만성뇌경막하혈종에 대한 임상적 고찰 = Clinical study on chronic subdural hematoma

다국어 초록 (Multilingual Abstract)

Chronic subdural hematoma is a relatively common disease which is practically always secondary to severe or minor injury to the head but may occur In connection with blood dyscrasias or cachexia in the absence of trauma. Early diagnosis and proper operative treatment result in complete recovery In most cases, but the outcome without operative treatment is almost invariably fatal.
During 1972 to 1975, 28 patients with chronic subdural hematoma were examined and operated in the Department of Neurosurgery, Korea University, and clinical observation and analysis were made particularly of the relationship of age to clinical and pathological findings.
Incidence of hematoma was predominated by men and estimated as 71.4% of total cases over the age group of 31 to 40 years and in the group of under 10 years were found in 3 cases. A history of craniocerebral trauma in varying degree was obtained In 23 cases(82%), and remainings had no history of it or any other illness.
The average time interval from trauma to operation was 31.7 days and it was shorter in the young patients who had more evidence of increased intracranial pressure.
The prevalence of the most commonly encountered symptoms and signs, especially in different age groups were analyzed. Headache was by far the commonest symptom in this series, being present in 20(71.4%) vomiting in vomiting in 15(53.6%), hemiparesis in 13(16.4%) speech disturbance in 5(18%), papilledema in 16(57.2%), and convulsion in 2(7.14%). There was a tendency that young patients had headache more frequent and severe than the older patients, while mental symptoms, such as somnolence, confusion, and memory loss were significantly more frequent in the older age group. Hemiparesis and other pyramidal tract signs were more frequent in the older age group.
Leukocytosis in peripheral blood was investigated in 75% of cases and roentgenograms of the skull showed evidence of a linear fracture in 10 of the total cases. Carotid angiograms were of diagnostic value in that they demonstrated a lentiform shaped avascular zone by in 28% and a crescent shaped-one in the remainders by an inward displacement of the terminal branches of the middle cerebral artery.
The hematomas were most frequently found in the parietotemporal region. The thickness of the hematomas as measured from angiograms increased with the age of the patient. On]y 1 of 28 cases died of reaccumulation of blood in the subdural space and bleeding in the gastrointestinal tract following the operation. Excellent recovery following operation is obtained in 82% of the cases at the time of discharge from hospital.