Chronic Subdural Hematoma Due to Cumulative Trauma to the Head / 대한산업의학회지

Chronic subdural hematoma usually occurs as a consequence of minor trauma. But, chronic subdural hematoma of occupational origin has not been reported yet in Korea. We experienced a case of chronic subdural hematoma induced by repeated trauma to the head. The patient was a 45-year-old male. He complained of repeated headache and nausea. By the computed tomogram, he diagnosed as chronic subdural hematoma and took the operation. He was not an alcoholism and had no intracranial disease nor coagulopathy. We studied all possibilities through working environment and personal environment survey. As a result, we decided the case as an example of cumulative trauma disorder to the head by occupational origin. We report a case of chronic subdural hematoma in the worker exposed repeated head trauma of occupational origin.

A Clinical Analysis of Delayed Traumatic Intracerebral Hematoma

The development of sophisticated diagnostic modalities, most notably computerized tomography(CT), led to an increasing awareness of delayed traumatic intracerebral hematoma(DTICH). But the general prognosis for functional recovery was poor in patients who developed DTICH. The author analysed 95 cases of DTICH admitted to the department of Neurosurgery, Dong-Guk University Hospital during three years from January 1990 to December 1992. The result were as follows: 1) The incidence of the DTICH was 5.1% of all head injured patients. 2) The average age of patient was 43.3 years and the most common cause was traffic accident(61.6%). 3) Of the 95 patients who were diagnosed as DTICH, the clues to undergo follow up CT were divided as routine follow up in 39, changes of the consciousness level in 38, changes of the pupil size in 18 patients. 4) Most of the DTICH formation were related to contusion site of the brain and were more commonly associated with rotational forces. 5) Twenty-one cases of DTICH occurred within 24 hours after trauma and 18 cases at 2 days after trauma. 6) The most common site of hematoma was frontal lobe followed by temporal lobe. 7) The factors affecting prognosis (1) age(p<0.01) (2) Glasgow Coma scale(GCS) at admission(p<0.01) (3) time interval between trauma and discovery(p<0.01) (4) hematoma volume(p<0.01). Location of hematoma did not affect outcome, but the patients with multiple hematoma or basal ganglia hematoma showed higher fatality than the others. 8) The overall fatality rate was 40%.

A Case of the Spontaneous Spinal Epidural Abscess: Case Report

Abscesses in the spinal epidural space are seen in 0.2~1.2 patients per 10,000 hospital admissions and are much rarer than intracranial abscess. The morbidity and mortality of patients with infections in this location can be high, and most authors emphasize prompt diagnosis combined with appropriate antibiotics and surgical theraphy. Although laminectomy is frequently used for deagnosis and decompression of the neural element, it can lead to instability, and there are orther reports emphasizing the importance of anterior decompression with stabilization. We discussed the clinical features, radiologic findings of the case, and reviewed the literatures of this disease.

A Case of the Spontaneous Spinal Epidural Abscess: Case Report

Abscesses in the spinal epidural space are seen in 0.2~1.2 patients per 10,000 hospital admissions and are much rarer than intracranial abscess. The morbidity and mortality of patients with infections in this location can be high, and most authors emphasize prompt diagnosis combined with appropriate antibiotics and surgical theraphy. Although laminectomy is frequently used for deagnosis and decompression of the neural element, it can lead to instability, and there are orther reports emphasizing the importance of anterior decompression with stabilization. We discussed the clinical features, radiologic findings of the case, and reviewed the literatures of this disease.

Sedimentation Level in Chronic Sudural Hematoma Visible on Computerized Tomography

Authors report five cases of chronic subdural hematoma that showed a specific sedimentation sign on computerized tomography(CT) as a clear interface dividing the hematoma into two parts:an upper hypodense and a lower hyperdense zone. All patients had definite history of head trauma more than 1 month before they developed acute disturbance of consciousness and pronounced hemiparesis. We had analyzed the clinical importance of this sedimentation level and reviewed the available literature. This finding was considered as a specific CT sign indicating a significant amount of recent hemorrhage within the subdural hematoma that was sufficiently old to result in its contents being homogenous prior to rebleed and clinically manifested by acute deterioration.

