急速に脳萎縮をきたした乳児虐待によるshaken baby syndromeの1例

抄録

The incidence of child abuse has been increasing recently, and the frequency of clinical encounters with abused children is rising. Shaken baby syndrome (SBS), in which intracranial hemorrhage or eyeground hemorrhage are caused by excessive shaking of infants, is attracting attention as an injury closely related to infant abuse. In this report, a patient with SBS who developed status epilepticus during the course is presented.

Patient: The patient was a 3-month-old male admitted with a primary symptom of convulsion. Disturbance of consciousness (JCS3) was noted on arrival, and head CT disclosed subdural hematoma along the falx cerebri and brain swelling over a wide area of the bilateral occipital lobes. Eyeground hemorrhage was noted bilaterally. The parents' description of the cause of injury was unclear, and imaging and funduscopic findings suggested SBS. Since the patient showed status epilepticus on admission, he was intermittently administered drugs including midazolam, but convulsion was not completely resolved. On the 3rd hospital day, convulsion was finally suppressed by the continuous administration of thiopental after securing the airway by tracheal intubation. However, brain atrophy progressed rapidly thereafter, disturbance of consciousness persisted, and development was delayed. SBS is an injury with a 15% mortality rate, but, as it mostly occurs in infancy, the outcome of the injury is more likely to be affected than those of adult injuries by complications such as secondary hypoxia and convulsion as well as the primary damage to the brain. In this patient, also, increased intracranial pressure due to brain edema and the persistence of status epilepticus are considered to have led to the rapid progression of brain atrophy. Physical abuse is the most frequent form of abuse in victims of child abuse encountered at the outpatient clinic, and, as abused children often sustain head injuries, in particular, opportunities in which neurosurgeons examine abused children are increasing. Therefore, it is important for neurosurgeons to consider SBS due to abuse in examining infants with head injuries. It is also necessary to begin systemic management including respiratory management more resolutely and earlier than in adults.