A Study of Patient who Developed a Traumatic Delayed Contralateral Hematoma after Decompression of a Traumatic Intracranial Hematoma.
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概要
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Six patients with intracranial hematomas developed new hematomas on the contralateral side following decompressive surgery for the initial lesion. This entity was named "traumatic delayed contralateral hematoma" (TDCH). In a typical case the patient displays an ipsilateral linear fracture after striking the side of the head, with development of a hematoma on the contralateral side. In the present series most patients were struck near the midline and plain skull films revealed fractures across the cranium, involving a dissociation fracture or linear fracture along the midline. In the reported cases, the first CT scan was taken within about 3 hours after the injury. The initial hematomas were acute epidural hematoma and acute subdural hematomas in almost equal numbars. In our series, cerebral edema, traumatic subarachnoid hemorrhage and cerebral contusion were seen on the side contralateral to the primary lesion. Most TDCH patients reported in the literature showed severe disturbance of consciousness. All 6 patients in the present series were comatose and 3 had no lucid intervals. The first surgical procedure was generally performed within 4 hours after the trauma and cerebral edema was generally seen during the procedure. In cases reported in the literature, findings according to the Grasgow outcome scale were severe disability or less in approximately 50%. The outcome of TDCH is naturally related to the complicating brain damage, progression of neurological deficit, and time until the secondary operation, so to improve the outcome of TDCH, it is necessary to anticipate the development of a secondary hematoma at the time of the first operation, and rapid and adequate countermeasures should be taken if a TDCH has formed.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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