著者

荻野 雅宏 中山 晴雄 重森 裕 溝渕 佳史 荒木 尚 McCrory Paul 永廣 信治

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.42, no.1, pp.1-34, 2019-08-20 (Released:2019-08-20)

参考文献数

58

---

【解説】「スポーツにおける脳振盪に関する国際会議」は2001年にウィーンで第1回会議が開かれたのち,近年は夏季オリンピックの年の秋に開催されており,第2回 (プラハ, 2004年),第3回 (チューリッヒ, 2008年),第4回 (チューリッヒ, 2012年) を経て,2016年にベルリンにて 「第5回国際スポーツ脳振盪会議」 が開催された。この国際会議の目的は選手の安全を確保することと,選手のコンディションを改善することであり,プロフェッショナル,アマチュアを問わず,スポーツで脳振盪を負った選手の状態を正しく評価し,安全にスポーツに復帰させることを目指すものである。さまざまな分野のエキスパートが討論を重ね,最終的に以下の共同声明 (consensus statement) を公開するとともに,声明の根拠となった系統的なレビュー12編24,25,i–x)を発表した。脳振盪を負った選手を評価する標準的ツールSport Concussion Assessment Tool (SCAT),5歳から12歳までの小児に用いるchild SCAT,非医療従事者が脳振盪を疑う際に用いるConcussion Recognition Tool (CRT) はそれぞれ,SCAT5,child SCAT5,CRT5へと改訂された。この共同声明 (McCrory P, Meeuwisse W, Dvoraket J, et al. Consensus statement on concussion in sport —the 5th inter­national conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 51: 838–847, 2017) や上記のツールはすべてWeb上で自由に閲覧でき,ダウンロードも可能である。関係者は原文にあたり,その内容に精通していることが求められるが,一部から公式な日本語訳を強く望む声があり,本学会のスポーツ脳神経外傷検討委員会の有志が,前版xi)の訳者らとともにこれにあたった。次回の改訂は2020年の秋以降に予定されているので,本稿が来る東京オリンピックならびにパラリンピックにおけるこの領域の基本的な指針となる。しかし本文中にもある通り,この共同声明は臨床的なガイドラインを目指すものでも,法的に正しい対処を示すものでもない。現時点における総論的な指針と考えるべきであって,個々のケースへの対応には,現場の裁量が認められていることを強調したい。

著者

大越 裕人 上條 貢司 畑下 恒寛 小林 郁夫

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.40, no.2, pp.113-116, 2017-12-20 (Released:2020-04-27)

参考文献数

11

---

Although chronic subdural hematomas usually affect elderly individuals, they sometimes affect young individuals. We present a case of 19-year-old male with a chronic subdural hematoma that occurred because of previous headbanging. During a rock concert, the patient was intensely headbanging, after which he experienced persisting headache, and his symptoms gradually deteriorated. He visited our hospital for a chief complaint of a headache. Brain CT revealed a right subdural hematoma, and he was urgently admitted. He was treated with emergency surgical drainage with a mass of hematoma. His postoperative status was pretty fair, and he was dis­charged on hospital day 8. Follow-up brain MRI showed an arachnoid cyst in the right frontal lobe, and the cyst was considered to be the cause of hematoma. To date, only two cases of headbanging-associated chronic subdural hematoma have been reported in western countries. To our knowledge, our patient is the first Japanese case.

著者

渡邉 瑞也 北村 高之 藤田 修英 鈴木 皓晴 杉山 夏来 清水 勇三郎 徳川 城治 中尾 保秋 山本 拓史

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.39, no.1, pp.37-40, 2016-08-10 (Released:2020-04-27)

