Introduction: A routine CT examination is not able to disclose the development of brain ischemia in an early reversible stage after the severe head injury. The aim of this work was to show the disturbances of perfusion in an early phase after the head trauma using perfusion brain scintigraphy (brain SPECT) and to use the most effective treatment. Methods: Patients after the severe head trauma with the syndrom of transtentorial herniation were involved in the study. The first and fifth postoperative day we performed CT and SPECT. The relationship between the finding of ischemia on CT and SPECT and the overall treatment results (Glasgow Outcome Score) were evaluated. Results: Brain ischemia was present in 10 patients (28%) on the first CT postoperative examination. In 8 of them (80%) there was an unfavorable result. There was brain ischemia in 33 patients (92%) on the first SPECT. In 14 of them (42%) there was an unfavorable result. Normal SPECT was only in 3 patients and all of them had a favorable result. Seventeen of 33 patients with ischemia on the first SPECT (52%) had improvement of perfusion on the second SPECT examination. Out of these 17 patients there were 16 (94%) with a favorable result. The same or more severe ischemia on second SPECT was observed in 16 (48%) patients. Only 3 of them (19%) had a favorable treatment result (Fischer exact test, p < 0.05).Conclusion: The development of brain ischemia was the most dominant pathophysiological mechanism, which was decissive for the treatment result of our patients. An early finding of decreased cerebral perfusion after the severe head trauma using SPECT leads to improved treatment results of these patients.

        Key words: severe head injury – brain ischemia – perfusion brain scintigraphy – SPECT