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KARIBE H, HAYASHI T, NARISAWA A, KAMEYAMA M, NAKAGAWA A, TOMINAGA T. Clinical Characteristics and Outcome in Elderly Patients with Traumatic Brain Injury: For Establishment of Management Strategy. Neurol Med Chir (Tokyo) 2017; 57:418-425. [PMID: 28679968 PMCID: PMC5566701 DOI: 10.2176/nmc.st.2017-0058] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/18/2017] [Indexed: 01/21/2023] Open
Abstract
In recent years, instances of neurotrauma in the elderly have been increasing. This article addresses the clinical characteristics, management strategy, and outcome in elderly patients with traumatic brain injury (TBI). Falls to the ground either from standing or from heights are the most common causes of TBI in the elderly, since both motor and physiological functions are degraded in the elderly. Subdural, contusional and intracerebral hematomas are more common in the elderly than the young as the acute traumatic intracranial lesion. High frequency of those lesions has been proposed to be associated with increased volume of the subdural space resulting from the atrophy of the brain in the elderly. The delayed aggravation of intracranial hematomas has been also explained by such anatomical and physiological changes present in the elderly. Delayed hyperemia/hyperperfusion may also be a characteristic of the elderly TBI, although its mechanisms are not fully understood. In addition, widely used pre-injury anticoagulant and antiplatelet therapies may be associated with delayed aggravation, making the management difficult for elderly TBI. It is an urgent issue to establish preventions and treatments for elderly TBI, since its outcome has been remained poor for more than 40 years.
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MESH Headings
- Accidental Falls/statistics & numerical data
- Age Factors
- Aged
- Aged, 80 and over
- Anticoagulants/adverse effects
- Atrophy
- Brain/pathology
- Brain/physiopathology
- Brain Damage, Chronic/epidemiology
- Brain Damage, Chronic/etiology
- Brain Damage, Chronic/prevention & control
- Brain Edema/etiology
- Brain Edema/physiopathology
- Brain Injuries, Traumatic/complications
- Brain Injuries, Traumatic/epidemiology
- Brain Injuries, Traumatic/physiopathology
- Brain Injuries, Traumatic/therapy
- Comorbidity
- Disease Management
- Disease Progression
- Humans
- Hyperemia/physiopathology
- Intracranial Hemorrhage, Traumatic/etiology
- Intracranial Hemorrhage, Traumatic/physiopathology
- Platelet Aggregation Inhibitors/adverse effects
- Practice Guidelines as Topic
- Subdural Space/pathology
- Treatment Outcome
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Affiliation(s)
- Hiroshi KARIBE
- Department of Neurosurgery, Sendai City Hospital, Sendai, Miyagi, Japan
| | - Toshiaki HAYASHI
- Department of Neurosurgery, Sendai City Hospital, Sendai, Miyagi, Japan
| | - Ayumi NARISAWA
- Department of Neurosurgery, Sendai City Hospital, Sendai, Miyagi, Japan
| | - Motonobu KAMEYAMA
- Department of Neurosurgery, Sendai City Hospital, Sendai, Miyagi, Japan
| | - Atsuhiro NAKAGAWA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Teiji TOMINAGA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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KARIBE H, HAYASHI T, HIRANO T, KAMEYAMA M, NAKAGAWA A, TOMINAGA T. Surgical management of traumatic acute subdural hematoma in adults: a review. Neurol Med Chir (Tokyo) 2014; 54. [PMID: 25367584 PMCID: PMC4533344 DOI: 10.2176/nmc.ra.2014-0204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Traumatic acute subdural hematoma (ASDH) is a major clinical entity in traumatic brain injury (TBI). It acts as a space occupying lesion to increase intracranial pressure, and is often complicated by co-existing lesions, and is modified by cerebral blood flow (CBF) changes, coagulopathy, and delayed hematomas. Because of its complicated pathophysiology, the mortality of ASDH is still remaining high. In this review article, its epidemiology, pathophyiology, surgical treatment, and salvage ability are described. With regard to epidemiology, as the population ages, growing number of elderly patients with ASDH, especially patients with prehospital anticoagulant and antiplatelets, increase. Concerning pathophysiology, in addition to well-known initial intracranial hypertension and subsequent ischemia, delayed hyperemia/hyperperfusion, or delayed hematoma is being recognized frequently in recent years. However, optimal treatments for these delayed phenomenons have not been established yet. With regard to surgical procedures, all of craniotomy, decompressive craniectomy, and initial trephination strategies seem to be effective, but superiority of each procedure have not been established yet. Since Glasgow Coma Scale (GCS) scores, age, papillary reaction, and computed tomographic findings are strongly correlated to outcome, each factor has been investigated as an indicator of salvage ability. None of them, however, has been defined as such one. In future studies, epidemiological changes as population ages, management of delayed pathophysiology, superiority of each surgical procedures, and salvage ability should be addressed.