参考文献数

16

---

A patient over 60 years old who had suffered gunshot wound to the head was transported to our hospital by emergency medical helicopter service. Computed tomography (CT) revealed the bullet had entered from the right parietal region, penetrated the brain, and lodged in the left parietal bone, leaving numerous bone and metal fragments scat-tered within the brain. Acute subdural hematoma (ASDH) on the left side had caused midline shift. Emergency decompressive craniectomy was performed to remove the hematoma and extract the bullet. Acute brain swelling occurred during dural closure, so evacuation of the necrotic brain and extensive duroplasty with artificial dura were also performed. Unfortunately, the patient died of central herniation the day after surgery. As gun ownership is strictly regulated under the Firearms and Swords Law, gunshot wounds are extremely rare in Japan. In particular, treatment of gunshot wounds to the head is hardly ever experienced. ASDH is rare after gunshot wound to the head, with only one case on the entry side, but the present case occurred on the opposite side to the point of entry. In general, ASDH is caused by tearing of the bridging veins in the subdural space and/or bleeding from the contusional brain. In the present case, the subdural hematoma on the opposite side to the point of entry was caused by continuous bleeding from the left parietal bone fracture extending into the subdural space through the dura tear.Knowledge of the treatment of patients with gunshot wounds to the head may become more important in the future in Japan. We report this case along with a review of the pertinent literature.

著者

川又 達朗 刈部 博 土肥 謙二 苗代 弘 平林 秀裕 村上 成之

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.30, no.1, pp.21-29, 2007-12-27 (Released:2022-06-27)

参考文献数

24

被引用文献数

1

---

In order to clarify clinical characteristics of "traumatic" intracranial hypotension (TIH) treated in Japan, 100 Japanese articles were reviewed and compared to 201 foreign articles. The results revealed the features of TIH in Japan as follows; 1) prolific numbers of the reported cases (227 cases) (foreign cases; 15 cases), 2) high incidence (69%) of traffic accident as a cause of injury (foreign cases; 20%), 3) long periods from injury to diagnosis; more than 1 year in many cases, 4) CSF leakage from lumber regions in vast majority cases (foreign cases: cervicothoracic regions; 91%), 5) fewer cases (55%) showing postural headache (foreign cases; 86%), 6) fewer cases (49%) showing dural enhancement on Gd-MRI (foreign cases; 93%), 7) fewer cases treated conservatively (foreign cases; 71%), 8) high numbers of blood patch procedure per patient, 9) lower cure rate (22%) by blood patch procedure (foreign cases; 100%). These results suggest that the clinical entity of TIH treated in Japan differs from that treated in foreign countries.

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

---

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.

著者

小野 健一郎 田之上 俊介 吉浦 徹 大川 英徳 松下 芳太郎 瀬野 宗一郎 城谷 寿樹

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.1, pp.6-11, 2023-06-30 (Released:2023-06-30)

参考文献数

12

---

Background: The purpose of this study was to clarify the criteria for initial treatment of chronic subdural hematoma (CSDH) by com­paring the backgrounds and post–treatment courses of patients who underwent drainage or middle meningeal artery (MMA) emboliza­tion for CSDH.Methods: We performed a retrospective investigation of 23 and 21 patients who underwent drainage and MMA embolization, respec­tive­ly, performed between April 2020 and July 2022 as initial treatment for unilateral CSDH.Results: There was no significant difference between the drainage and embolization groups in terms of age (78 vs 76 years), gender, lateral­ity of lesion, maximum diameter of hematoma (21 vs 19 mm), pretreatment Markwalder grading system (MGS) score (1 vs 1), or length of hospital stay (5 vs 17 days) between the groups. Pretreatment midline shift was greater in the drainage group than the MMA embolization group (8.8 vs 6.6 mm). Operative time was shorter in the drainage group (32 vs 79 min). Recurrence occurred in 2/23 (8.7%) of the drain­age group, in whom addi­tional MMA embo­lization was per­formed. Additional drainage was required due to exacerbation of symptoms in 4/21 (19%) of the MMA embo­lization group. No perioperative complications occurred in either group. There was no significant difference in median pre­operative MGS score (1 vs 1) or mean maximum hematoma diameter (18 vs 19 mm) in the 17 patients who showed resolution of CSDH by MMA embolization alone or in the 4 patients who required additional drain­age. Mean midline deviation was 6.1 and 8.9 mm in the embo­lization alone and additional drainage groups, respec­tively, and was significantly greater in those who required additional drainage (p=0.002).Conclusions: The postoperative course between patients who under­went drainage or embolization for CSDH showed no significant difference in the case of very mild preoperative neurological findings (MGS score of about 1). Patient selection for MMA embolization as the initial treatment for CSDH should be clarified based on clinical symptoms and the radiological findings.