The Clinical Analysis of Serum Creatine Kinase BB(CK-BB) in Acute Head Injury Patients

The extent of brain damage is known to be an essential predictive factor in the clinical course of patient with severe head injury. The purpose of the work was to study the usefulness of brain type creatine kinase(CK-BB) as a iochemical index of brain injury. We performed a Tri-check isoenzyme electrophoresis to determine the serum level of CK-BB in 123 patients with head injury. CK-BB isoenzyme was detected in the serum in 24 out of 123 patients with acute brain injury(19.5%). The peak of CK-BB activity ranged from 2 to 85IU/1 and mean value was 21.40+/-21.66IU/1. The activity was higher in patients with diffuse axonal injury, intracerebral hematoma and subdural hematoma than any other cases. The serum CK-BB isoenzyme was more frequently detected in low GCS score cases at admission and these patients had poor outcome than high GCS score cases. High CK-BB activity in serum was associated with poor prognosis, but a low CK-BB activity in serum was not necessarily a good prognostic sign. The presence of the serum CK-BB isoenzyme correlated with admission GCS score and with the ultimate outcome. We conclude that CK-BB level in serum is a reliable marker of cerebral parenchymal injury and may enhance the predictive value of the Glasgow coma scale score when used in conjunction with this indicant.

The Clinical Analysis of Serum Creatine Kinase BB(CK-BB) in Acute Head Injury Patients

The extent of brain damage is known to be an essential predictive factor in the clinical course of patient with severe head injury. The purpose of the work was to study the usefulness of brain type creatine kinase(CK-BB) as a iochemical index of brain injury. We performed a Tri-check isoenzyme electrophoresis to determine the serum level of CK-BB in 123 patients with head injury. CK-BB isoenzyme was detected in the serum in 24 out of 123 patients with acute brain injury(19.5%). The peak of CK-BB activity ranged from 2 to 85IU/1 and mean value was 21.40+/-21.66IU/1. The activity was higher in patients with diffuse axonal injury, intracerebral hematoma and subdural hematoma than any other cases. The serum CK-BB isoenzyme was more frequently detected in low GCS score cases at admission and these patients had poor outcome than high GCS score cases. High CK-BB activity in serum was associated with poor prognosis, but a low CK-BB activity in serum was not necessarily a good prognostic sign. The presence of the serum CK-BB isoenzyme correlated with admission GCS score and with the ultimate outcome. We conclude that CK-BB level in serum is a reliable marker of cerebral parenchymal injury and may enhance the predictive value of the Glasgow coma scale score when used in conjunction with this indicant.

The Change of Total Ascorbic Acid Level in the Experimental Spinal Cord Injury

The changes of total ascorbic acid level in the spinal cord tissues following experimental spinal cord injury were observed in the 20 cats. Three small areas (2x1.5cm sized) in the thoracic cord following laminectomy were made and the specimens were removed in one control and the other two areas after 5 & 30 minutes following impact injury respectively in each cat. The significant decrease of the total ascorbic acid level after 5 & 30 minutes following experimental spinal cord injury was found.

A Clinical Analysis of Spontaneous Cerebral & Cerebellar Hematoma

The Clinical analysis of 130 spontaneous intracebral & cerebellar hematoma confirmed by brain CT & admitted to this neurosurgical clinic past years & 5 months were made with literature review. 1) The age incidence showed increase over fourth decade and male to female ratio was 56.1:43.9. 2) 50.4% of total patients showed hypertension but 40.3% did not checked their B.P. & 9.3% had normal B.P. before cerebral hemorrhage. Among 50.4% of hypertension cases, 72% received antihypertensive treatment intermittently, 2.9% regularly and the rest 24.3% did not. 3) 69.7% of hematoma located in basal ganglia & thalamus. In nonoperated patients, the morbidity & mortality showed no marked difference in their location except pontine & cerebellar hematomas. In operated patients the morbidity & mortality was prominent in putaminal hemorrhage than in thalamus and cerebellum. Most of putaminal hematoma had semicomatose or comatose mental state and ventricular hemorrhage in 87.5%. 4) The morbidity & mortality increased in proportion to size of hematomas, grade of unconsciousness in admisson and state of intraventricular hemorrhage. 5) About time interval from ictus to operation, the patients within first 24 hours are 29 cases(51.1%) and the next 24 hours are 13 cases(26.5%). The mortality rate of two groups were 55.1% & 53.8% respectively but no death in the patients with operation performed after 48 hours. 6) The morbidity & mortality rate were as follows. In the non operated patients (90 patients), no or mild neurological deficits:22.2% moderate:21.1% severe:20% and moribund or death:36.6%. In the operated patients no or mild neurological deficits:16.3% moderate:18.4% severe:18.4% and moribund or death:46.9%. The results of total patients showed no or mild neurological deficits:20.1%, moderate:20.1%, severe:19.4% and moribund or death:40.2%.