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Affiliation(s)
- Hiroshi KARIBE
- Department of Neurosurgery, Sendai City Hospital, Sendai, Miyagi;,Address reprint requests to: Hiroshi Karibe, MD, PhD, Department of Neurosurgery, Sendai City Hospital, 3-1, Shimizu-koji, Wakabayashi-ku, Sendai, Miyagi 980-8574, Japan. e-mail:
| | - Toshiaki HAYASHI
- Department of Neurosurgery, Sendai City Hospital, Sendai, Miyagi
| | - Takayuki HIRANO
- Department of Neurosurgery, Sendai City Hospital, Sendai, Miyagi
| | | | - Atsuhiro NAKAGAWA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi
| | - Teiji TOMINAGA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi
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KARIBE H, HAYASHI T, HIRANO T, KAMEYAMA M, NAKAGAWA A, TOMINAGA T. Surgical Management of Traumatic Acute Subdural Hematoma in Adults: A Review. Neurol Med Chir (Tokyo) 2014; 54:887-94. [DOI: 10.2176/nmc.cr.2014-0204] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Atsuhiro NAKAGAWA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
| | - Teiji TOMINAGA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
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NAKAGAWA A. Variation in pathogenicity and cultural characteristics among isolates reverted from protoplasts of Sclerotium rolfsii. ACTA ACUST UNITED AC 2001. [DOI: 10.3186/jjphytopath.67.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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KUMAGAI H, SAKAI F, HUKUHARA T, SAJI Y, NAKANISHI S, SAWABE T, NAKAGAWA A. SITE OF ACTION OF TRANS-PI-OXOCAMPHOR IN THE CENTRAL NERVOUS SYSTEM OF THE CAT. ACTA ACUST UNITED AC 1996; 14:229-30. [PMID: 14215553 DOI: 10.1254/jjp.14.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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SAKAI F, HUKUHARA T, SAJI Y, NAKANISHI S, SAWABE T, NAKAGAWA A, TAMURA M, KUMADAKI N. [ON THE PARODOXICAL WAVES IN THE ELECTROENCEPHALOGRAM OF THE URETHANE-ANESTHETIZED CAT]. Arch Int Pharmacodyn Ther 1964; 152:338-45. [PMID: 14265653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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MURATA I, NAKAGAWA A, FURUMOTO S. [SO-CALLED PAIN DISEASE (5)]. Nihon Seikeigeka Gakkai Zasshi 1964; 38:680-1. [PMID: 14217409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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GOTO T, TANAKAMARU S, KUDO F, MIYAGAWA Y, NAKAGAWA A, TOYODA D. [ARTERIOSCLEROSIS AND ALLIED DISEASES. 1. APOPLEXY, WITH SPECIAL REFERENCE TO DIFFERENTIAL DIAGNOSIS]. Kumamoto Igakkai Zasshi 1964; 38:207-12. [PMID: 14161635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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GOTO T, TANAKAMARU S, KUDO F, MIYAGAWA Y, NAKAGAWA A, TOYODA D. [CASE OF ANOMALY OF A. VERTEBRALIS DEXTRA]. Kumamoto Igakkai Zasshi 1964; 38:203-6. [PMID: 14161634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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ARATANI H, YAMANAKA Y, NAKAGAWA A, HINOI H, NAKAMURA S. [PHARMACOLOGICAL STUDY ON A NEW ANTIBIOTIC, RIFAMYCIN SV]. J Antibiot B 1963; 16:312-6. [PMID: 14086070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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ARATANI H, NAKAGAWA A, YAMANAKA Y, MINAKATA K, HINOI H. [Pharmacological studies on synthetic penicillins. 2. Effect on the central nervous system]. J Antibiot B 1963; 16:40-4. [PMID: 14040790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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ARATANI H, NAKAGAWA A, MINAKATA K, HINOI H, TANAKA M. [Pharmacological studies on synthetic penicillins. 