A CT scan is performed on this patient. Which of the following statement(s) is/are true concerning the findings on CT scan and the patient’s management?

a. The CT finding that correlates most significantly with intracranial hypertension is compression or obliteration of the basilar cisterns 

d. Intracerebral hematomas are routinely treated with craniotomy

The CT finding which correlates most significantly with intracranial hypertension is compression or obliteration of the basilar cisterns. Not only does this finding portend a stormy intracranial pressure course, but the primary predictor of outcome in patients with this CT picture is the peak level intracranial hypertension occurring during the first 72 hours. Intracranial pressure monitoring should be immediately initiated in any patient with cisternal compression and the intracranial hypertension should be vigorously treated. Intracerebral hemorrhage and cerebral contusion are common after trauma and are readily visualized on CT scan. Brain contusion appears as a focal, heterogeneous density with hemorrhage interspersed with injured tissue. Intracerebral hematomas are generally more homogeneous in their high density appearance. These lesions tend to “blossom” over time due to continued hemorrhage and the development of edema. Therefore, it is important to closely observe and monitor the ICP of such patients because a significant and hazardous mass effect may evolve, requiring surgical extirpation. Cerebral contusions and intracerebral hematomas are treated operatively only when a mass effect results in intracranial hypertension or signs of herniation.