This paper studied the recognition of concussion, which lately has been considered a problem in sports-related head injuries. Participants in a judo leadership training session were surveyed. The result of the survey showed that while most respondents were aware that symptoms such as “impaired consciousness” should be regarded as symptoms of concussion; only half of the respondents knew that symptoms such as “behavioral change” should be regarded as symptoms of concussion. This indicates that it might be possible to overlook concussion or underestimate its symptoms. About half of the respondents said they had experienced the occurrence of concussion on the mat while teaching, and at least 40% of respondents had the judoka resume training without providing sufficient rest. Concussion had long been categorized as a “mild symptom” among head injuries; however, the potential risks associated with concussion have been pointed out in recent years. Therefore, it is important to recognize and understand concussions correctly to ensure the safety of judoka.

抄録全体を表示

Introduction: Acute brain swelling after head trauma is generally believed to be caused by impaired cerebrovascular autoregulation (vaso–paralysis), cellular edema, and vasogenic edema. Brain swelling caused by vaso–paralysis after repeated head trauma has gained attention as "second impact syndrome" and is frequently reported. However, reports of cer­ebral edema following concussion are rare.

Case: A 24–year–old male soccer player with no history of concussion experienced facial head trauma by impact with an opponent player’s knee during a match. Immediately after the injury, the patient presented with disorientation, amnesia, and headache, and a concussion was sus­pected, and the patient was admitted to our hospital. At examination 3 h post–injury, the patient’s orientation improved, but the headache persisted, along with mild antegrade amnesia, sluggish thinking, impaired memory, and concentration. Magnetic resonance imaging (MRI) of the head ruled out intracranial hemorrhage. However, fluid–attenuated in­ver­sion recovery, diffusion–weighted imaging, and ADC revealed a high–intensity area in the right temporo–occipital cortex. Arterial spin label­ing ruled out increased blood flow to this site. With rest and treatment, MRI signal changes disappeared the next day, and subjective symptoms improved 3 days after presenting to our hospital. Following a graduated return to play protocol, the patient returned to play within 1 week and did not experience any recurrence of symptoms.

Discussion: This case was diagnosed clinically as a concussion as head MRI revealed vasogenic edema localized to the right temporo–occipital cortex. Since no increase in cerebral blood flow was observed, the cause was determined to be transient hyperpermeability rather than vaso–paralysis. The MRI signal resolved one day post–injury, and the patient returned to sports smoothly. Based on these results, the concus­sion diagnosis may not have been clinically severe.

Conclusion: Concussions may result from vasogenic edema due to in­creased vascular permeability.

抄録全体を表示

スポーツ医学の分野では,脳振盪が注目されており,予防を中心にさまざまな研究が行われている.軽症の頭部外傷である脳振盪の予防が強調されるのはなぜであろうか.スポーツによる脳振盪の特徴は,繰り返して起こしやすいこと,軽症であるがゆえに診断,重症度の評価と競技への復帰時期の判断が難しいことである.繰り返す脳振盪は,頭部外傷後脳症や脳振盪後症候群などを引き起こす.尚早な復帰は症候群や急性硬膜下血腫など,重篤な頭部外傷の発生につながる可能性がある.脳振盪を起こしやすいスポーツ環境は,急性硬膜下血腫による死亡率が高いことも報告されている.スポーツ頭部外傷,特に脳振盪について現状の考え方をまとめる.

