抄録
Clinical characteristics and problems of acute traumatic brain injury (TBI) were investigated, in our consecutive 18 cases with chronic hemodialysis (HD) (M:F=9:9, 75±11y.o.). The most frequent cause of trauma was fall (67%), as the second was a traffic accidents (22%). The frequent intracranial lesions were acute subdural hematomas (72%), cerebral contusions (61%), and so on. The most frequent symptom was depression of alertness, as focal neurological deficits were less frequent. Duration to neurosurgical unit hospitalization from TBI was less than 6hrs in 7 cases (39%), 6-24 hrs in 4 (22%), and more than 24 hrs in 7 (39%). In 6 out of 11 cases, which took more than 6 hrs for hospitalization, hemodialysis with heparin had been done before hospitalization without neuroradiological examination of TBI. Neurological status deteriorated during pre-hospitalized hemodialysis in 5 out of these 6 cases. GCS scores were 13-15 in 78%, 9-12 in 6%, and 17% of cases. GOS scores are GR in 33%, MD in 33%, SD in 6%, VS in 11%, and D in 17% of cases. Frequent causes of poor outcome were HD related systemic complications or delay in diagnosis and treatment of TBI. These result suggest that early diagnosis and appropriate management of HD related complications is important for acute TBI in patients with HD.
