症例報告
スノーボードで，脳振盪症状のあるなか２回目の頭部外傷により急性硬膜下血腫をきたした３症例
2012 年 35 巻 2 号 p. 167-170
詳細
2012 年 35 巻 2 号 p. 167-170
We have reported three patients with acute subdural hematoma (ASDH) due to second head injury in concussion state during snowboarding. The outcome of two cases was good and that of the other one was fatal.
Patient 1; 19-year-old man suffered from an occipital hit and causing nausea with transient loss of consciousness (LOC). CT scan on that day was normal. Next day, he had another neck injury and got CT scan again, which showed thin ASDH not requiring evacuation. Patient 2; 22-year-old woman experienced transient LOC after occipital hit, suffered from head injury again on the next day. She became comatose rapidly after the second injury. Immediate removal of ASDH restored her consciousness although she had permanent diplopia. Patient 3; 32-year-old man suffered from an occipital hit and presented transient LOC followed by amnesia. He continued snowboarding ignoring the physician's restraint. He fell down four hours after the first hit and was transferred to our institute in coma. Severe brain swelling was confirmed in emergent craniotomy and the patient died sixteen days later.
Concussion is most common head injury in sports and the subsequent second impact in post concussive state might result in poor outcome, as known as second impact syndrome (SIS). Patient 3 might correspond to SIS caused even in non-contact recreational snowboarding. An importance of appropriate conceptual education must contribute to the safety management of this sport to avoid severe head injury. Enlightenment and knowledge of SIS should be recognized for the sports physicians as well as the snowboarders.
