受傷後に急速なびまん性脳腫脹を認め転帰が悪化した小児重症頭部外傷の一例

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  • Rapidly diffuse brain swelling following pediatric traumatic brain injury: a case report

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A 6-year-old boy was admitted to the emergency department due to a traffic accident. In physical examination, he presented disturbance of consciousness, Glasgow coma scale score 7 (E1,V2, M3), and didn’t present anisocoria and motor paresis. CT examination revealed a contusion and depression fracture in rt frontal lobe. MRI examination, T2*, revealed a dot hemorrhage in splenium of corpus callosum, and diffuse axonal injury was suspected. Operation for depression fracture was performed and intracranial pressure (ICP) monitor was inserted. Initial ICP revealed 17 mmHg. However ICP was rapidly elevated to 80 mmHg after 1 hour following operation, without hypoxia and hypotension. CT examination revealed diffuse cerebral swelling. Decompressive craniectomy was performed for ICP control, but it present a widespread ischemic area and no abnormalities in vessels at 3D-CTA. Brain hypothermia therapy (35˚C, 6 days) was performed with ICP control, below 20 mmHg.Finally he was transferred with vegetative state. In pediatric head injury, an autoregulation in cerebral vessels are immaturity, so that it reveals a specific hemodynamics, and seizure or subclinical seizure can occur. It is important of monitoring on ICP, hypoxia, hypotension and so on, with ICP monitor, continuous electroencephalogram (cEEG).

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