중증 미만성 뇌손상의 예후에 관한 분석

Abstract

Computed tomography(CT) has enabled early recognition and treatment of focal injuries in patients with head trauma. However, CT has been less beneficial in identifying diffuse brain injury(DBI). The authors have analyzed retrospectively, a series of 132 patients with DBI observed for 2 years from Aug. 1986 to Jul. 1988 to evaluate the significance of the factors affectiong ourcome. Eighty-three patients were selected as being compatible with moderate and severe diffuse axonal injury(DAI) classified by Gennarelli, defined by coma without a CT lesion that is an obvious cause and coma greater than 24 hr with or without decerebration. The results are summarized as follows： 1) The 38(45.7％) out of 83 patients were found below age of 20, but there was no statistical significance between age distribution and outcome. 2) In case of initial Glasgow coma scale(GCS) of 7 or 8, 32(86.5％) out of 37 patients revealed good outcome, but 18(90％) of 20 patients with a score of 3 or 4 revealed poor outcome(p＜0.001). 3) With regard to brain swelling in CT, there was significant statistical difference to outcome(p＜0.05). 4) Small hemorrhages on corpus callosum, basal ganglia, basal cistern, peritentorial, lateral ventricle that is characteristic CT findings for DAI were showed 58(70％) out of cases. It might be concluded that initial GCS, brain swelling and small hemorrhages in CT were significant factors affecting outcome in DAI.