高齢者頭部外傷の特徴と問題点 [in Japanese] Clinical Characteristics and Problems of Traumatic Brain Injury in the Elderly [in Japanese]
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高齢者頭部外傷は予後不良とされ, 病態の解明, 治療法の開発, 予防への取り組みは, 高齢化社会を迎えた本邦における喫緊の課題である. 本稿では, その特徴と問題点について言及・考察する. 高齢者頭部外傷は運動機能や生理機能の低下による転倒・転落が多い. 急性期頭蓋内病変では急性硬膜下血腫の頻度が高く, 血腫量が多いことが特徴で, 加齢による硬膜下腔の拡大など解剖学的特徴に起因する. また, 遅発性頭蓋内血腫や脳血流変化など, 解剖学的・生理学的特徴に関連する病態も高齢者に特徴的である. 近年普及した抗凝固・血小板療法は, 頭蓋内出血増悪の一因であり, さらに治療を困難にしている. 今後, さらなる研究が期待される.
In recent years, instances of traumatic brain injury (TBI) in the elderly has been increased. This article addresses the clinical characteristics and problems of TBI in the elderly. Either falls to the ground from standing or from heights are the most frequent causes of elderly TBI, since both motor and physiological functions are degraded in the elderly. Acute subdural hematomas (ASDH) are the most frequently encountered acute traumatic intracranial lesions. Their high frequency has been proposed to be associated with the increased volume of the subdural space resulting from atrophy of the brain often found in the elderly. The delayed aggravation of intracranial hematomas has also been explained by such anatomical and physiological changes present in the elderly. Delayed hyperemia/hyperperfusion may also be a characteristic of elderly TBI, although its mechanisms are not fully understood. In addition, widely used pre-injury anticoagulant and antiplatelet therapies may be associated with delayed aggravation, making the management of TBI in the elderly difficult. Establishing preventions and treatments for elderly TBI is an urgent issue since its outcome has remained poor for more than 40 years.
- Japanese Journal of Neurosurgery
Japanese Journal of Neurosurgery 23(12), 965-972, 2014
The Japanese Congress of Neurological Surgeons