Traumatic spreading depression syndrome. Review of a particular type of head injury in 37 patients

Abstract

From 1476 hospital admissions with head injury, 37 patients were selected on the basis of distinctive clinical features which appeared to share a single and benign aetiology. In head injuries of this type, transient neurological disorders resulted from trivial or rather mild head injuries. These disorders, which included headache, nausea and vomiting, pallor, somnolence, irritability and restlessness, stupor, hemiparesis and aphasia, appeared after a lucid interval which was usually less than two hours; then the patient either recovered, or went on to develop convulsive attacks. Recovery without convulsions was usual in children and adolescents; convulsions occurred both in infants and younger children. The symptoms were not attributable to cerebral compression but were probably due to a self-limiting cortical phenomenon. It appears that convulsive attacks occurring within a few hours of this type of head injury may not be significant as precursors of post-traumatic epilepsy. It is suggested that there is a close relation between the convulsive attacks and the non-convulsive symptoms seen in this type of injury and that both are based on a common process which has the characteristics of the spreading depression of Leão. This type of head injury should be classified as a distinct clinical entity, in which no surgical treatment is required and the prognosis is good.