CT時代における頭部外傷直後の治療の再考察 : 硬膜外血腫再出血例4例に基づいて

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In the treatment of head injuries, before the CT scan was generally used, the level of con-sciousness had long been considered to be of utmost importance in evaluating the clinical condition of patients, especially to differentiate intracranial hematoma. CT scan provides a very useful ar-mamentarium for finding the intracranial pathology easily and safely. In three cases a very thin epidural hematoma, shown on the initial CT examination taken several hours after the trauma, had increased in size to such an extent that surgical intervention was necessary, and in one case, evacuation of an acute epidural hematoma on one side resulted in a massive epidural hematoma on the opposite side. In the two cases, hypertonic solution was given at another hospital after CT examination which revealed a very thin epidural hematoma. Both pa-tients were reported to be alert then. After episodes of frequent vomiting, followed by a restless state in one case, their consciousness dropped to a semicoma. A second CT was taken immediately after the deterioration, to reveal a massive epidural hematoma. A patient, who was alert on admission and had a very thin intracranial clot on CT, taken 80 minutes after the trauma, vomited frequently during the routine X-ray examination and deteriorated rapidly into a semicomatous state with anisocoria 70 minutes after the initial CT examination. A massive epidural hematoma was noted in the second CT. Judging from the chronological sequence of the head injury, namely, initial CT examination, deterioration, and confirmation of a large amount of intracranial blood clots, it was obvious that bleeding started again after the initial CT examination, resulting in the massive hematoma. It is reasonable to assume that in certain cases bleeding may start by acute lowering of the intracranial pressure, as well as by elevation of blood pressure and/or extensive fluctuation of intracranial pressure in patients who are restless and/or vomit frequently. In order to avoid any possible development of hazardous hematoma in those in which intracranial surgical lesions have been ex-cluded by the initial CT examination, heavy sedation and use of effective antiemetics should be us-ed, even if such medication would mask the level of consciousness. The latter disadvantages are well counteracted by repeated CT examination. Hypertonic solutions should not be given at the early stages of the head injury, unless cerebral herniation seems to be urgent.
社団法人日本脳神経外科学会の論文
1984-02-15

CT時代における頭部外傷直後の治療の再考察 : 硬膜外血腫再出血例4例に基づいて

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