原著
Child abuseによることが明らかな乳幼児頭部外傷例の臨床像の特徴
キーワード:
Acute subdural hematoma,
Battered child syndrome,
Child abuse,
Head injury,
Shaken baby syndrome
2007 年 30 巻 1 号 p. 45-52
詳細
2007 年 30 巻 1 号 p. 45-52
Objective: The diagnosis and managements of the head injury in battered children are greatly complicated by medical history and the mechanisms of injury. In the present study, we evaluated the clinical features of the head injury in battered children.
Methods: Clinical signs and symptoms, the mechanisms of injury, intracranial pathology, and prognosis of 25 battered children with head injury treated between 1984 and 2003 were retrospectively analyzed.
Results: The age of 25 children was between 1 month and 2 years old. The average of the ages was 7 months old. In 68% of 25 patients, the age was 6 months or less. The medical history of head injury was unclear in 16 children. The chief complains were disturbance of consciousness, convulsion, vomiting and hypothermia. Retinal hemorrhages were recognized in 88% of the patients and these were bilateral in 68%. Acute subdural hematomas (19 cases) and chronic subdural hematomas (6 cases) were shown on CTs or MRIs. In four cases, cerebral contusions were complicated as intracranial pathology. In 44% of the patients, the hypoxic-ischemic injury was confirmed on CTs or MRIs. Fractures of limbs and ribs were recognized on skeletal survey in 40% of the patients. 71% of 17 survival cases had moderate or severe psychomotor disabilities at the end of follow-up periods.
Conclusion: In children under 2 years of age with subdural hematomas, clinical investigations other than CT and MRI, included ophthalmoscopy by opthalmologist and skeletal survey, are crucial and mandatory for early diagnosis of the child abuse.
