著者

栗原 まな 小萩沢 利孝 吉橋 学 飯野 千恵子 安西 里恵 井田 博幸

出版者

一般社団法人 日本小児神経学会

雑誌

脳と発達 (ISSN:00290831)

巻号頁・発行日

vol.43, no.4, pp.285-290, 2011 (Released:2014-12-25)

参考文献数

18

被引用文献数

5

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16歳未満で急性脳症を発症し, 当科でリハビリテーションを行った103例の予後を検討した. 対象を(1)群 : 代謝異常に起因する1例, (2)群 : サイトカインストームに起因する24例, (3)群 : けいれん重積型68例, (4)群 : 難治頻回部分発作重積型5例, (5)群 : 意識障害が主体である5例に分類し, 発症年齢, 既往歴, 発症に関連する因子, 後遺症の状況を検討した. 発症年齢は平均3歳であったが, (4)群は平均6歳5カ月と高かった. 既往歴では熱性けいれん, 喘息, theophylline服用が目立ったが, 有意差は得られなかった. 発症に関連する因子としてはインフルエンザ罹患36例, HHV-6罹患7例などがあった. 後遺症は知的障害89.3%, 高次脳機能障害77.7%, てんかん68.9%, 運動障害27.2%の順に多く, 重症度は(1)(2)(3)(4)(5)群の順に軽度になっていた. 高次脳機能障害では注意障害, 視覚認知障害などがみられた.

著者

栗原 まな 宍戸 淳 吉橋 学 藤田 弘之 小萩沢 利孝 井田 博幸

出版者

一般社団法人 日本小児神経学会

雑誌

脳と発達 (ISSN:18847668)

巻号頁・発行日

vol.46, no.4, pp.265-269, 2014 (Released:2014-12-25)

著者

栗原 まな 吉橋 学 飯野 千恵子 安西 里恵 田辺 仁彦

出版者

一般社団法人 日本脳神経外傷学会

雑誌

神経外傷 (ISSN:24343900)

巻号頁・発行日

vol.46, no.2, pp.70-77, 2023-12-10 (Released:2023-12-18)

参考文献数

10

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Objective: Traumatic brain injury (TBI) resulting from a traffic accident is not so common in young children. We reviewed our experience to clarify the status for further medical care.Methods: Nineteen patients aged under 7 years with severe TBI caused by traffic accidents underwent inpatient rehabilitation in our hospital between 1993 to 2010, and were followed up until after age 18 years. We retrospectively investigated the causes of injury, treatment during the acute stage, and outcomes including physical disability, intellectual disability, higher brain dysfunction, and epilepsy, and family functioning. The patients were divided into 4 groups by outcome: group I (7 cases) were independent, group II (2 cases) participated in "employment of persons with disabilities", group III (6 cases) had employment that required support, and group IV (4 cases) required full assistance for all activities of daily life. Clinical factors were compared between the 4 groups. The change in severity for each patient at 7, 13, and 18 years of age was assessed.Results: Average age at injury was 5 years in all 4 groups. Many accidents such as jumping into the road, not wearing seat–belt, and so on seemed to be preventable by adult intervention. The outcome worsened depend­ing on the depth and extent of loss of consciousness. Contusion was most prominent type of brain injury in all groups. Focal damage was prominent and diffuse damage was not seen in group IV. No infarction was found in groups I and II. Neurosurgical treatment was prominent in groups III and IV. Limited help for higher brain dysfunction was required in group I. Some support for higher brain dysfunction and mild mental disability was necessary in group II. Individual support programs for intellectual disability and higher brain dysfunction were necessary in group III. Full support for all daily life was essential in group IV. The severity of disability was gradually im­proved in most patients, but a few in group III showed regression due to intractable epilepsy and bad family functioning.Conclusion: Nineteen young patients with severe TBI caused by traffic accident were examined. Prevention of traffic accidents is the most im­portant intervention. Moreover, good programs to support higher brain dysfunction and family care are the keys to better outcome.