ABE, SHUICHI

NAGANO, TAKAYUKI

SAIKI, IWAO

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Title Penetrating Head Injury in a Child with Hemorrhage in theBilateral Basal Ganglia : Case ReportAuthor(s)NAGANO, TAKAYUKI; ABE, SHUICHI; SAIKI, IWAOCitation日本外科宝函 (1980), 49(2): 205-208Issue Date1980-03-01URL http://hdl.handle.net/2433/208415RightType Departmental Bulletin PaperTextversionpublisherKyoto UniversityArch Jap Chir 49 (2), 205～208, Marz, 1980 症例Penetrating Head Injury in a Child with Hemorrhage in the Bilateral Basal Ganglia一 CaseReport－一TAKAYUKI NAGANO, SHUICHI ABE Department of Neurosurgery, School of Medicine, Iwate Medical University lwAo SAIKI Department of Neurosurgery, Toyama Red Cross Hospital, Toyama, Japan. Received for Publication, Jan. 30, 1980 Abstract A 3 year old boy sustained penetrating head injury with hemorrhages in the bilateral basal ganglia is presented. lntracerebral hemorrhages of traumatic origin are quite rare in children, especially in the basal ganglia. It is postulated that hemorrhages occurred from leakage of the lenticulostriate arteries due to the shear strain of the head following head injury. Introduction Traumatic intracerebral hemorrhages in the region of the basal ganglia are apparently limited not only in adults but in children1≫2 emphasized in the basal ganglions, where hypertensive intracerebral hemorrhage are so frequent. Case Report This 3 year-old boy was transferred to our hospital shortly after the head injury on July l, 1978, when he was playing along the railway line, bowed by the passing train and hit his left temporo-parietal region. On examination at the admission, his conscious level was semicomatose with anisocoria (right : 2.5mm, left : 3.5mm) and light reaction was absent bilaterally. Right eye was deviated into the inner side without positive findings in the fundus. Bilateral deep tendon reflexes were exaggerated moderately without weakness of extremities. No pathological reflexes, no rhinorrhagia and no otorrhagia were Key words : Head injury, Intracerebral Hematoma, Basal ganglia. 索引語・頭部外傷，脳内血腫，基底核部．Present address Department of Neurosurgery, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Japan. 206 日外宝第49巻第2号（昭和55年3月）Fig. 1 Computerized tomography (CT) scan taken 1 day after operation Fig. 2 CT scan taken 6 days after operation Fig. 3 CT scan taken 10 days after operation recognized. An open wound, about 7cm in length, on the left temporal region was revealed. Emergency operation, including the debridement of the cerebral contusio, removal of the bone fragments and external decompression was undergone immediately. Computerized tomography (CT) scans, 1st day postoperatively, showed slight shift of the midline strucutres from left to right and high density areas in the bilateral basal ganglia suspected hemorrhages (Fig. 1.). CT scans, 6th postoperatively, revealed that the high density area in the right basal ganglia changed into the low density at the level of the pineal body and around the high density area in the left basal ganglia appeared wide low density area. A CT scan, 10th day after the opera-tion, demonstrated the disappearing of the high density areas in the bilateral basal ganglia into the low density which confirmed the hemorrhages. Four vessels angiography by the Seldinger technique was carried out posto-peratively and no positive findings were revealed. TRAUMATIC HEMORRHAGE IN THE BILATERAL BASAL GANGLIA 207 Discussion Since the report of BOLLINGER, 1891, on“late traumatic apoplexy”， various reviewsわon the etiology of intracerebral hemorrhage due to the head injury have been reported but definite theory has not stil established. It is definite that traumatic intracerebral hemorrhages in children are unusual, whereas some cases町川 dueto