乳幼児慢性硬膜下血腫 : 乳幼児急性硬膜下血腫(中村I型)の役割

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Infantile acute subdural hematoma is clinically characterized by generalized convulsions, preretinal hemorrhage and bulging fontanelles occurring shortly after mild head injury mostly in infancy and in early childhood. In its mild form, the patient stays awake, though more or less irritable for several days, and mostly passes undiagnosed unless subdural tapping is performed. In its severer form, the patient lapses into a stuporous or comatose state with hemiplegia and/or other grave signs and sometimes dies. It is said that the majority of infantile chronic subdural hematomas originates from infantile acute subdural hematomas, although there are few documented cases reported as such. Four cases of infantile chronic subdural hematomas with a precedent history of infantile acute subdural hematomas were presented. Case 1 was a 14 month-old boy with CT and surgical evidence of bilateral chronic subdural hematoma. At the age of 9 months he had had a history of mild head injury followed by an immediate convulsion and a bulging fontanelle. Case 2 was a 15 month-old boy with the left hemiplegia and CT evidence of the right chronic subdural hematoma and of the right calcarine infarction. At the age of twelve months, he had had a mild occipital head injury followed by an immediate convulsion and disturbed consciousness. Case 3 was a seven month-old boy with CT evidence of bilateral subdural hematoma which was evacuated surgically. Three weeks prior to this, he fell down followed by an immediate convulsion and preretinal hemorrhage. CT taken two hours posttrauma documented the presence of an acute bilateral subdural hematoma. Case 4 was a twelve month-old girl with CT evidence of a left chronic subdural hematoma biconvex in shape. At the age of eight months, she had had a mild head injury followed by vomiting and a generalized convulsion. CT examination at that time was reported to show a thin acute subdural hematoma. This, however, had been considered thin enough to be treated conservatively. CT taken one month and two months, respectively, after the trauma showed widened low density areas over both hemispheres as well as prominent sulci and enlarged ventricles. These were mis-interpreted to indicate "brain atrophy". The four cases of infantile chronic subdural hematomas reported here all had clinical evidence strongly suggestive of the presence of the preceeding acute subdural hematoma. One of them, moreover, had CT documentation of its presence. It may be concluded that infantile acute subdural hematoma, if untreated or neglected, is an important etiology of infantile chronic subdural hematoma.
日本脳神経外科学会の論文
1981-06-15

乳幼児慢性硬膜下血腫 : 乳幼児急性硬膜下血腫(中村I型)の役割

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