著者

石崎 竜司 田代 弦

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.40, no.2, pp.92-95, 2017-12-20 (Released:2020-04-27)

参考文献数

7

---

Background: There is an argument for the benefit of the helmet wearing at the time on a bicycle ride. We discuss the usefulness for head injury in traffic accident.Methods: We reviewed 13 cases, admitted to PICU in our hospital from April 2011 to April 2015, by traffic accident on a bicycle ride. We compared sex, age, conscious level and imaging findings between the cases with (A group) and without bicycle helmet (B group).Results: There was no significant difference in two groups about sex, age, and conscious level. However, more cases exist in B group as for skull fracture, brain contusion, and subcutaneous hematoma. On the other hand, A group had more cases suffered from the diffuse axon injury and subarachnoid hemorrhage.Conclusion: Helmet is effective to the direct injury of head, but might be little effective to the rotational injury.

著者

守山 英二

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.37, no.1, pp.7-17, 2014-06-20 (Released:2020-04-28)

参考文献数

21

---

Objective: The Cerebrospinal Fluid Hypovolemia Research Group beneficiary of a scientific research grant from the Ministry of Health, Labour and Welfare (MHLW) has con­cluded, that minor traumas, including motor vehicle accident, may cause spinal CSF leak. Because the first aim of MHLW research group was to confirm the occurrence of spinal CSF leak after minor trauma, very strict image diagnostic criteria were adopted. The purpose of this study is to weigh the MHLW criteria against the existing image diagnostics.Materials and Methods: Between March 2011 and January 2013, 178 patients suspected with spinal CSF leak underwent combined radioisotope cisternography (RIC) and computed tomography myelography (CTM). Serial spinal MRIs were performed before and after combined RIC ⁄ CTM studies.Results: RIC revealed overt RI leak in 47 patients (Group P), and CTM confirmed CSF leaks in 27 patients. In 52 patients with indirect RIC findings including early bladder filling and/or accelerated RI clearance (Group I), CTM confirmed CSF leaks in 7 patients. Eleven patients presented with typical clinical and radiological features of spontaneous intracranial hypotension (SIH) (Group P: 7, Group I: 4). Serial spinal MRI after combined RIC ⁄ CTM showed increased CSF leak in 33 ⁄ 47 patients (Group P), and 15 ⁄ 52 patients (Group I). In these patients, most CSF leaks were located at thoracolumbar junction.Conclusion: This study shows spinal CSF leak is a complication of minor trauma. In the diagnosis of spinal CSF leak, RIC has several advantages in addition to its inherent ability, especially when combined with CTM. Combined RIC ⁄ CTM often increases CSF leak, resulting in the enhanced sensitivity of spinal MRI.

著者

日本頭部外傷データバンク検討委員会

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.45, no.supplement, pp.S01-S47, 2022-09-30 (Released:2022-10-01)

著者

大山 裕太 大井川 秀聡 大貫 隆広 指田 涼平 木倉 亮太 井上 雄貴 中里 一郎 廣川 佑 川口 愛 高屋 善德 藤原 廉 朝見 正宏 後藤 芳明 石川 久 宇野 健志 田中 純一 大山 健一 小野田 恵介 山根 文孝 安心院 康彦 三宅 康史 坂本 哲也 松野 彰 辛 正廣

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.44, no.2, pp.44-49, 2021-12-20 (Released:2021-12-20)

参考文献数

11

---

Background: We experienced a case of head pene­trating injury caused by a crossbow that was initially treated in the Hybrid Emergency Room (ER).Case: A 25–year–old male who lost conscious­ness and was collapsed in his room with penetrating crossbow in his head, was transported to our hospital. After routine checkups, the pa­tient was immediately move to the Hybrid ER. A head CT and digital subtraction angio­graphy (DSA) was performed and no obvious injury in the intracranial major vessels was confirmed. The crossbow was safely removed there. The patient was then moved to the central operating room and underwent a relevant sur­gical procedure. Postoperative diffusion–weighted MRI showed a high–signal area in the corpus callosum and disorders of con­sciousness continued for a while. The corpus callosum lesion was determined to be cytotoxic lesion and the patient was followed up. His conscious state gradually improved and the ab­normal signal in the corpus callosum disappeared on the 40th hospital day. On the 91st hospital day, the patient was transferred for additional rehabilitation.Conclusion: A Hybrid ER is one of a surgical unit installing CT and DSA. The ability of multi­modal medical treatment is useful to traumatic brain injury, especially penetrating head injury for which we often need to carry out flexible surgical procedure.

