الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The World Health Organisation (WHO) considers Traumatic Brain Injury (TBI) to be a worldwide menace that cuts across all the continents. In Egypt, injuries burden is significant, as it was the fifth leading cause of death in 2004. Progressive intracranial haemorrhage (PIH) is a common occurrence in patients with intracranial haemorrage (ICH) that increases the probability of secondary injury to the brain. The prognosis is worse with patients with PIH.
The aim of this study is to determine the incidence of PIH in patients with TBI and the potential risk factors that cause PIH.
The study consisted of 91 patients admitted to the emergency department of Alexandria University with intracranial haemorrage from July 2022 to December 2022.
Three head CT scans were done to the patients within a period of 24 hours. The 1st CT was taken at admission, 2nd taken at 4-8hrs and 3rd at 24 hrs after admission. The volume of the haematoma was calculated using the Tada fomular V= a × b × c × 1/2, where ‘V’ represents hematoma volume; ‘a’ indicates the diameter of the largest area of the hematoma layer; ‘b’ shows the upright diameter of the diameter of the largest area of the hematoma layer, and ‘c’ is the layer thickness. History and physical exam was done and past medical history including medication history was taken. Coagulation profile and a complete blood count was done including liver function tests (LFTs). Patients were followed up with CT scans and GCS assessment.
We demonstrated that the incidence of PIH was 38.2% with 35 patients having increase in ICH. The most common cause of ICH and subsequently PIH was RTA. The number of patients with PIH who were more than 40 years was 15 (56.5%) and 5 (71.4%) at 4-8hrs and 24hrs respectively. Newly diagnosed hypertensive patients and those who were non-compliant to antihypertensive medication were found to be at risk of PIH with 7(25%) at 4-8 hrs and 4 (57.1%) of cases at 24hrs. Patients suffering from heart disease and on aspirin were at risk especially by 24hrs, with 4 (28%) of them exhibiting PIH. It was also shown that, patients with combined lesions and those with SAH are at risk with 5(17.1%) and 7(25%) respectively having PIH. We also found that the number of patients who had PIH with increased PTT were 9(33.3%), PT 16(57.1%) and INR 13 (46.4%) .
The age of the patient, history of hypertension, heart disease, use of aspirin, non-compliance to hypertensive medication, subarachnoid haemorrage, combined haemorragic lesions, PTT, PT, and INR were found to be statistically significant for the assessment of risk factors for PIH. About thirty percent of the increase in PIH occured within the 1st 4-8 hrs of injury. The GCS, site of trauma, gender presence of a fracture and brain oedema did not have any statistical significance.
In conclusion, the incidence of PIH is high and under reported, especially, if the 1st CT is done after 4 hours. A previous history of hypertension, non-compliance to medication and patients with heart disease on aspirin are a risk factor to PIH. SAH and deranged coagulation profile should be viewed as a risk factor to PIH.