Objective: To investigate the clinical typing and prophylactico-therapeutic measures for acute posttraumatic brain swelling (BS).Methods: A retrospective study was performed in 66 cases of acute posttraumatic BS. There were 3 groups based on computered tomography (CT) scanning: 23 cases of hemisphere brain swelling (HBS) with middle line shift for less than 5 mm within 24 hours ( Group A), 20 with middle line shift for more than 5 mm (Group B ), and 23 with bilateral diffuse brain swelling (Group C).Results : (1) The mortality rates of the operative and nonoperative management in Group A, Group B, and Group C were 20.0%, 31.6%, and 75.0% versus 44.4%,0, and 85.7 %, respectively ( P ＞ 0.05 ); while the rates in subgroups with different middle line shift ( more than 5 mm and less or equal 5 mm) were 29.2% and 75.0% versus 75.0% and 44.4%, respectively (0.05 ＞P ＞0.01). (2) The good recovery rate and mortality in Group A were 47.8 % and 39.1%, respectively and in Group C, 8.7 % and 78.3%, respectively. There was a very significant difference between Group A and Group C (P ＜0.01). (3) The total survival rate of the selective comprehensive therapy was 53.1%.Conclusions : ( 1 ) Acute posttraumatic BS needs to be diagnosed correctly and promptly with CT scanning within 4 hours. (2) For patients with midline shift for more than 5 mm, especially with thin-layered subdural hematoma,surgical intervention is essential to reduce the fatality of acute posttraumatic BS.