[Clinical problems in the management of aged patients with severe head injury: analysis of neurological findings and CT findings].
Aged patients were defined as those of 65 years or more of age. Among 457 patients with severe head injury [Glasgow Coma Scale score (GCS) of 8 or less], sixty-five aged patients (14%) were analyzed with special reference to their pretreatment neurological status, CT findings and outcome in comparison with 141 (31%) of those from 40 to 64 years of age. As a cause of injury, the incidence of traffic accidents and falls and tumbles did not differ statistically in both groups. Neither did the severity (GCS score) significantly differ in the two groups. Three important neurological findings [pupillary abnormality, impaired or absent oculocephalic reflex and poor motor response (GCS motor score < or = 3)], were analyzed as the prognostic factors. Poor motor response was the sole finding that was significantly more frequent in the aged. On CT in the aged, acute subdural hematoma was most common among the extraparenchymal hematoma. Hemorrhagic lesions were the more common parenchymal lesions. On the other hand, diffuse cerebral swelling was rare in the aged. The outcome was significantly poor in the aged; only 6% had good outcome (good recovery and moderate disability), and 80% died. In conclusion, these results suggested that the poor outcome was due to severe primary brain damage added to poor brain plasticity in the aged.
Ono
J
J
Department of Neurosurgery, Chiba University School of Medicine.
Isobe
K
K
Watanabe
Y
Y
Yamaura
A
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D006259:Craniocerebral Trauma / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015600:Glasgow Coma Scale; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D009420:Nervous System / Q000503:physiopathology*; D009460:Neurologic Examination; D011379:Prognosis; D014057:Tomography, X-Ray Computed