the bleeding factors or the cerebro-vascular disorders have been reported. INGRAHAM and MATSON4> did not find a single case in a series of 1330 cases of head injury requiring hospitalization. JAMIESON et al5> found only one case of traumatic intracerebral hematoma in childhood out of 63 surgically treated cases. MAKINO et aF> also reported only one case of intracerebral hematoma out of 82 cases of traumatic intracranial hematoma in children in 10 years. They emphasize that intracerebral hemorrhages due to apparent head injury cannot happen to occur in children anatomically and phisiologically because the inner surface of the skull in childhood is smooth and myelinizations of the brain are stil immature. So, it is necessary to examine the bleeding factors and cerebro-vascular disorders when we treat the children with spontaneous intracerebral hemorrhages whose causes unknown. Some cases of traumatic intracerebral hemorrhages reported in children are almost adjacent type which are a part of a severe contusion whereas the central type in which hemorrhages occur primarily in the centrum of the lobe has not been reported. In our case, traumatic intracerebral hemorrhages occurred in the bilateral basal ganglia in a 3 year-old boy without any cerebro vascular disorders or bleeding factors. Its cause would be difficult to explain clearly but it is postulated that hemorrhages in the bilateral basal ganglia happened from leakage of the lenticulostriate arteries due to the shear strain of the head. CT scan in our case easily confirmed the diagnosis of the hemorrhages in the bilateral basal ganglia in a child and consequently cases like ours would be expected in future. Acknowledgment We are grateful to Prof. H. KANAYA of Department of Neurosurgery of Iwate Medical Univer・ sity for his advise. References 1) Angrist A, Mitchell N : Traumatic hemorrhage of the internal capsule. Arch Surg 46: 265-276, 1943. 2) Courville CB, Blomquist OA : Traumatic intracerebral hemorrhage with particular reference to its pathogenesis and its relation to“delayed traumatic apoplexy" Arch Surg 41 1-28, 1940. 3) Evans JP, Scheinker IM Histologic studies of the brain following head trauma. I Post-traumatic petechial and massive intracerebral hemorrhage. J Neurosurg 3 : 101-113, 1946. 4) Ingraham FD, Matson D : Neurosurgery of Infancy and Childhood. Springfield : Charles C 208 日：外宝第49巻第2号（昭和55年3月）Thomas, 1954, 456 pp. 5) Jamieson KG, Yelland JDN Traumatic intracerebral hematoma. Report of 63 surgically treated cases. J Neurosurg 37 : 528-532, 1972. 6) Lagos JC, Siekert RG : Intracranial hemorrhage in infancy and childhood. Classification and outline of management. Clin Pediatrics 8 : 90-97, 1969. 7) Makino H, Nakada Y, et al : Acute traumatic intracranial hematoma in infancy and childhood. 1 General introduction and discussion. Neurol Med Chir (Tokyo) 17 : 187-193, 1977. 8) McLaurin RL, McBride BH : Traumatic intracerebral hematoma. Review of 16 surgically treated cases. Ann Surg 143 : 294-305, 1956. 9) Potter JM : Head injury and haemophilia. Acta Neurochir 14 : 380-387, 1965. 10) Till K : Paediatric Neurosurgery. Oxford : Blackwell Scientific Publications, 1975, 267 pp. 11) Travis R, Michell OC, et al: Intracranial surgery in hemophilia. Use of potent antihemophilic factor concentrated. Amer Surg 34 : 602-604, 1968. 和文抄録両側基底核部出血を来した開放性脳損傷の小児例岩手医科大学脳神経外科長野隆行，阿部秀富山赤十字病院脳神経外科斉木 巌小児における脳内血腫は出血性素因によるもの，脳 常なく又，血液凝固因子においても何ら陽性所見はな内血管の異常によるものは種々報告されているが外傷 し外傷により両側基底核部に出血を起こしたもので性のものはまれである．今回我々は開放性脳損傷に伴 ある．その発生機序に関しては，外傷により基底核部い，両側基底核部出血をきたした小児例を経験したの にズレが生じ，そのためにレンズ核線状体動脈が破綻で報告した．この症例において術後の脳血管撮影で異 したためと推測した

両側基底核部出血を来した開放性脳損傷の小児例

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両側基底核部出血を来した開放性脳損傷の小児例

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