著者

中嶋 広太 石崎 竜司 上村 紘也 田代 弦

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.44, no.2, pp.39-43, 2021-12-20 (Released:2021-12-20)

参考文献数

18

---

An 8–year–old girl accidentally fell, and a pencil in her hand punctured the left temporal side of her skull. Her vital signs were normal at the time of transport to the previous hospital. Head computed tomography (CT) showed that the pencil had perforated from the left temporal side of her head to the left caudate nucleus, with hematoma along the perforating path, ventricular hematoma, traumatic subarachnoid hemorrhage, and subdural hematoma. Vascular evaluation using head CT angiography did not reveal any obvious main trunk vessel occlusion or injury. The patient was intubated and sedated to prevent the pencil from pulling out, and craniotomy was immediately performed to remove the pencil. The area of craniotomy was determined assuming right frontotemporal craniotomy, and the skin incision was made to include the pencil insertion site. The pencil was removed, and external decompression was performed to avoid cerebral edema. Postoperatively, the patient was managed in the pediatric intensive care unit. Prophylactic admin­istration of antimicrobials and anticonvulsants was initiated, and the patient did not develop signs of infection or convulsions. Postoperative follow–up imaging showed no traumatic intracranial aneurysm formation. After reduc­tion of brain swelling, cranioplasty was performed on postoperative day 23. Rehabilitation evaluation showed no obvious sequelae, and the patient was discharged to home on postoperative day 35. Although perforating head injuries in the temporal region are relatively rare, they more likely occur in children with soft skulls than in adults. For the treatment of perforating head trauma, it is important not to perform blind removal until surgical treatment. Preoperative assessment of vascular damage should be performed for decision making regarding the appropriate surgical treatment and postoperative management. Subsequently, it is important to confirm that there is no traumatic cerebral aneurysm formation.

著者

森

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.40, no.2, pp.121-128, 2017-12-20 (Released:2020-04-27)

参考文献数

24

---

Background: Children with minor head injury have a low, but serious risk of traumatic intracranial haemor­rhage. Medical research on criteria for head computerized tomo­graphy (CT) examinations for children is still inconclusive, because CT scanning is required to identify severe traumatic head injury, including acute epidural haematoma. However, radiation exposure is also an important problem.From the medical perspective the decision to take neuro-imaging, including CT examination, for children with minor head injury must be made carefully, because of the possibility of negative impact on cognitive abilities or an increased risk of cancer from ionizing radiation.From the legal perspective, when a pediatric patient with a minor head injury who did not have a CT head examination performed at the discretion of a doctor, but died several hours later from a traumatic intra­cranial haemorrhage, the doctor who had failed to order the head CT examination could be sued for medical malpractice. On the other hand, even if decreased cognitive abilities or an increased cancer risk occur more than a decade after that radiation exposure in a patient who had a head CT examina­tion during childhood because of minor head trauma, a doctor who ordered the CT examination is not at risk of being sued for medical malpractice.Conclusion: A balanced judgment between medical and legal problems of medical care must be made. In other words, medical issues related to society, like the criteria for the CT scanning of children with a minor head injury, must be considered carefully.

著者

溝渕 佳史 永廣 信治 荻野 雅宏 McCrory Paul スポーツ頭部外傷検討委員会(日本脳神経外傷学会)

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:03895610)

