[논문]지연성 외상성 뇌실질내 출혈 환자의 치료를 결정하는 임상적, 영상학적 예후인자에 대한 평가

류제일; 김충현; 김재민; 정진환

doi:10.20408/jti.2015.28.4.223

지연성 외상성 뇌실질내 출혈 환자의 치료를 결정하는 임상적, 영상학적 예후인자에 대한 평가
Assessment of the Clinical and the Radiological Prognostic Factors that Determine the Management of a Delayed, Traumatic, Intraparenchymal Hemorrhage (DTIPH) 원문보기

Journal of trauma and injury : JTI, v.28 no.4, 2015년, pp.223 - 231

류제일 (한양대학교 의과대학 한양대학교 구리병원 신경외과) , 김충현 (한양대학교 의과대학 한양대학교 구리병원 신경외과) , 김재민 (한양대학교 의과대학 한양대학교 구리병원 신경외과) , 정진환 (한양대학교 의과대학 한양대학교 구리병원 신경외과)

Abstract ▼ AI-Helper

Purpose: Delayed, traumatic, intraparenchymal hemorrhage (DTIPH) is a well-known contributing factor to secondary brain damage that evokes severe brain edema and intracranial hypertension. Once it has occurred, it adversely affects the patient's outcome. The aim of this study was to evaluate the prognosis factors for DTIPH by comparing clinical, radiological and hematologic results between two groups of patients according to whether surgical treatment was given or not. Methods: The author investigated 26 patients who suffered DTIPH during the recent consecutive five-year period. The 26 patients were divided according to their having undergone either a decompressive craniectomy (n=20) or continuous conservative treatment (n=6). A retrospective investigation was done by reviewing their admission records and radiological findings. Results: This incidence of DTIPH was 6.6% among the total number of patients admitted with head injuries. The clinical outcome of DTIPH was favorable in 9 of the 26 patients (34.6%) whereas it was unfavorable in 17 patients (65.4%). The patients with coagulopathy had an unexceptionally high rate of mortality. Among the variables, whether the patient had undergone a decompressive craniectomy, the patient's preoperative clinical status, and the degree of midline shift had significant correlations with the ultimate outcome. Conclusion: In patients with DTIPH, proper evaluation of preoperative clinical grading and radiological findings can hamper deleterious secondary events because it can lead to a swift and proper decompressive craniectomy to reduce the intracranial pressure. Surgical decompression should be carefully selected, paying attention to the patient's accompanying injury and hematology results, especially thrombocytopenia, in order to improve the patient's neurologic outcomes.

주제어

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문제 정의

(10-14) However, in cases of DTIPH patients, treatment method, timing, and screening of subjects for treatment are still controversial. This study aims to suggest an appropriate treatment plan for patients in the risk group and morbidity group, who might become DTIPH patients, by comparing decompressive craniectomy with conservative treatment in DTIPH patients.

제안 방법

The authors defined DTIPH as a case of the increase of bleeding or hemorrhage occurring in a new location after a certain period of time after confirming the presence of brain lesions due to injury through the brain CT scan. In terms of size, the hematoma with the largest diameter was examined, and a follow-up examination was performed when clinical symptoms were exacerbated, or within 12 hours after the first examination.
The initial level of consciousness was assessed using the Glasgow Coma Scale (GCS),(2,4,5,15,16) and classified by score into severe consciousness disorder (GCS<8), moderate consciousness disorder (GCS: 8-11), and mild consciousness disorder (GCS>12). Neurologic prognosis was assessed by using the Glasgow Outcome Scale (GOS),(15-17) and classified into favorable prognosis when GOS was 4-5 points and poor prognosis when GOS was 3 points or less.
The authors defined DTIPH as a case of the increase of bleeding or hemorrhage occurring in a new location after a certain period of time after confirming the presence of brain lesions due to injury through the brain CT scan. In terms of size, the hematoma with the largest diameter was examined, and a follow-up examination was performed when clinical symptoms were exacerbated, or within 12 hours after the first examination.

대상 데이터

(21) These abnormalities in coagulation factors are closely associated with increased intake of anticoagulants, such as aspirin and warfarin, due to the recent increase in cardiovascular and cerebrovascular diseases, and patients who took such medicines increased the mortality rate four times compared to patients who did not take the medicines.(22) In this study, two patients who had a history of cerebral infarction and were taking aspirin and anticoagulants died after surgery. Of nine patients who had thrombocytopenia, seven died, revealing that thrombocytopenia itself has an adverse effect on the prognosis regardless of whether or not surgery is administered.
Of 1028 patients who were admitted due to brain injury from January 2000 to October 2005, 794 patients were selected as subjects. A total of 234 patients who experienced chronic or subacute subdural hemorrhage or subdural hygroma more than two weeks after the head injury were excluded.

데이터처리

For the statistical analysis, using SPSS 12.0 (Chicago, IL, USA), Fisher’s exact test and independent samples T-test were performed, and p values less than 0.05 were considered statistically significant.

성능/효과

(3) defined hemorrhage found in the site, which was normal on the first CT scan within 48 hours after the head injury, or near the site where bleeding was first detected as DTIPH.(4) DTIPH is reported to occur in 1 to 8% of patients with severe head injury, and the mortality rate is known to be over 40%. Despite many studies on the mechanisms and treatments of brain injuries, the mortality rate is still high, and though patients survive, serious neurological sequelae remain in many cases.
Intraparenchymal hemorrhage, where lesions that are not present right after the head injury develop after a certain period of time, is reported to occur within 4 hours to 4 days after the injury in general. In this study, intraparenchymal hemorrhage developed within a minimum of 4 hours to a maximum of 72 hours. As a pathogenesis mechanism, first, there is an increase of permeability of endothelium,(19) due to the loss of blood flow and automatic control mechanism, and next, extravasation in the site of cerebral contusion can be argued2).
003).The mean degree of brain midline movement was 12.95 mm before surgery in the favorable prognosis group, and 14.49 mm in the poor prognosis group, which was statistically significant (p=0.034). With regard to coagulopathy, 7 out of 9 patients with thrombocytopenia died, and 10 out of 17 patients with normal platelet counts died.
With regard to GCS score before performing decompressive craniectomy for DTIPH, the mean score was 8.4 points in the favorable prognosis and 6.3 points in the poor prognosis group. Patients with high GCS scores showed favorable prognosis, which was statistically significant (p=0.

