急性硬膜下血腫에 對한 臨床的考察 = The Clinical Observation on the Acute Subdural Hematoma

다국어 초록 (Multilingual Abstract)

Acute Subdural Hematoma is the one which neurosurgeons encounter commonly in severe head injuries and needs emergency surgery. But the fact that the mortality of it is still very high (60-90%), inspite of the recent improvement of the technique of anesthesia, transfusion, and the use of drug which could reduce the intracranial pressure such as mannitol and steroids, is disheartening to all neurosurgeons.
In my country, the acute subdural hematoma has been recognized and treated since the 1950th, by neurosurgeons and sporadic reports for the subdural hematomas which included acute, subacute and chronic forms has appeared. Nevertheless, the report of the collected acute subdurall hematomas is rarely seen. The reason is felt that the illness is quite common around us but the mortality is so high to make the report be delayed.
The authors have treated 40 cases of surgically confirmed acute subdural hematomas during 18 months from April 1969 to Sept. 1970 and as observed clinically.
Followings are the results.
1) The sex incidence showed Male, 3 to Female 1, and age incidence ranged 5 years of age to 70 years. But it was most common in 3rd decade to 5th decade.
2) Most common mode of injury was traffic accident(27 cases) and there were 8 cases of falling accident and 5 cases of direct batting over the head by blunt materials.
3) There were no lucid intervals in 3/4 of the cases but in 11 cases, the lucid interval could he seen. Most common pupillary change was ipsilateral mydriasis(28 cases). Bilateral mydriasis were in 2 cases and others showed miotic or normal pupils. Bilateral positive Babinski's signs were noted in 22 cases and there were 3 cases of positive unilateral Babinski's sign.
4) Site of the hematoma: Most common site of the hernatoma was temporo-parietal region. but there were 2 cases of confined frontal pole lesions and 2 cases of posterior fossa lesion. In 34 cases of 40, the site of hematoma was confirmed by carotid angiography and on the rest, direct surgery was performed without carotid angiography. There were 2 cases of bilateral: acute subdural hematomas.
5) Mortality 20 cases of 40, have survived. The age, level of consciousness, bilateral positive Babinski's sign, and intracranial and/or extracranial associated injuries were felt to be the influencing factor to the mortality. In 5 cases of 20 which expired, have died one month after surgery and the cause of death were intractable diabetes insipidurs, septicemia, pneumonia, acute renal failure and intractable convulsive seizure.
In survivors, hemiplegia, hydrocephalus, aphasia and mental deteriorations were observed which improved gradually except the 5 cases and 15 cases of 20 which have survived could remain to return to his usual daily activity.