patients who received conservative management.

Results and discussion. The study population was predominantly male patients of working age (86.6%; mean age 39.0±0.7 years). Road traffic accidents (RTA) were the leading cause of TICH (45–60%). The most frequent haematoma locations were frontal (30.5%) and fronto-temporal (19.5%). At admission, consciousness impairment below 13 GCS points was recorded in 78.1% of patients; coma was present in 18.3%. A direct relationship was established between haematoma volume (< 30 mL, 30–45 mL, > 45 mL) and the severity of neurological deficit. The surgical group more frequently demonstrated motor deficits (hemiparesis), anisocoria, and displacement syndrome. Multiple TICH (17.1%) were associated with a mortality rate of 28.6% versus 5.9% for single haematomas (p < 0.05). In the 2020–2024 cohort, a reduction in mortality from 8.5% to 6.9% was associated with earlier hospital admission (71.4% within 6 hours) and extended neuromonitoring.

Conclusion. The clinical presentation of TICH is determined by haematoma location and volume, the presence of associated intracranial injuries, level of consciousness, and patient age. Indications for surgical treatment include haematoma volume exceeding 30 mL, midline shift greater than 5 mm, progressive consciousness impairment, and signs of displacement syndrome. Early neuroimaging and standardised clinical assessment using the GCS allow optimisation of treatment strategy and improvement of functional outcomes.

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