The significance of promoting the accumulation and utilization of data on the prognoses of head injuries, etc. in Japan in the future is organized here with consideration of policy. Epidemiologically, new demands for preventive medical intervention related to trauma have been raised, such as the prevention of fractures and falls and the effective provision of consecutive medical and welfare care for acquired disabilities, as the population aged and health care standards improved in Japan in recent years. Regarding Japanese epidemiological information related to trauma, little cross-sectional data, such as needs for care by stage, was accumulated, while much information was available on acute-phase medicine. In constructing a community-based integrated care system, “the establishment of methodologies to operate structures for cross-sectional and multi-professional cooperation by community and structures for understanding the current status and issues in the community and evaluating the system based on them” was an issue in the area of welfare and nursing care. The Act for Comprehensive Welfare for Persons with Disabilities requires policy evaluation, cooperation between medicine and welfare, and putting into practice evidence-based health and welfare policies for people with disabilities is needed for supporting independent decision-making by people with disabilities. Promoting the accumulation and utilization of information on the prognoses of trauma is significant as a cross-sectional information tool for local governments to create a seamless health ⁄ medical ⁄ welfare ⁄ nursing care system with no disparity for promoting health and welfare policies for people with disabilities, and to realize the information accumulation and utilization, starting it as a model in the field of neurosurgery, seems appropriate and reasonable in Japan.
Background and purposes: We retrospectively reviewed clinical features of chronic subdural hematomas in the patients with hematological diseases.
Methods: A total of 410 patients with chronic subdural hematoma(s) admitted to St. Marianna University Yokohama City Seibu Hospital between 2008 and 2015 were reviewed. Among these patients, 9 corresponding cases were collected.
Results: The average age of the patients was 65.5 years. In three out of 9 patients, preceding head injury was found in the past history. Based on complete blood counts on admission, blood transfusion was needed prior to surgical treatment in order to correct bleeding tendency mostly due to platelets deficiency. Because of cerebral herniation signs, emergency surgery was necessary in three patients. All underwent common burr hole aspiration surgery under local anesthesia. No surgical complication including postoperative hemorrhages was encountered. Neurological deficits were disappeared immediately after the surgery. However, another surgical treatment was added in 4 patients because of recurrent accumulation of subdural bloody fluid. Although nearly a half of the patients showed good prognosis, coexisting hematological disorders progressed to death within six months after the surgery in four out of 9 patients.
Conclusion: Chronic subdural hematomas are generally recognized as a benign disease having good outcome when appropriate treatments were given. However, as the patients concomitantly having hematological diseases, their prognosis might be pessimistic.
Objective: Chronic subdural hematoma is one of the most common diseases in neurosurgical practices. The treatment method is well established, but seizures develop as a complication in 2.3% to 20.4% of patients. We examined patients with seizures to clarify the status of patients at the onset of seizures and define risk factors for seizures.
Methods: From January 2000 through December 2014, we examined 1,077 patients with chronic subdural hematomas (1,257 hematomas) who underwent burr-hole surgery in our department. To identify risk factors for seizures, we retrospectively compared the clinical characteristics of patients with seizures with those of patients without seizures.
Results: Seizures developed as a complication in 35 patients (3.25%) with 36 hematomas (2.86%). Many patients initially had partial seizures before operation. After hematoma removal, the seizures were relatively well controlled. Risk factors for seizures were past stroke, anticoagulant drug, disturbance of consciousness, hemiparalysis, and hematoma organization.
Conclusion: It was thought that past stroke had much symptomatic seizures. It was thought that cardiogenic cerebral infarction was caused by anticoagulant administration. Disturbance of consciousness and hemiparalysis were attributed to seizures. Because it was difficult to diagnose organization of hematoma solely on the basis of preoperative imaging studies, preoperatively predicting the risk of seizures is considered challenging.
Background: Some patients with TBI (traumatic brain injury) might go on to manifest attentional deficit in the workplace although they performed well in standard neuropsychological tests. We, therefore, developed an original paper-and-pencil type dual-task (Oiso DT-A) for assessing inattention. We showed that the Oiso DT-A might be valuable and sensitive for detecting inattention including mild deficit. The task, however, was not applicable for patients with the dominant-hand dysmobility because it included written calculation. The purpose of this study was to investigate the validity of newly developed DT (Oiso DT-B) which could be completed with the non-dominant hand.
