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Brain and Nerve No to Shinkei Volume 24, Issue 8 （August 1972）

Brain and Nerve 脳と神経 24巻8号（1972年8月発行）

Japanese English

研究

乳幼児の硬膜下血腫—特に早期診断について SUBDURAL HEMATOMA IN INFANCY AND CHILDHOOD, WITH SPECIAL REFERENCE TO THE EARLY DIAGNOSIS 多淵芳樹 ¹ , 坂本敬三 ² , 小林憲夫 ² , 林一好 ² Yoshiki Tabuchi ¹ , Keizo Sakamoto ² , Norio Kobayashi ² , Kazuyoshi Hayashi ² ¹神戸大学医学部第一外科 ²兵庫県立こども病院脳神経外科 ¹Department of Surgery, 1st Division, Kobe University School of Medicine ²Department of Neurosurgery, Kobe Children's Hospital pp.1003-1014

発行日 1972年8月1日 Published Date 1972/8/1

DOI https://doi.org/10.11477/mf.1406203169

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Abstract 文献概要
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緒言

　兵庫県立こども病院開設以来，私共は1年2ヵ月の間に19例の乳幼児硬膜下血腫を経験した。この間本院の脳神経外科で入院治療をおこなつた症例は127例であり，そのうち硬膜下血腫（15％）は血腫以外の頭部外傷（I〜III型，31％）に次いで多かつたが，水頭症とほぼ同頻度であり，頭部外傷のなかに占める割合は33％（19／58）である（第1表）。病院の特殊性（入院はすべて医師の紹介による）もあるが，乳幼児の硬膜下血腫は私共がはじめに想像していた以上に多く，脳神経外科医また頭部外傷を取り扱う一般外科医にとつても重要な疾患であり早期に診断できれば，その予後は良いと考えられる。

　つぎに乳幼児の硬膜下血腫特有の経過をとつた症例，慢性硬膜下血腫2例と急性硬膜下血腫1例をあげ，私共の症例を中心にその症候・診断・治療および予後，特に早期診断の手がかりとしての縫合離開suture widening，Nahtsprengungについて述べたい。

Fourteen chronic and five acute subdural hema-tomas which were experienced for 14 months after Kobe Children's Hospital was opened, were studied.

The clinical characteristics, diagnosis, neurosurgi-cal treatments and prognosis of the subdural hema-toma in infancy and childhood, these are analysed in this paper.

The important 5 factors of the clinical character-istics are past history of the head injury and the bi th injury (69%), disturbance of the consciousness (54%), convulsion (61%) paresis (70%), and fever (70 %). The retinal bleeding of the chronic subdural hematoma is a few in incidence, and valuable sign, if it is presented.

The symptoms and signs of the chronic subdural hematoma in infancy and childhood were improved especially by the suture widening and this character-istic improvement corresponded to the time of the suture widening. This suture widening did not occur only in the chronic cases (95%), but also in the acute cases (100%), which were very usefull for the early diagnosis and treatments. If it is seen in the plain skull x-ray films, it must be angio-graphically differentiated from the space occupying lesion in the skull.

The neurosurgical treatments of the chronic sub-dural hematoma were, as following, in our cases.

1. frontal tapping, only……………………3 cases

2. burr hole or trepanation,only…………6 cases

3. 1+2……………………………………………2 cases

4. 3+majorcraniotomy…………………………1 case

5. 4+subdural peritoneal shunt……………2 cases

It was thought that its prognosis was very fair ; postoperative convulsion was seen in the 3 cases, pyramidal tract sign in one case and disturbance of the growth in one case. The other cases were normal neurologically, without sequelae.