Nigam et al reported a grading system for temporal lobe contusion based on findings seen on a brain CT scan. The grade can help to guide management. The authors are from multiple hospitals in India.
Exam: brain CT within 6 hours
Patient selection: evidence of a temporal lobe contusion
Parameters for temporal lobe contusion grading:
(1) size relative to the temporal lobe
(2) location
(3) ambient cistern
(4) associated injury
Parameter
Finding
Points
size
< 25% of temporal lobe
1
25 to 50% of temporal lobe
2
> 50% of temporal lobe
3
location
polar, lateral
1
posterior
2
medial
3
ambient cistern
open
1
partially seen
2
obliterated
3
associated injury
none
1
contusion of contralateral temporal lobe
3
contusion elsewhere
2
diffuse axonal injury
4
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 4
• maximum score: 13
Score
Grade
Common Management
4
1
conservative
5 to 7
2
conservative or delayed surgery
8 to 13
3
surgery (decompressive craniotomy, evacuation of the contusion)
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