巻号頁・発行日

vol.39, no.1, pp.1-26, 2016

---

<p>【 解 説 】 「スポーツにおける脳振盪に関する国際会議」 はおよそ4年に一度開催される。2001年にウィーンで第1回会議が開かれ,第2回 (プラハ,2004年),第3回 (チューリッヒ,2008年) を経て,2012年には再びチューリッヒにて 「第4回国際スポーツ脳振盪会議」 が開催された。この4回にわたる国際会議の目的は,選手の安全確保と健康改善であり,プロフェッショナル,アマチュアを問わず,スポーツで脳振盪を負った選手の状態を正しく評価し,安全にスポーツに復帰させることを目指すものである。さまざまな分野のエキスパートが討論を重ねて 「共同声明 (consensus statement)」 を発表する一方,脳振盪を負った選手の臨床所見を競技場内外で明らかにする評価ツール 「Sport Concussion Assessment Tool (SCAT)」 が作成された。</p><p>SCAT2からSCAT3への改訂にあたって変更されたのは,重症な状態を早期に評価できるようにしたことである。はじめに救急対応を取るべき状態 (Glasgow Coma Scaleが15点未満,精神状態の悪化,脊髄損傷の可能性,症状の進行 ・ 悪化あるいは新たな神経症状の出現) が記載された。そのため,SCAT2では3番目の評価項目であったGlasgow Coma Scaleが1番目に変更され,意識状態の評価を早期に行うことを重視している。さらに5項目目に頚部の評価が加えられ,脊髄損傷などの重症外傷を評価できるよう改訂された。バランステストの項目では,SCAT2ではModified Balance Error Scoring System (BESS) を用いて評価していたが,SCAT3ではBESSとつぎ足歩行の両方か,もしくはどちらか一方を選択できるようになっている。またSCAT2は10歳以上を対象にしていたため,SCAT3では13歳未満の選手用にChild SCAT3が追加された。</p><p>以下は,</p><p>McCrory P. Consensus Statement on Concussion in Sport: The 4th international Conference on Concussion in Sport, Zurich, November 2012. BJSM 47(5): 250-258, 2013.の翻訳である。</p>

著者

荻野 雅宏 中山 晴雄 重森 裕 溝渕 佳史 荒木 尚 McCrory Paul 永廣 信治

出版者

一般社団法人 日本脳神経外傷学会

雑誌

神経外傷

巻号頁・発行日

vol.42, no.1, pp.1-34, 2019

---

<p><b>【解説】</b></p><p>「スポーツにおける脳振盪に関する国際会議」は2001年にウィーンで第1回会議が開かれたのち,近年は夏季オリンピックの年の秋に開催されており,第2回 (プラハ, 2004年),第3回 (チューリッヒ, 2008年),第4回 (チューリッヒ, 2012年) を経て,2016年にベルリンにて 「第5回国際スポーツ脳振盪会議」 が開催された。この国際会議の目的は選手の安全を確保することと,選手のコンディションを改善することであり,プロフェッショナル,アマチュアを問わず,スポーツで脳振盪を負った選手の状態を正しく評価し,安全にスポーツに復帰させることを目指すものである。さまざまな分野のエキスパートが討論を重ね,最終的に以下の共同声明 (consensus statement) を公開するとともに,声明の根拠となった系統的なレビュー12編^24,25,i–x)を発表した。</p><p>脳振盪を負った選手を評価する標準的ツールSport Concussion Assessment Tool (SCAT),5歳から12歳までの小児に用いるchild SCAT,非医療従事者が脳振盪を疑う際に用いるConcussion Recognition Tool (CRT) はそれぞれ,SCAT5,child SCAT5,CRT5へと改訂された。</p><p>この共同声明 (McCrory P, Meeuwisse W, Dvoraket J, et al. Consensus statement on concussion in sport —the 5th inter­national conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 51: 838–847, 2017) や上記のツールはすべてWeb上で自由に閲覧でき,ダウンロードも可能である。関係者は原文にあたり,その内容に精通していることが求められるが,一部から公式な日本語訳を強く望む声があり,本学会のスポーツ脳神経外傷検討委員会の有志が,前版^xi)の訳者らとともにこれにあたった。</p><p>次回の改訂は2020年の秋以降に予定されているので,本稿が来る東京オリンピックならびにパラリンピックにおけるこの領域の基本的な指針となる。しかし本文中にもある通り,この共同声明は臨床的なガイドラインを目指すものでも,法的に正しい対処を示すものでもない。現時点における総論的な指針と考えるべきであって,個々のケースへの対応には,現場の裁量が認められていることを強調したい。</p>

著者

山田 哲久 名取 良弘

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.35, no.1, pp.16-21, 2012-11-10 (Released:2021-04-20)

