小児急性外傷性頭蓋内血腫 : 1 総説

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Eighty two clinical cases of acute intracranial hematoma due to apparent head injury were examined and treated in past 10 years. These clinical cases were analyzed based on clinical history, type of trauma, symptomatic signs and methods of their treatment. It is strongly suggested that the acute subdural hematoma should be reclassified on the basis of its mode of clot formation and not to confuse with post traumatic subdural liquid collection, in rather chronic form. Acute subdural hematoma which predominantly occur in male, was experienced on 40^<-1>clinical cases and it was classified in type I & type II. Type I acute subdural hematoma occurs following a rather mild injury such as fall on floor without fracture. This type is frequently seen in infants of approximately 10 to 14 months of age. A rather huge clot is usually found in frontal area probably due to a tear of a large vein in the frontal lobe. No severe primary brain damage is associated and operative results are usually good. Type II are always accompanied with some degree of brain damage and traffic accidents were the most frequent cause. Post operative results were varied in accordance with degree of primary or secondary brain damage and even with extensive external decompressive craniectomy, their prognosis were poor in some cases. Extradural hematoma was experienced on 40 cases and 8 of them were under the age of 2. An initial loss of consciousness was absent in most of cases which made the diagnosis very difficult, thus delay in surgical operation or in referral to the neurosurgeons was experienced. Fractures were found in parietal area in more than 90% of cases therefore a burr hole in parietal area as an initial operative procedure is suggested. Local neurological findings were absent in 12 cases out of 40 and the most predominant clinical signs were paleface with pre-shock state, repeated noxious vomiting and consciousness disturbance.
日本脳神経外科学会の論文

小児急性外傷性頭蓋内血腫 : 1 総説

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