Traumatic brain injuries are present in emergency settings persistently. They are of concern regarding intracranial hemorrhage events and their subsequent complications, among which brain death is the end of the clinical scenario. However, 70-80 percent of head traumas are benign with no damage to the brain or function, relief spontaneously by conservative interventions [4] [3].
Head trauma is more prevalent among patients aged 21-30 years old and is of concern due to its higher incidence in past years [15]. Intracranial hemorrhages consist of many types, including epidural hemorrhage (EDH), subdural hemorrhage (SDH), subarachnoid hemorrhage (SAH), and intraventricular hemorrhage (IVH). Head traumatic hemorrhagic lesions can also be accompanied by contusion or midline shift, worsening the clinical prognosis. Assessments of the patient include Glasgow Coma Scale (GCS) assessment and the brain CT scan to diagnose the type of hemorrhage [6,13,8,2,10,14].
According to the Uniform Determination of Death Act (UDDA) guideline; it states that brain death diagnosis is an irreversible absence of brain function caused by lesions involving the entire brain. Bedside examinations for confirmation of brain dead include loss of responsiveness, movement, and brain stem reflexes that confirm the patient's comatose state. It should be kept in mind that the consumption of sedative drugs, hypothermia, hypotension, or metabolic disturbances must be excluded or corrected initially before making the brain-dead diagnosis. Apnea test assesses the brain stem function in detecting the absence of respiratory drive [11]. Insufficient blood supply to the brain is considered critical paraclinical evidence approving the brain death event [7]. Brain CT angiography (with a sensitivity of 85.7 %) is superior to CT scan (with a sensitivity of 76%) in the diagnosis of brain death; however, CT scan is a useful tool in making the diagnosis [12,5].
According to health data reports of the global burden of diseases, subarachnoid hemorrhage (a prevalent type of intracerebral hemorrhage (ICH)) consists of 0.47 percent of the leading causes of death in Iran and 0.8 percent of death's leading causes globally. DALYs of subarachnoid hemorrhage reported with the rate of 61,014.08 years in Iran and 12,403,459.25 globally in 2017; indicated the enormous emotional and economic burden of intracranial hemorrhages affecting the involved families [1].
Considering unusual complications arising from traumatic brain injuries on patients, the early detection and the required interventions according to the type of cranial hemorrhage predict the clinical outcome and final prognosis. It would be sufficient to decrease the occurrence rate of brain death as the end-stage brain injury. Unfortunately, few reports are available regarding different types of cranial hemorrhages, leading to brain death events in head trauma patients. Here we have assessed the prevalence of different types of intracranial hemorrhages, which have led to brain death in head trauma patients.