참고문헌 (25)

National center for health ststistics: Advance report of final mortality statistics, 1985. Washington DC: US Goverment printing office: 1987; 36-42.
Unterberg AW, Stover J, Kress B, Kiening KL. Edema and brain trauma. Neuroscience 2004; 129 : 1021-9.
Ban M, Agawa M, Fukami T. Deplayed evolution of posttraumatic contralateral extracerebral hematoma after evacuation of initial hematoma. Neurol Med Chir (Tokyo) 1991; 31 : 927-30.

상세보기
Jose A, Antoni T, Manuel L. Delayed Posttaumatic Hemorrhage. Stroke 1995; 26: 1531-5.

상세보기
Cooper PR. Delayed traumatic intracerebral hemorrhage. Neurosurg Clin N Am 1992; 3: 659-65.

상세보기
Prat R, Calatayud-Maldonado V. Prognostic factors in posttraumatic severe diffuse brain injury. Acta Neurochir (Wien) 1998; 140: 1257-61.

상세보기
Jamshid G. Traumatic brain injury. Lancet 2000; 356: 923-9.

상세보기
Liu WG, Yao Y, Zhou JY, yang XF. Enlargement of posttraumatic intracereberal haematoma. Incidence and time course. J Int Med Res 2005; 33: 119-22.

상세보기
Shaya M, Dubey A, Berk C, Gonzalez-Toledo E, Zhang J, Caldito G, et al. Factors influencing outcome in intracerebral hematoma. A simple, reliable, and accurate method to grade intracerebral hemorrhage. Surg Neurol 2005; 63: 343-8.

상세보기
Albanese J, Leone M, Alliez JR, Kaya JM, Antonini F, Alliez B, et al. Decompressive craniectomy for severe traumatic brain injury. Evaluation of the effects at one year. Crit Care Med 2003; 31: 2535-8.

상세보기
Gaab MR, Rittierodt M, Lorenz M, Heissler HE. Traumatic brain swelling and operative decompression. A prospective investigation. Act Neurochir 1990; 51: 326-8.
Guerra WK, Gaab MR, Dietz H, Mueller JU, Piek J, Fritsch MJ. Surgical decompression for traumatic brain swelling. Indication and result. J Neurosurg 1999; 90: 187-96.

상세보기
Lee SW, Kim OL, Woo BG. Prognostic factors in patients with severe head injury. J Korean Nurosurg Soc 1999; 28: 1288-92.
Winter CD, Adamides AA, Rosenfeld JV. The role of decompressive craniectomy in the management of traumatic brain injury. A critical review. J Clin Neurosci 2005; 12: 619-23.

상세보기
Aoyagi N, Hayakawa I, Takemura N. Traumatic delayed intracerebral hematoma-clinical aspect. No Shinkei Geka 1985; 13: 17-25.
Hukkelhoven CW, Steyerberg EW, Rampen AJ, Farace E, Habbema JD, Marshall LF, et al. Patient age and outcome following severe traumatic brain injury. An analysis of 5600 patients. J Neurosurg 2003; 99: 666-73.

상세보기
Young HA, Gleave JR, Schmidek HH, Gregory S. Delayed traumatic intracerebral hematoma. Report of 15 cases operatively treated. Neurosurgery 1984; 14: 22-5.

상세보기
Fukamachi A, Nagaseki Y, Kohno K, Wakao T. The incidence and developmental process of delayed traumatic intracerebral hematomas. Acta Neurochir (Wien) 1985; 74: 35-9.

상세보기
Hung KS, Liang CL, Wang CH, Chang HW, Park N, Juo SH. Outcome after traumatic frontal intracerebral haemorrhage : a comparison of unilateral and bilateral haematomas. J Clin Neurosci 2004; 11: 849-53.

상세보기
Modesti LM, Hodge CJ. Barnwell IU: Intracerebral hematoma after evacuation-chronic extracerebral fluid collections. Neurosurgery 1982; 10: 689-93.

상세보기
Engstrom M, Romner B, Schalen W, Reinstrup P. Thrombocytopenia predicts progressive hemorrhage after head trauma. J Neurotrauma 2005; 22: 291-6.

상세보기
Mina AA, Knipfer JF, Park DY, Bair HA, Howells GA, Bendick PJ. Intracranical complication of preinjury anticoagulation in trauma patients with head injury. J Trauma 2002; 53: 668-72.

상세보기
McCarron MO, Nicoll JA, Ironside JW, Love S, Alberts MJ, Bone I. Cerebral amyloid angiopathy-related hemorrhage. Interaction of APOE epsilon 2 with putative clinical risk factor. Stroke 1999; 30: 1643-6.

상세보기
Roof RL, Hall ED. Gender differences in acute CNS trauma and stroke. Neuroprotective effect of estrogen and progesterone. J Neurotrauma 2000; 17: 367-88.

상세보기
Hatashita S, Hoff JT. The effect of craniectomy on the biomechanics of normal brain. J Neurosurg 1987; 67: 573-8.

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