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題名 | 嬰兒搖晃症候群之早期CT影像=The Early CT Image of Shaken Baby Syndrome |
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作者 | 沈戊忠; 周德陽; 蔡長海; Shen, Wu-chung; Cho, Der-yang; Tsai, Chang-hai; |
期刊 | 中國醫藥雜誌 |
出版日期 | 19971200 |
卷期 | 2:4 1997.12[民86.12] |
頁次 | 頁227-231 |
分類號 | 417.517 |
語文 | chi |
關鍵詞 | 嬰兒搖晃症候群; 廣泛腦水腫; 硬腦膜下腔血腫; 蜘蛛網膜下腔出血; 電腦斷層攝影; Shaken baby syndrome; Diffuse brain edema; Subdural hematoma; Subarachnoid hemorrhage; Computer tomography; |
中文摘要 | 本文報告七例嬰兒搖晃症候群(shaken baby syndrome)。病患年齡由一個月至一一歲。其初期症狀為意識不凊,噁吐,抽筋,且因為多數病患缺乏明顯的外傷跡象,因此在急診時常與腦炎、腦膜炎難以鑑別。但在初期的CT(第一期),可以見到薄層硬腦膜下腔血腫(SDH),及蜘蛛網膜下腔出血(SAH)。SDH通常位於額頂葉區,而SAH則在人腦半球間裂及小腦天幕下。茌數小時至一二天內,臨床症狀會加劇,而CT也會進人第二期,即廣泛腦水腫,這種腦水腫可能是內頸動脈栓塞所引起的。有4例是單側人腦半球腦水腫(但2例合併對側額葉),另3例為雙側大腦半球都有廣泛腦水腫。臨床上如果能在第一二期之間做積極的減壓手術,可以減少日後神經性後遺症,及智能障礙,所以早期診斷非常重要。而這類病患往往有視網膜出血。因此,我們建議,當嬰兒有急性腦性病變,而CT顯示有SDH,SAH時,應警覺是否為嬰兒搖晃症候群?而檢查眼底是否有視網膜出血,如有,就可確定診斷,應採取積極的減壓手術,並密切追蹤CT,看看在數小時到兩天內有無變成廣泛腦水腫。 |
英文摘要 | We report 7 cases of shaken baby syndrome. The ages of the patients ranged from 1 month to 12 months, with an average of 5 months. The early symptoms included consciousness disturbance, vomiting, irritability and coma. This syndrome is very difficult to distinguish from other kinds of acute encephalopathy such as meningitis or encephalitis because visible external injury of the head is usually lacking. However, in the very early stage (phase 1), we can see a thin layer of acute subdural hematoma (SDH) in the frontal region, and subarachnoid hemorrhage (SAH) in the interhemispheric fissure or subtentorial space. Several hours to days later, during which period the clinical symptoms usually deteriorate, the CT shows diffuse brain tissue ederna (phase 2). In our series brain tissue ederna was found in 4 cases in the unilateral hemisphere (two cases also had edema on the contralateral side of the frontal lobe), and 3 cases in the bilateral cerebral hemispheres. The brain edema was likely due to total or partial occlusion of the internal carotid artery. All cases were associated with retinal hemorrhage. In phase 1, if the clinician performs a craniotomy or other aggressive procedures to relieve the intracranial pressure, the brain damage will decrease, and serious brain damage can be avoided. Therefore early diagnosis is very important. From our research, we suggest when an infant is brought to the emergency department with acute encephalopathy of unknown etiology, and CT shows a thin layer of acute subdural hematoma or SAH, the eye fundi should be checked immediately. Once retinal hemorrhage is noted, the diagnosis of shaken baby syndrome is established, and aggressive surgical procedures to relieve the intracranial pressure must be undertaken to decrease complications. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。