3. Distribution in the body]. J Antibiot B 1963; 16:45-9. [PMID: 14040787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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ARATANI H, NAKAGAWA A, TANIGUCHI T, TANAKA M. [Pharmacological studies on psoromic acid, a constituent of lichens]. J Antibiot B 1963; 16:4-7. [PMID: 14040789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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NAGANUMA K, SATO A, NAKAGAWA A, AIDA M, SAITO H, HIROSAWA M, AOKI K. The effect of pituitary and adrenocortical hormones on the serum protein pattern. Jpn J Med Sci Biol 1962; 51:1226-32. [PMID: 13937118 DOI: 10.2169/naika.51.1226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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ARATANI H, NAKAGAWA A, MUNAKATA K, FUJII Y. [Pharmacological studies on chloramphenicol morpholine acetate]. J Antibiot B 1962; 15:198-208. [PMID: 14040788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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YUKAWA N, MIURA Y, HAYASHI M, DOI K, NAKAGAWA A, UKIMURA S, OSAKA F. [Stomach diseases and surgery]. Naika 1962; 10:90-4. [PMID: 14009452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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GOTO T, NISHI U, KOGA T, ITO I, NAKAGAWA A, TOYODA D, YOKOTA S, MIMURA K, TOYONAGA K. 72. The Study on Prognosis of the Head Injuried Patients. Neurol Med Chir (Tokyo) 1962. [DOI: 10.2176/nmc.4.196a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- T. GOTO
- 1st Surgical Department, Kumamoto Medical College
| | - U. NISHI
- 1st Surgical Department, Kumamoto Medical College
| | - T. KOGA
- 1st Surgical Department, Kumamoto Medical College
| | - I. ITO
- 1st Surgical Department, Kumamoto Medical College
| | - A. NAKAGAWA
- 1st Surgical Department, Kumamoto Medical College
| | - D. TOYODA
- 1st Surgical Department, Kumamoto Medical College
| | - S. YOKOTA
- Neuro-Psychiatric Department, Kumamoto Medical College
| | - K. MIMURA
- Neuro-Psychiatric Department, Kumamoto Medical College
| | - K. TOYONAGA
- Neuro-Psychiatric Department, Kumamoto Medical College
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GOTO T, NISHI U, KOGA T, ITO I, NAKAGAWA A, TOYODA D, YOKOTA S, MIMURA K, TOYONAGA K. 72. The Study on Prognosis of the Head Injuried Patients. Neurol Med Chir (Tokyo) 1962. [DOI: 10.2176/nmc.4.196b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- T. GOTO
- 1st Surgical Department, Kumamoto Medical College
| | - U. NISHI
- 1st Surgical Department, Kumamoto Medical College
| | - T. KOGA
- 1st Surgical Department, Kumamoto Medical College
| | - I. ITO
- 1st Surgical Department, Kumamoto Medical College
| | - A. NAKAGAWA
- 1st Surgical Department, Kumamoto Medical College
| | - D. TOYODA
- 1st Surgical Department, Kumamoto Medical College
| | - S. YOKOTA
- Neuro-Psychiatric Department, Kumamoto Medical College
| | - K. MIMURA
- Neuro-Psychiatric Department, Kumamoto Medical College
| | - K. TOYONAGA
- Neuro-Psychiatric Department, Kumamoto Medical College
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NAKATSUKA M, ARATANI H, NAKAGAWA A, NUNAKATA K, TATEISHI H. [Pharmacological studies on radioisotopes. I. Autonomic nervous system]. Gencho Hiroshima Igaku 1961; 9:1433-44. [PMID: 14478228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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NAKATSUKA M, ARATANI H, NAKAGAWA A, MUNAKATA K, TATEISHI H. [Pharmacological studies on radioisotopes. II. Ophthalmological observations]. Gencho Hiroshima Igaku 1961; 9:1445-52. [PMID: 14478227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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ARATANI H, NAKAGAWA A, TATEISHI H. Pharmacological studies on antifungal antibiotic, moldcidin B. J Antibiot (Tokyo) 1961; 14:199-204. [PMID: 14448359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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