Methods: A total of 134 healthy individuals and 36 TBI patients were the subjects. The Oiso DT-B combined visually and audibly presented selective cancellation-tasks. A subject was required to identify and respond to both target stimuli of number 7 (visual sub-task) and words with three letters (auditory sub-task) for three minutes. The performance was scored based on the correct rate (both sub-tasks), success rate (both sub-tasks), and the number of correct answers in the visual sub-task. Performances of Clinical Assessment for Attention (CAT) developed by The Japan Society for Higher Brain Dysfunction and Kana pick-up test were also measured for TBI patients.
Results: All patients could complete Oiso DT-B without a difficulty. Based on a simple and unique definition of cut-off values, abnormal performance in TBI patients was detected more frequently in the Oiso DT-B than in any sub-task of CAT and Kana pick-up test although the specificity values were comparable.
Conclusion: The Oiso DT-B as well as DT-A also might be valuable and sensitive for detecting inattention including mild deficit.
Background and Purpose: As a model for epidemiological research based on case registration system, adult chronic subdural hematoma (CSDH) study is presented, which has been investigated with the data from the Miyagi Neurotrauma Data Bank. In this article, both advantages and disadvantages of local epidemiological research based on case registration system are discussed.
Clinical Materials and Methods: The local case registration system in this study covers all of neurosurgical facilities in Miyagi prefecture, and the patient registration has been started since 1996. Adult patients with CSDH, registered between 2005 and 2007, are subjected to this study (1,445 patients, M:F=1,021:424, mean age 71.2±12.8 y.o.), to investigate the incidence of adult CSDH.
Results: The overall incidence of adult CSDH was 20.6 ⁄ 100,000 ⁄ year, with 39.2 in the age group of 60–69 y.o., 76.5 in the age group of 70–79 y.o., and 127.1 in the age group of over 80 y.o. Compared to previous reports, this study demonstrates a marked increase in the incidence of CSDH. Not only population aging but also both increase in diagnosis accuracy and current medical trends (such as increases of the elderly patients who receive hemodialysis, anticoagulant, and/or antiplatelet therapies) may influence the increase of CSDH incidence.
Conclusion: The Miyagi Neurotrauma Data Bank is a local survey, being reliable in its data quality, quantity, and completeness. The local features of Miyagi area suggest that the results of this study reflect the trend of Japan. A local survey based on case registration system may have a potential to generalize a universal truth, although it depends on its research design and/or on local features.
Objective: We retrospectively analyzed our own cases of subacute subdural hematoma (SSH) to investigate the clinical characteristics of SSH.
Materials & Methods: From January 2011 to October 2015 we experienced 5 cases with SSH at our institution. Frequency, age, gender, clinical course, radiological findings, operative findings and outcomes were reviewed.
Results: During the same period we treated 85 patients with acute subdural hematoma, thus frequency of SSH accounted for 5.9％. The patient’s ages ranged from 45 to 89 years with a mean age of 72 years. There were 2 men and 3 women. The cause of injury was fall on the same level in 4 patients, fall in 1. Glasgow coma scale score on admission was 15 in 4 patients, 14 in 1. Initial computerized tomography (CT) scans revealed mixed density subdural hematoma in 2 patients, homogenously high density in 3. The mean maximal thickness of hematoma was 10 mm. Time intervals to worsening were 5 to 13 posttraumatic days with a mean time interval of 9.6 days. Symptomatologically all patients developed contralateral hemiparesis. CT scans on worsening revealed mixed density in 2 patients, iso in 2, low in 1. The mean maximal thickness of hematoma was 13 mm and revealed mass sign and mild midline shift. Magnetic resonance imaging was obtained only in case 3 and demonstrated high signal intensity on T1 weighted images, low signal intensity on T2 weighted images, high signal intensity with the low intensity rim close to the brain surface on diffusion weighted images. All patients underwent craniotomy to evacuate hematoma. Postoperatively 4 patients recovered fully and 1 patient died of pulmonary failure.
