@article{oai:niigata-u.repo.nii.ac.jp:02000707,
 author = {今井, 邦英 and Imai, Kunihide and 八木, 和徳 and Yagi, Kazunori and 石川, 忍 and Ishikawa, Shinobu},
 issue = {10-12},
 journal = {新潟医学会雑誌},
 month = {Dec},
 note = {We can not necessarily find sufficient reports that investigate the pathophysiology and the clinical course of the subacute subdural hemorrhage (SASDH). In other words, this state is a relatively rare pathology and the origin, mechanism of occurrence, clinical course and prognosis have not analyzed yet in detail. Now, we have experienced a rare case who suffers from the acute subdural hematoma (ASDH) after the head trauma. Then, after the conservative treatments, the rapid growth of the volume of the hematoma with radiographical irregularity by computed tomography (CT) has identified in subacute stage (about one month after). In addition, this patient manifested neurological deterioration, mainly consciousness disturbance resulting in the aspiration pneumonia which may be the fatal cause. Therefore, we performed chemotherapy (administration of antibiotics) without the hyperalimentation such as tube nutritional support or intravenous hyperalimentation. Fortunately, the presented case has showed the slight shift of midline structure, not but the compression to midbrain by the uncal gyrus, the disappearance of the ipsilateral ambient cistern as the signs of intracranial herniation. In addition, he was marked elderly. So, operation (craniectomy, evacuation of the subdural hematoma and the external decompression) was not performed but the conservative therapy. In the subacute stage (one month later), since the hematoma has grown rapidly with radiographical irregularity (mixture of high density and low one) as described above, we performed the operation (perforation and drainage). However, His neurological improvement (mainly recovering from the consciousness disturbance) has not obtained. Therefore, we have investigated the relatively rare reports concerning the pathophysiology of the SASDH. Even if the signs of the uncal herniation that deteriorate the prognosis of the patients suffering from SASDH has not identified, the presented case of this disorder would suffer from systemic complication such as a swallowing disturbance and an eating difficulties resulting in the serious aspiration pneumonia because of the decreasing elastance of the brain after the disappearance of the hematoma. Even if the volume of the brain recover, it is suggested that the cerebral blood flow would not decrease compared with it before the trauma., 亜急性硬膜下血腫の病態生理，臨床経過について検討を加えた報告は必ずしも多くはない．これは，比較的珍しい病態であり，成因，発生機序，臨床経過，予後については，未だ詳しく検討されてはいない．今回，我々は，頭部外傷(打撲)後，急性硬膜下血腫を形成し，保存的加療を施行，亜急性期に血腫体積の急激な増大を見，意識障害を始めとする神経症状の悪化が見られた症例を経験した．また，引き続き，意識障害に伴う誤嚥性肺炎を合併し，化学療法(抗生剤の投与)を含む全身管理を要した．対象症例は，急性期に，画像上，文献的に，予後不良の兆候としての軽度の正中構造の偏位を見たものの，鉤回による中脳の圧迫，迂回槽の消失等，脳ヘルニアを示す兆候が見られなかったため，また，高齢であったため，本来なら，為されるはずの急性硬膜下血腫に対しての開頭，血腫除去，外減圧術は施行されず，保存的加療によって，経過観察を行った．亜急性期(発症後約1カ月)になり，血腫の増大を認め，CTでは，高吸収域の中に低吸収域を認めたため，穿頭，洗浄，ドレナージ術を行ったものの，意識障害を中心とする神経症状の改善は見られなかった．比較的報告例の少ない亜急性硬膜下血腫の病態生理について，文献的考察を含めて，検討を行った．上述の神経学的予後を悪化させる因子の主体を為す鉤回ヘルニアを示す兆候はなくても，高齢者の亜急性硬膜下血腫症例は，脳自体の可塑性の低下から，血腫による圧迫が消失後も，脳の体積および機能の回復は難しく，終日臥床，嚥下障害，摂食障害さらに誤嚥性肺炎を併発した．具体的な，神経学的予後の改善方法を見出すのは，困難であることを改めて，痛感した．},
 pages = {243--248},
 title = {高度の誤嚥性肺炎を合併した亜急性硬膜下血腫の1例},
 volume = {135},
 year = {2021}
}