頭腔内血腫における受傷から死亡までの時間と損傷の程度について
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In recent years much attention has been paid to external injuries of the head, especially to intracranial hematoma. With the advancement in its diagnosis and treatment, effective treatment is gradually being exercised. In intracranial hematoma, differing from direct lacerations of the brain, hematoma and accompanied edema compress the brain stem, and this leads to death. Thus, early removal of hematoma is absolutely necessary in order to decrease the effect of edema.<BR>In the case of intracranial hematoma, it is believed to be important to find out the time involved from the early stage of its formation until death to promote proper treatment and from the point of legal medicine. Thus, statistical observation was made of deaths caused by intracranial hematoma among deaths caused by external injuries which occured during the 16 year period, from 1951 to 1966. The time involved until death occurred was as follows :<BR>1. Total number of cases observed : 560 with 459 cases in male (82 %) and 101 cases in female (18 %) . Epidural hematoma (hereafter referred to as E. D. H.) consisted of 184 cases (33 %) ; subdural hematoma (hereafter S. D. H.) 338 cases (60 %) ; cases of the above two combined numbered 38 (7 %) . In this report the last is omitted due to its small number.<BR>2. In these cases, ages range from 3 months old to 90 years old. In general, the youth and middle-age groups were the most affected. S. D. H. quite frequently was found in infants less than 4 years old and those more than 60 years old while deaths from E. D. H. were found to be extremely few among infants and old-age groups.<BR>3. Time involved from injury to death : The shortest is 25 minutes while the longest is 165 days (S. D. H.) . Some 60 % died within 24 hours while 74 % died within 48 hours.<BR>4. Time until death, depending on the severeness of intracranial hematoma : Those suffering from a severe case died shortly, but in the case where hematoma existed in the basal region of the brain or the occipital region, time until death was short even with a slight injury.<BR>5. Death and position of hematoma : In most of the cases hematoma was observed in the temporal region (E. D. H. 64 % ; S. D. H. 56 %), followed by the frontal, occipital, basal and parietal regions, in order. When hematoma existed in the basal region or the occipital region, time until death is short as compared to other regions. It is believed that this is due to immediate effect on the brain stem.<BR>6. Injured region and hematoma : In the case of E. D. H., some 2 % died with hematoma existing on the opposite side from the injured region while for S. D. H. it was 17 %.<BR>7. Death and contusion of the brain : Some 53 % died from contusion of the brain (chiefly limited to cortex region) combined with E. D. H. or S. D. H. It is believed that death is related more with the scope and degree of contusion rather than the effect on the region.<BR>8. Death and fracture of a bone : Some 85 % died from E. D. H. combined with fracture of a bone and 44 % from S. D. H. and fracture. It is natural that there is more death occur ring from E. D. H, but time is short according to the region of the fracture, such as the base of the skull, temporal bone or occipital bone. In the case of front bone, time is comparatively long.<BR>9. Death and lucid interval : Some 70 % died with lucid interval in E. D. H. and 75 % died within 24 hours regardless of contusion or not. Some 46 % died with lucid interval in S. D. H. and death arrived within 24 hours for 67 %. Contusion of the brain also contributed 1o death while those without contusion consisted of 45 %.
- 学校法人 昭和大学・昭和医学会の論文