原著
腎透析患者の外傷性急性硬膜下血腫の検討：透析脳の脆弱性と頭部打撲の機序の文献的考察
2011 年 34 巻 2 号 p. 145-150
詳細
2011 年 34 巻 2 号 p. 145-150
Objective. To investigate the cause of poor prognosis of traumatic acute subdural hematoma in patients undergoing renal hemodialysis we reviewed our own cases at our institution.
Materials and methods. From 2001 to 2010 we experienced six patients with traumatic acute subdural hematoma on renal hemodialysis. Five were male, 1 female. The average age of injury was 65 years old. The mechanisms of injury, the use of antiplatelets and/or anticoagulants, outcomes and duration of dialysis were retrospectively analyzed.
Results. The mechanisms of injury included fall on the same level due to faintness immediately after hemodialysis in five patients, fall down the stairs in 1 patient. All of these patients received antiplatelets. No patient received anticoagulants. A mean score of Glasgow Coma Scale on admission was 5.6. Craniective decompression, evacuation of hematoma, placement of external ventricular drainage and intracranial pressure monitoring and normothermia were carried out on acute stage. Outcomes at discharge were severely disabled in two cases, persistent vegetative status in 2 and dead in 2. Duration of dialysis was less than one year in four cases, three years in 1 and thirteen years in 1.
Conclusions. Traumatic acute subdural hematoma in patients undergoing intermittent renal hemodialysis appeared to occur at early phase after hemodialysis initiated. Faintness might be the major cause of head trauma while severe high energy trauma is quite rare. Vulnerability of brain on dialytic patient against head trauma and common use of pre-injury antiplatelets and/or anticoagulants therapy are thought to be responsible for poor prognosis.
