Delayed traumatic intracerebral hematomas: 'Spat-Apoplexie'. Report of two cases

Two patients who suffered a head trauma experienced sudden clinical deterioration more than 1 week after their injury. The initial computerized tomography (CT) scan demonstrated a small hematoma underlying a depressed skull fracture in one patient and a small interhemispheric subdural hematoma in the other. Both patients had made a complete recovery and follow-up CT scans were normal when clinical deterioration suddenly occurred. Both patients developed a large intracerebral hematoma and underwent emergency evacuation of the mass. The first patient recovered with the exception of a moderate hemiparesis and dysphasia, but the second patient died. Delayed traumatic intracerebral hematomas have been described in the literature. Since the advent of CT scanning, the incidence of this phenomenon has been estimated as between 1.7% and 7.4% of closed head injuries. In 1981, Otto Bollinger described four patients who suffered head injury, followed days to weeks later by death from an apoplectic event. His criteria for diagnosis of 'traumatische Spat-Apoplexie' included the absence of preexisting vascular disease, a definite history of trauma, an asymptomatic interval of at least several days, and an apoplectic episode. These two cases reemphasize the existence of Spat-Apoplexie as a rare clinical condition. In the presence of CT findings of even small traumatic intracerebral or extracerebral hematomas, the possibility of this late complication should be kept in mind.