Conclusions: Even though subdural hematoma is treated conservatively at acute stage, it should be kept in mind that it may develop at subacute stage and cause neurological deterioration.
Objective: Chronic subdural hematoma is one of the most common diseases in neurosurgical practice with a well-established treatment method. Typical treatment includes burr-hole surgery. However, there are some reports of postoperative intracranial hemorrhage.
Methods: We examined burr-hole surgery performed in the treatment of chronic subdural hematoma at the Department of Neurosurgery at our hospital between January 2000 and December 2014. In total 1,077 patients (1,257 hematomas) were included in the study. We examined the clinical features of 19 patients (21 hematomas) who developed postoperative intracranial hemorrhage. We compared the postoperative intracranial hemorrhage and non-intracranial hemorrhage cases.
Results: Cases with postoperative intracranial hemorrhage could be divided into four main patterns. Pattern A was characterized by intraoperative brain contusion. Pattern B-1 had a relatively good prognosis and was characterized by a subdural hematoma on the operated side. Pattern B-2 had a poor prognosis and was characterized by a subdural hematoma on the operated side caused by blood vessel damage at the time of drainage tube removal. Pattern C had a poor prognosis and was characterized by a subdural hematoma contralateral to the operated side. Pattern D had a poor prognosis and was characterized by an internal hemorrhage of the brain parenchyma. Patients with bleeding were more likely to exhibit Pattern C or D. The proportion of cases with a history of malignant tumor was significantly greater among the cases with postoperative intracranial hemorrhage than non-intracranial hemorrhage cases.
Conclusion: The tendency for a bleed to occur influenced the region of the bleed, not the operation site, and the prognosis was poor. Attention is necessary during surgery and at the time of drainage tube removal to prevent damage to local structures.
Traumatic extracranial carotid artery aneurysms are rare in the pediatric population. Treatment options include surgery, anticoagulation therapy and endovascular treatment. There have been only limited reports in the literature documenting endovascular carotid artery stent placement in the pediatric population.
We present a case of endovascular carotid stenting for traumatic carotid dissecting aneurysm in a 11 years-old boy. The boy presented right arm weekness after falling from ninth floor. His head computed tomography (CT) scan demonstrated traumatic subarachnoid hemorrhage. Angiography was performed to control severe nasal bleeding, and severe stenosis was demonstrated at extracranial internal carotid artery.
CT angiography on 27th day showed extracranial internal carotid artery dissecting at the same place. Endovascular stenting was used to treat the dissecting aneurysm 47 days after injury.
A follow-up CT angiography performed at seven months showed no recurrence of aneurysm nor stenosis.
Paroxysmal sympathetic hyperactivity (PSH) is a form of autonomic instability, following acute neurological insults, such as severe traumatic brain injury. PSH is characterized by intermittent agitation, diaphoresis, hyperthermia, hypertension, tachycardia, or tachypnea, accompanied by hypertonic movement. We treated a 13-year-old girl who suffered from autonomic instability, associated with elbow flexion of both arms, two months after a traffic accident. Her conscious was disturbed and she did not respond to verbal commands. Magnetic resonance imaging showed diffuse axonal injury signs in the basal ganglia. Ictal body temperature was >39ﾟC, with prominent sweating on the forehead. Physical and laboratory examination revealed no abnormalities besides elevated creatine kinase levels. These episodes lasted approximately a few minutes twice a day. Given the extreme episodes and background, PSH was suspected. However, conventional therapy with antipyretic, anti-convulsants, and sedatives was ineffective. Oral baclofen was not effective. The severe spasticity in both arms prevented full rehabilitation, and she was transferred to our hospital. Following lumbar intrathecal baclofen therapy (ITB), autonomic instability resolved, and she appeared to be more comfortable. A pump was implanted for continuous ITB, and good recovery was seen after the procedure. The patient was transferred to a rehabilitation hospital. Comatose status was gradually relieved. ITB appears to offer a useful therapeutic option for intractable PSH with severe spasticity.