高令者における慢性硬膜下血腫

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タイトル別名
  • Chronic Subdural Hematoma in the Elderly
  • コウレイシャ ニ オケル マンセイ コウマクカ ケッシュ リンショウ ショウジ
  • Clinical Featurs and Prognosis
  • 臨床症状と予後について

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During the last 4 years, we have investigated clinical features and prognosis of 21 cases of chronic subdural hematoma who were all of ages over 65 years old. The average ages was 77.1 years old and sex distribution was not observed. In this group of 21 patients, a history of trauma was noted in 95%, history of hypertension in 52%, diabetes mellitus in 19% and chronic alchoholism in 14%. Among initial symptoms or signs given by the family at admission to the hospital, the most remarkable findings was gait disturbance in 43% (weakness of under ext., hemiparesis, hemiplegia.), mental or personality changes in 24%, incontinentia in 28%, headache in 24%, dementai in 24%, altered consciousness in 24% and others symptoms such as seizure and vertigo in 5%. Diagnosis before admission were cerebral infarction in 43%, cerebral artherosclerosis in 14%, intracerebral hemorrhage in 14%, senile dementia in 10% and other several diseases as head injury, brain tumor, meningitis in 5%. As it was predicted by various different diagnosis before admission, differential diagnosis of chronic subdural hematoma in the elderly is difficult covered by senile dementia, cerebral vascular disease, concomitant other vascular disease and etc. The chief complaint on admission was disturbance of consciousness in 43%, mental disoder in 38%, symptoms of hemiparesis or hemiplegia in 71%, incontinentia in 28%, headache in 24%, speech disturbance in 24% and aphasia in 10%. Anisocoria and papilledema was noted only in 3%. By the lumbar puncture, it was shown that cerebrospinal fluid pressure was increased (over 180mmH2O) in 7 cases (33%) and decreased (under 120mmH2O) in 8 cases (38%). The CSF protein level was elevated over 50mg/dl in 5 cases (24%) in such cases with old apoplexia and cerebral infarction. Angiographic examination demonstrated conculusivelly the presence of a subdural space occupying lesion in almost all cases of a subdural space occupying lesion in almost all cases of our 17 patients. Improvement was recognized in findings of clinical featurs and results of CBF. In cases of good prognosis CBF recovered excellently after 3 months of operation. When compared with younger patients with chronic subural hematoma in the aged caused lesser compression upon cerebral tissue since their brain suffered atrophy, accompanying previous cerebral vascural disturbance and intracranial space was dilated.

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