乳幼児急性硬膜下血腫の検討

INVESTIGATIONS OF ACUTE SUBDURAL HEMATOMA IN INFANCY

Ｉ．緒言

　最近頭部外傷患者の激増とともに，乳幼児の頭部外傷もしだいに増加しつつある。従来小児の頭部外傷は成人のそれと原則的には同一のものであるといわれてきたが，乳幼児についてみると，外傷機転，発症経過，後遺症などについて，種々さらに検討すべき余地があると考える。特に乳幼児の急性硬膜下血腫に関しては，われわれが最近経験した症例の検討により，上記事項，特に後遺症に関してきわめて重視すべき看過できない問題があることに気がついたので報告する。

Eight cases of acute subdural hematoma in in-fancy experienced in our clinic recently were re-ported. Especially the mental complication due to cerebral atrophy which was revealed on the followup studies was emphasized in this paper.

All of them had a bagattele head trauma on the occipital region as a cause of this disease.

After the head trauma, they cried hardly and were looked a pale, then lost the consciousness fol-lowing by convulsive seizure. Such onset and course are characteristic on acute subdural hematoma in infancy.

As the head trauma is very bagattele, one is apt to give misdiagnosis for this patients as epileptic seizure, encephalitis, memingitis and or dyspepsia etc.

Six cases of them had the retinal hemorrhage on the ophthalmoscopic findings, and the thin avascular area over the cortex was revealed in five cases out of eight cases by carotid angiography.

Two cases died postoperativelly in spite of the emergency operation. On the other six cases ab-normal electro-encephalogram meaned the cerebral atrophy were revealed by the followup studies.

On three cases out of four cases that the hemato- ma removed surgically after twelve hours of onset, the severe cerebral atrophy were formed not only by EEG but pneumoencephalography, carotid an-giography and or operative findings, and they be-came severe mental retarded children.

We think that the acute subdural hematoma in infancy might be a causal effects of the mental retardation and or cerebral atrophy.