抄録全体を表示

軽症頭部外傷は救急外来を受診する頭部外傷のなかで最も多い。近年，スポーツ選手や軍事活動に従事する兵士のように，軽症頭部外傷を繰り返し受傷した人たちが，受傷から数年後に慢性的な認知機能障害や抑うつ状態を呈することが報告され，繰り返される軽症頭部外傷に関連する慢性外傷性脳症（chronic traumatic encephalopathy: CTE）が注目されている。軽症頭部外傷の患者の多くは比較的若年者であり社会的な影響が大きいため，海外ではその病態の解明や診断，治療法の研究が盛んにおこなわれている。軽症頭部外傷のうち受傷直後から頭痛，めまい，嘔気，意識消失などの一過性の症状を呈し，画像上明らかな異常を認めないものを脳振盪と呼ぶ。脳振盪は明確な診断基準がないため，アセスメントツールを用いて症状の経過をフォローして診断を試みる。脳振盪を含む軽症頭部外傷に関連する病態としてCTEの他，急性期に発生するシンドローム（second impact syndrome: SIS），急性期から引き続き起こる脳振盪後症候群（post-concussion syndrome: PCS）がある。これらの病態は軽症頭部外傷を繰り返すことによって発生するリスクが高くなるといわれているが，そのメカニズムは明確ではない。現在のところ，軽症頭部外傷を受傷した患者に対しては再度頭部に衝撃を与えないように安静を保つことが重要である。スポーツでは，プレー中に受傷した選手は直ちにプレーを中止させる。またプレーへの復帰は段階的に行い，症状の変化を経時的に観察し，重症化の徴候を見逃さないように注意する。治療は対症療法が中心で，重症化，慢性化の予防に対する薬物療法などの有用な治療法はない。軽症頭部外傷に対しては保護者・指導者の教育が重要である。リスクの高い環境にいる場合，とくに脳が発達過程にある小児に対しては，繰り返す受傷を予防できる環境と，受傷した場合への対策を整える必要がある。そのため本邦のガイドラインの作成と軽症頭部外傷への理解，プロトコールの遵守の徹底が望まれる。

抄録全体を表示

 ガイドラインの理念は, 医療の質を一定の水準に保ち診療に資すことであり, そのためには, 診療・治療・管理のminimal essentialが求められ, 新たなエビデンスに対応して常に改訂することが不可欠である. 本ガイドラインは2000年に初版が発刊され, 2006年の第2版に続く改訂であり, 常に変化する日本の医療環境と神経外傷学の発展に対応してきた. 本項では第3版においてアップデートされた項を解説するとともに, 日本脳神経外傷学会の日本頭部外傷データバンクの結果から, 本ガイドラインが重症頭部外傷の治療に及ぼした影響と重症頭部外傷の治療・管理の現状を解説する. 急激な病態の変化に対応しなければならない重症頭部外傷では, 治療の選択が脳神経外科医の裁量に委ねられることが多い. 高度な裁量を遂行するためには判断能力を高めることが必要であり, その1つの方法として本ガイドラインを活用していただければ幸いである.

抄録全体を表示

Background: Most patients recover fully from mild traumatic head injury (mTHI), but a few patients have persistent neurocognitive problems. The purpose of this study is to provide whether magnetic resonance imaging (MRI) can provide more detailed information of the mTHI than computed tomography (CT) in the young patients.

Methods: We enrolled 20 patients younger than 20 years with mTHI, who underwent CT and MRI in the acute stage after injury. We compared the intracranial traumatic findings (ITF) of CT with MRI. Furthermore, we compared the depiction ability of ITF on 2D image with 3D image.

Results: One (5%) of 20 patients had ITF with CT (acute sub and epidural hematoma 1). 5 (25%) of 20 had ITF with MRI (acute sub and epidural hematoma 1, brain contusion and acute subdural hematoma 2, and brain contusion 2). There was no significant difference the time needed to MRI scanning form CT scanning between positive group and negative group of ITF with MRI (p<0.07). 3D image of FLAIR was more sensitive for the visualization and detection of ITF than 2D image.

Conclusion: MRI is more sensitive than CT in the detection of ITF with mTHI. Particularly, 3D FLAIR provides detail information of ITF.

抄録全体を表示

スポーツにおける脳振盪の問題点としては,受傷時に併発しうる致死的合併症である急性硬膜下血腫,その後の急性期に再び打撃を被ることによって致死的脳損傷を生じうる症候群,そして,繰り返しの外傷により認知機能の低下をきたす慢性脳損傷などが挙げられている.これらの観点からは,脳振盪を起こしたスポーツ選手の管理および現場への復帰は重要な課題である.脳振盪では意識内容の変化を起こしているが,重症度の判定に際しては,意識消失や記銘力障害の有無や期間よりも,脳振盪に関連した諸症状,徴候の持続時間が重要であるとされている.脳振盪の客観的評価としては,ペーパーベースのSCATカードやcomputer based testingが行われている.また,重症な脳振盪の際には,神経心理学的評価も評価に加味される.復帰に際する原則は,症状の消失があるまで休息をとることである(身体機能,認知機能上の休息).そして,それから段階的復帰が強く望まれている.しかし,現実には,脳振盪からの復帰を規定している団体はわずかであり,統一性もなく,個々のレベルで対応したり,指導がなされていないのが現状である.本邦においても,関連諸団体による脳振盪からの復帰のガイドラインの作成が望まれる.

