Fukui K, Abe T, Kumon Y, Sakaki S, Fujita H, Hatakeyama T
Department of Neurological Surgery, Ehime University School of Medicine.
No Shinkei Geka. 1996 Oct;24(10):945-8.
We encountered 3 cases of battered children with acute subdural hematoma. In this report, we discuss the difficulties in treating this condition surgically, and we emphasize the importance of early diagnosis and treatment of abused children and their parents. Case 1: A girl, aged 2 months, was brought in by her mother, because the child had become drowsy. The mother stated that the child had been battered by her father. Physical examination revealed tense anterior fontanelle, bruises on her face, consciousness disturbance and retinal bleeding. Marked anemia was revealed on laboratory studies. A computed tomographic (CT) scan demonstrated an interhemispheric subdural hematoma in the parietooccipital region. She was treated conservatively for 2 months. Follow-up CT revealed a bilateral chronic subdural hematoma. Burr hole irrigation and drainage on both sides brought about complete disappearance of these lesions. Case 2: A girl, aged 1 year and 9 months, was brought in by her parents. According to her mother's allegation, the child fell down from the top of an indoor slide and became comatose. Physical examination revealed severe malnutrition, loss of consciousness, dilated pupils and negative light reflex. Numerous areas of subcutaneous bleeding and skin erosions were seen on her back and abdomen. Marked anemia was revealed on laboratory studies. CT scan demonstrated a left acute subdural hematoma and massive brain swelling. Despite an emergency craniotomy, the child died 5 days later. Case 3: A 4-year-old boy was admitted in a comatose state. According to his mother's allegation, he was thrown to the floor from a 1.5m height and struck against a wall by his father. Physical examination revealed severe malnutrition, consciousness loss, dilated pupils and negative light reflex. Many scratches and bruises were seen over his whole body, especially on his back. Marked anemia was revealed on laboratory studies. A CT scan demonstrated a left acute subdural hematoma and massive brain swelling. Three days later, he died despite emergency craniotomy. The incidence of battered children is increasing in Japan, and these cases sometimes involve severe head injuries, such as subdural hematoma. In these cases, successful surgical treatment is difficult after admission to the neurosurgical institute. This may result from late admission as well as marked anemia and malnutrition. Therefore, we conclude that early diagnosis of child abuse and treatment of the abused child and psychological treatment for their parents are very important.
我们遇到了3例受虐儿童合并急性硬膜下血肿的病例。在本报告中，我们讨论了手术治疗这种情况的困难，并强调了对受虐儿童及其父母进行早期诊断和治疗的重要性。病例1：一名2个月大的女孩由母亲送来，因为孩子变得嗜睡。母亲称孩子遭到了父亲的殴打。体格检查发现前囟紧张、面部有瘀伤、意识障碍和视网膜出血。实验室检查显示有明显贫血。计算机断层扫描（CT）显示顶枕部大脑镰旁硬膜下血肿。她接受了2个月的保守治疗。随访CT显示双侧慢性硬膜下血肿。双侧钻孔冲洗引流使这些病变完全消失。病例2：一名1岁9个月大的女孩由父母送来。据母亲称，孩子从室内滑梯顶部摔下后昏迷。体格检查发现严重营养不良、意识丧失、瞳孔散大且光反射阴性。在她的背部和腹部可见多处皮下出血和皮肤糜烂。实验室检查显示有明显贫血。CT扫描显示左侧急性硬膜下血肿和严重脑肿胀。尽管进行了紧急开颅手术，孩子还是在5天后死亡。病例3：一名4岁男孩昏迷入院。据母亲称，他被父亲从1.5米高处扔到地上并撞到了墙上。体格检查发现严重营养不良、意识丧失、瞳孔散大且光反射阴性。全身可见许多擦伤和瘀伤，尤其是背部。实验室检查显示有明显贫血。CT扫描显示左侧急性硬膜下血肿和严重脑肿胀。尽管进行了紧急开颅手术，他还是在3天后死亡。在日本，受虐儿童的发生率正在上升，这些病例有时会涉及严重的头部损伤，如硬膜下血肿。在这些病例中，进入神经外科机构后成功进行手术治疗很困难。这可能是由于入院较晚以及明显的贫血和营养不良所致。因此，我们得出结论，对虐待儿童的早期诊断、对受虐儿童的治疗以及对其父母的心理治疗非常重要。
