著者

飯田 幸治 栗栖 薫 有田 和徳 右田 圭介 大庭 信二 岡林 清司 大谷 美奈子

出版者

Japanese Association for Acute Medicine

雑誌

日本救急医学会雑誌 (ISSN:0915924X)

巻号頁・発行日

vol.11, no.5, pp.225-230, 2000-05-15 (Released:2009-03-27)

参考文献数

13

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The case of a 20-year-old woman presenting with delayed, potentially fatal intracranial hypertension as a result of a head injury is reported. On admission, the patient had a Glasgow Coma Scale (GCS) score of 10. A brain CT scan showed an epidural hematoma in the left temporal region and a mild contusion of the bilateral frontal lobes. Two days after her injury, the patient's consciousness level suddenly deteriorated (GCS 4). Transcranial Doppler (TCD) examination disclosed a marked reduction (18cm/sec) in the velocity of the blood flow through the middle cerebral artery and a significant increase (2.11) in the pulsatility index. A second brain CT scan showed diffuse brain swelling but no changes in the size of the hematoma. The intracranial pressure (ICP) was 58mmHg. Although the cause of the acute brain swelling was unknown, moderate hypothermia therapy was initiated. The ICP was difficult to control during the hypothermia treatment but was maintained at above 20mmHg for most of the time. Hypothermia treatment was continued for 18 days before ICP control was regained. The patient was discharged with mild memory disturbances 4 months after admission. A literature, review has suggested that the TCD and ICP values of this patient could have been fatal. Thus, moderate hypothermia treatment may improve the outcome of potentially fatal intracranial hypertension.

著者

有田 和徳 魚住 徹 大庭 信二 中原 章徳 大谷 美奈子 三上 貴司 小林 益樹

出版者

一般社団法人 日本救急医学会

雑誌

日本救急医学会雑誌 (ISSN:0915924X)

巻号頁・発行日

vol.5, no.2, pp.192-196, 1994

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Case 1: A 46-year-old female was admitted with sudden onset of coma. CT scan revealed brain stem and bilateral thalamic infarction. On day 3, all brain stem function was absent, while an EEG showed slow-wave activity in the frontal area. Transcranial Doppler sonography demonstrated antegrade flow in the bilateral middle cerebral arteries. Cardiac arrest occurred on day 5. Case 2: A 59-year-old male was admitted in a comatose state. A CT scan revealed a large cerebellar hematoma. Removal of the hematoma and drainage of lateral ventricle were performed, but the patient never regained brain stem function. On days 13 and 14, his condition satisfied the criteria for brain death proposed by the Japanese Ministry of Health and Welfare, except for the persistent EEG activity. Cerebral blood flow studies showed adequate blood flow in both supra and infra-tentorial regions. EEG activity was also observed on day 19. The patient experienced cardiac arrest on day 30. A state of isolated brain stem death, cessation of brain stem function accompanied by persistent EEG activity, may result from a severe cerebrovascular accident in the posterior cranial fossa. This state is usually transient, leading to total brain death, but it may continue for several days when lateral ventricular drainage is performed.

著者

有田 和徳 魚住 徹 大庭 信二 中原 章徳 大谷 美奈子 三上 貴司 小林 益樹

出版者

Japanese Association for Acute Medicine

雑誌

日本救急医学会雑誌 (ISSN:0915924X)

巻号頁・発行日

vol.5, no.2, pp.192-196, 1994-04-15 (Released:2009-03-27)

参考文献数

6

被引用文献数

2

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Case 1: A 46-year-old female was admitted with sudden onset of coma. CT scan revealed brain stem and bilateral thalamic infarction. On day 3, all brain stem function was absent, while an EEG showed slow-wave activity in the frontal area. Transcranial Doppler sonography demonstrated antegrade flow in the bilateral middle cerebral arteries. Cardiac arrest occurred on day 5. Case 2: A 59-year-old male was admitted in a comatose state. A CT scan revealed a large cerebellar hematoma. Removal of the hematoma and drainage of lateral ventricle were performed, but the patient never regained brain stem function. On days 13 and 14, his condition satisfied the criteria for brain death proposed by the Japanese Ministry of Health and Welfare, except for the persistent EEG activity. Cerebral blood flow studies showed adequate blood flow in both supra and infra-tentorial regions. EEG activity was also observed on day 19. The patient experienced cardiac arrest on day 30. A state of isolated brain stem death, cessation of brain stem function accompanied by persistent EEG activity, may result from a severe cerebrovascular accident in the posterior cranial fossa. This state is usually transient, leading to total brain death, but it may continue for several days when lateral ventricular drainage is performed.