A Clinical Observation on Craniocerebral Injuries in Adult.

Rhee, Hyun Jae; Choi, Maeng Ki; Kim, Youn; Choi, Kil Soo; Chu, Jeong Wha; Sim, Bo Sung

Original Article

Journal of Korean Neurosurgical Society 1972;1(1): 67-78.

Hyun Jae Rhee, Maeng Ki Choi, Youn Kim, Kil Soo Choi, Jeong Wha Chu, Bo Sung Sim

Department of Neurosurgery, Seoul National University, College of Medicine, Seoul, Korea.

ABSTRACT

In modern society, characterized by variability of daily life, complicated industrial structure and surprisingly increased traffics, the danger of unexpected accident if always threatening the people. In America, for instance, almost 0.5% of the whole population annually suffers from head injury. About two thirds of traffic accident patients have head injury of various forms. Among the head injury patients due to traffic accidents, the commonest cause of death is head injury itself in about 70%. In this study, 585 cases of adult head injury patients over 15 years of age, observed at the Department of Neurosurgery, Seoul National University Hospital during the period from January, 1966 till September, 1971 were reviewed. 1) There were 447 men and 138 women; male female ratio was 3:1.2) The commonest cause of head injury was traffic accident (57.3% of the total patients). A second common cause was "falls"(25.5%). 3) In skull fracture patients, vault fractures were twice as frequent as basal skull fracture. The incidence of simple fractures was remarkably higher than that of compound fractures, the ratio being 7:4. The incidence of linear fractures was slightly higher than that of depressed fractures, the ratio being 6:5. Most of linear fractures were simple fractures, but about 79% of depressed fractures were compound fractures. 4) Among the intracranial hemorrhagic lesion, subdural hematoma occupied about half of the total cases, most of whom were acute cases. The predilection site of subdural hematoma was the cerebral convexity (frontal, parietal and temporal areas). The epidural hematoma , of which the predilection site was temporal area, occupied about 30 % of the total intracranial hemorrhage lesions. Temporal lobe was the predilection site of intracerebral hematoma. 5) About half of the patients with intracranial hemorrhagic lesions were accompanied by skull fractures. About 28% of the cases with skull fractures were accompanied by intracranial hemorrhagic lesions. 6) Altered consciousness was observed in about 90% of the total patients. Lucid interval was observed in 26% of the cases with intracranial hemorrhagic lesion. Vomiting occurred in a quarter of the total patients and early convulsive attacks were noticed in 5%. 7) Overall mortality rate of all the head injury patients was 12.3% and their operative mortality rate was 20.1%. The mortality rate in the patients with skull fractures was five times as high as in the patients without skull fractures. The mortality rate in the patients with intracranial hemorrhagic lesions was nearly three times as high as in those without. The mortality rate in the patients with linear skull fractures was about three times as high as in those with depressed skull fractures. 8) Sequelae were noticed in about half of the total patients. The most frequent one was postconcussion syndrome, the incidence being 36% of the total patients. 9) Associated injuries were found in about 10% of the total patients. The frequent ones were clavicle fracture, tibia/fibula fracture and mandible fracture, in order.