[PS7-1C-3] Neurosurgical perspectives in the treatment of abusive head trauma; past, present and future
When examining the head injuries of infants under 2 years of age it is important to distinguish abusive head trauma (AHT). The incidence of AHT under 1 year old is equivalent to 14-40 cases per 100,000 infants, comparable to neonatal meningitis (25-32 / 100,000 births) and acute lymphocytic leukemia (28.7-36.6 / 100,000: less than 1 year old). AHT is a generic name for head trauma caused by any mechanisms of child abuse, regardless of the involvement of a specific injury tactic. AHT is a broad term and is a diagnosis name containing "Shaken Baby Syndrome (SBS)" in which abnormal shaking action is apparently involved as an injury crisis. Physical findings accompanying AHT include consciousness disturbance, convulsions, vomiting, developmental delay, etc., but only "apnea" showed a significant correlation with AHT. Acute subdural hematoma (ASDH) is the most common in head CT scan, and it is also significantly observed at postmortem autopsy. Multiple rib fractures, long tube bone fracture, skull fracture, subcutaneous hematoma are also noteworthy findings. As ophthalmic findings, there are many multilayers, bilateral retinal bleeding. Even when there is no finding of trauma on the body surface compared to severe intracranial damage, it is necessary to doubt the AHT. Since severe brain swelling affects treatment prognosis, continuous observation and intervention from initial response to intensive care after surgery are important. Although the outcome of AHT is extremely pessimistic, reports on the effectiveness of rehabilitation are also accepted, every effort must be made to preserve normal remaining function.