Gutierrez F A, Raimondi A J
Childs Brain. 1975;1(5):269-90. doi: 10.1159/000119578.
27 cases of acute posttraumatic subdural hematomas diagnosed and treated by the authors from 1968 to 1972 are presented. Five were newborns, 18 were infants, and three were toddlers. The youngest patient was 38 h and the oldest 5 years old. The most common age was between 1 and 3 months. Falls were the most frequent cause of injury, parental or familial abuse was next. A correlative analysis of the different clinical pictures in each of these age groups is made. We stressed that the presence of hemorrhages in the fundi, and convulsions, in the infant who has suffered a head injury, are indications for contrast studies. A critical analysis of subdural taps, as a method of diagnosis and treatment, is made: we seriously doubt that subdural taps are of any real value in the clinical management of a child with acute head injury. Comparative analysis of the surgical treatment and results is made. Twelve patients were treated with repeated subdural taps, 15 with craniotomy. Of the former group, 41.6% developed a chronic subdural whereas only 13% of the latter group developed this complication. Five out of the 27 patients died. Comparative psychological evaluation of these two groups, surgical and nonsurgical, is presented. In the surgical group 72.7% had an IQ over 80 and in the nonsurgical group only 25% had an IQ over 80. A correlative analysis of the clinical picture, method of diagnosis, surgical result, and psychological tests are analyzed.
本文介绍了作者在1968年至1972年期间诊断和治疗的27例急性创伤后硬膜下血肿病例。其中5例为新生儿，18例为婴儿，3例为学步儿童。最年幼的患者为38小时，最年长的为5岁。最常见的年龄在1至3个月之间。跌倒为最常见的受伤原因，其次是父母或家庭虐待。对这些年龄组中每一组的不同临床表现进行了相关分析。我们强调，头部受伤的婴儿眼底出血和惊厥是进行造影检查的指征。对硬膜下穿刺作为一种诊断和治疗方法进行了批判性分析：我们严重怀疑硬膜下穿刺在急性头部受伤儿童的临床管理中是否具有任何实际价值。对手术治疗及结果进行了比较分析。12例患者接受了反复硬膜下穿刺治疗，15例接受了开颅手术。在前一组中，41.6%发生了慢性硬膜下血肿，而后一组中只有13%发生了这种并发症。27例患者中有5例死亡。对手术组和非手术组这两组进行了比较性心理评估。手术组中72.7%的患者智商超过80，而非手术组中只有25%的患者智商超过80。对临床表现、诊断方法、手术结果和心理测试进行了相关分析。
