高齢者の急性硬膜下血腫—特に軽微な頭部外傷で発症した症例の検討

Acute Subdural Hematoma Caused by Mild Head Trauma in the Aged

I．はじめに

　高齢者の外傷は頻度の上からは若年者に比べて少ない．しかし，平均寿命の延長に伴い次第に人口の高齢化が進行し，高齢者の頭部外傷も増加の傾向にある．高齢者の頭部外傷は，高齢者の特殊性のため，その臨床病態は成人のものとは異なるとされている^10,20）．従って，高齢者の頭部外傷の治療に際しては，高齢者に特有の生理学的ないし病理学的特殊性をよく認識しておく必要がある．高齢者では精神，身体機能の退化に基づく発症機転によるものが多く，わりあい軽度の外傷でも重症化する症例が多く見られる．今回われわれは，比較的軽微な頭部外傷により発症した高齢者の急性硬膜下血腫について臨床的に検討を加えたので報告する．

We encountered 8 cases of acute subdural hematoma caused by mild head trauma in the aged. In this report, these cases were analyzed, taking into consideration clin-ical symptoms, CT scan, operative findings and out-come. The age ranged from 70 to 92 years (mean age of 79.7 years). 4 patients were male and 4 female. Head trauma was caused by falls in 4 patients, but in the other 4 patients the causes were unknown. Initial symp-toms were headache, nausea and vomiting in 5 patients and mild disturbance of consciousness with lucid inter-vals in 3 patients. Seven patients had more than 100 on JCS and less than 9 on GCS on admission. Small cra-niotomy (HITT) was performed in 4 patients. Large craniotomy was performed in 2 patients, and decom-pressive craniectomy was carried out in 2 patients. The bleeding focus came from the cortical artery of the mid-dle cerebral artery in 4 patients, cerebral contusion in 2 patients, and was unknown in 2 patients for HITT. CT scan on admission showed mixed density area of acute subdural hematoma in all of the patients, and in-traventricular hemorrhage, intracerebral hemorrhage and subarachnoid hemorrhage in 3 patients. CT scan after operation revealed a new area of cerebral contu-sion in 3 patients, delayed traumatic intracerebral hematoma (DTICH) in 2 patients, and hypertensive in-tracerebral hemorrhage in 1 patient. Two patients reco-vered to good and fair- without general complication. But the outcome in 5 patients with general complication was poor for 3 patients and fatal for 2 patients. In con-clusion, large craniotomy is recommended because of bleeding from the cortical artery of the middle cerebral artery. To ensure a good outcome, diagnosis of acute subdural hematoma should he made at an early stage before the patients condition deteriorates.