抄録全体を表示

In contact sports, such as boxing, rugby, American football, and judo, the risk of cerebral concussion or acute subdural hematoma by head blow, remains in high in Japan. The prognosis of an acute subdural hematoma is very poor and the mortality rate reachs to 55%. Dr. Ryo Uchida of Aichi University of Education investigated the fatalities in school judo classes, and clarified that more than 110 students aged 12 to 17 died as a result of judo accident in Japan. The fatalities is more than five times higher in any other sports. According to the investigation of Kobayashi, in Britain, Germany, Canada, the United States, and Australia, where judo population is larger than Japan, fatal accident in judo could not be found. On the judo community in Japan, the high mortality rate of judo is thought to be caused by underestimation of the danger of “concussion” and too hard drill works. Therefore, All Japan Judo Federration should take measures immediately in order to save a precious young life, because of the government plan that new national curriculum reforms will be required in all junior high school students to practice judo or some other “budo” starting along the 2012 school year.

抄録全体を表示

Field accident in American football causes traumatic brain injuries such as concussion and subdural hematoma. It is highly possible that serious brain injury is developed by repeated concussions during a comparatively-short term. Therefore, it is difficult to judge when the injured players are returned to games. We obtained the videotapes in which a head-to-head collision in actual American football game was recorded. A struck player developed concussion without loss of consciousness, with loss of memory and with no apparent abnormalities by CT scan. A reconstruction simulation of player's head collision using mathematical dynamic model (MADYMO) and finite element (FE) head and helmet model was conducted based on the accident videotapes.

抄録全体を表示

アメリカンフットボールにおける頭頚部の重傷外傷はこの競技が誕生した19世紀後半より問題視されている．米国では研究結果からエビデンスに基づいたルール改正やヘルメットの改良によってこれら重傷外傷の一応の解決をみている．近年，脳振盪が社会的問題として注目されているが，現状，効果的な解決策は見いだされていない．この解決には，さらなる研究体制の整備とエビデンスに基づいた予防策の検証が必要である．

抄録全体を表示

　　　The aim of this study is to visualize Judo accident using the reconstruction analysis for the medical field, and propose an injury risk assessment system based on detailed statistical analysis of the past cases for calling medical field’s attention. In the assessment system, the mechanical input caused by the accident is obtained from replication of the motion called as Waza in Judo based on game video by using whole body numerical simulation, then the obtained acceleration response of the head was input to a human head finite element model to evaluate the injury risk by using the calculated mechanical parameter inside the skull. In this study, the replicated motion based on the video was verified by comparing the movement loci of the player’s head analyzed by a three-dimensional motion analysis system experimentally. In this paper, two concussion suspected accident cases were analyzed by using the purposed evaluation system, and the concussion was evaluated by seven mechanical parameters generated inside the skull caused by the collision. The injury risk evaluated by the parameters belonged to the dangerous range that may cause concussion. The brain injury risk can be successfully estimated by the reconstructed simulation of the game video and FE analysis.

抄録全体を表示

リスクリテラシーとは,リスクに接する際に,その背景にまで考えを及ばせ,リスクの波及範囲を正確に見極め対処する力を備え,さらにリスクを予防する能力のことをいう.市民生活におけるリスクリテラシーにおいては,日常の生活における種々のリスクに加え,不期遭遇的なクライシス状況に対応する能力も求められている.そこで本稿ではリスクマネジメントの概念についてまず整理をし,さらにクライシス状況に対し準備すべき具体的事項について武道家として概説する.

抄録全体を表示

By technical progress of the Location Information and the expansion of the use range, the Location Service came to have big value to connect the community in IoT (Internet of Things).

A digital map, a smartphone, a beacon are core items of the location service called pinpointing, movement, the matching. These infrastructure looks at the area as a platform of the local service, and support cooperation, mutual assistance, informal economy by the sharing including defense, and it is possible for a thing.

The own area cluster (Terrace) which measured it distributes the services that assumed Location Information a Key through a platform and makes a future market to tie indoor and the outdoors, an area and a wide area to. The local IoT Internet of Things platform is important investment in reproduction for local continuation.

抄録全体を表示