参考文献数

7

---

Chronic subdural hematoma is one of the most common diseases encountered in neurosurgical practices. The relationship between the case number of chronic subdural hematoma and seasons has not been reported until now. The relationship between recurrence rate of chronic sub­dural hematoma and seasons has not been reported, too. We examined the monthly case number of and recurrence case number of chronic subdural hematoma in our hospital.The examination included 769 adult patients who had undergone the first one burr-hole surgery between January 2000 and December 2010. We examined the monthly number of cases (recurrence cases and non-recurrence cases), recurrence rate, and recurrence risk factor.The number of cases was higher in August, April, July and September. November and March had few cases. Recurrence rate was highest in July and lowest in December. We found an association between age and monthly recurrence rate among a recurrence risk factor.We think that there is an association between the daily life activity of the elderly person and case number of chronic subdural hematoma. The daily life activity of elderly persons shows seasonality. Therefore, we think that the case number of chronic subdural hematoma shows seasonality. To decrease the recurrence rate, examination of the post­operative volume of infusion and an appropriate rest period are necessary.

著者

福田 修 小山 新弥 黒田 敏

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.38, no.1, pp.9-13, 2015-09-10 (Released:2020-04-27)

参考文献数

13

---

Severe head injuries with organic lesions in skiing were characterized. We reviewed the patients, backgrounds, the situations of 30 head traumas (6.0%) with organic lesions, out of 504 skiing-related head injuries from 2004/05 to 2012/13 winter seasons in Niigata, Japan. The patient ages were from 8 to 75 (average 37.0 ± 19.0). They were 27 men and 3 women. 30 lesions consisted of 16 cranio-facial fractures, 7 acute subdural hematomas, 3 subarachnoid hemorrhages, 2 brain contusions, an epidural hematoma and a chronic subdural hematoma.The predominant feature of ski-related severe head injuries in this period is that expert or intermediate skier hit forehead by fall or jump or collision at a gentle slope. Craniotomies were performed in 2 subdural hematomas and the outcome was GR in 59-year-old woman and was MD in 75-year-old man, respectively.In comparison with the past nine seasons (1994/95-2003/04) study in this area, the characteristics in this period is that the number of patients, the number of severe head injuries, the number of operation were decreased. The average age of the patients increased. The predominant feature of ski-related severe head injury in the past period is that intermediate skier hit a forehead by collision at a middle slope. There were differences in the pattern, situation and mechanism between those two periods. Greater awareness may be needed to ensure safety, especially helmet use and manner observance.

著者

山本 陽子 岡崎 敏之 依田 啓司 永廣 信治

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.37, no.2, pp.88-95, 2014-12-20 (Released:2020-04-27)

参考文献数

22

---

Background: The previous data of Japan Neurotrauma Data Bank collecting head injury was almost enrolled in the urban area. However, head injuries also happen in the mountain area. We analyzed the patients in our hospital located in mountain area in Tokushima prefecture, Japan to find the characteristics of the head injury in mountain area.Methods: From April 2009 to September 2013, 285 patients with head injury were hospitalized and 10 patients with head injury who were already cardio pulmonary arrest on arrival were transported in our hospital. We researched all these patients and examined characteristics of the patients and mechanism of the injury.Results: There were 190 men and 105 women, and the mean age was 65.7 years. The head injuries were caused by fall (35.6%), followed by tumble (29.2%) and traffic accident (26.8%). The most frequent cause in the falls was mountain slope (23.8%), followed by stairs (20.0%) and cliff (13.3%). The fall-rerated head injuries sometimes included subarachnoid hemorrhage, acute subdural hematoma and brain con­tusion at once. The most common trauma-related complication about the fall injury was the spinal injury and followed by the lung injury. The most common fatal case of the fall injuries was acute subdural hematoma. Physiological abnormality on arrival, Glasgow Coma Scale score ≦8, diabetes mellitus, dialysis, and anticoagulant or antiplatelet drug were significant factors of the outcome (p<0.05).Conclusion: In the mountain area of the country, the elder­lies frequently got injured with head and the most common cause of the head injury was fall. Especially, the fall from mountain slope and cliff were very dangerous and these injuries could become the high energy injury for the elderly.