Speakers

Treatment strategies for head injury in elderly patients
1108 13:30-13:40
Neuro-trauma & Intensive Care/303A
In Japan, the population is rapidly aging. More than half of the patients with severe head trauma were elderly people aged 65 or older in Japan. We will consider treatment strategies for head injuries in the elderly. The biggest cause of pathology specific to head trauma in elderly patients is brain atrophy. Due to the increase in the intracranial pressure buffering space caused by brain atrophy, small amounts of hematoma are asymptomatic, but symptoms progress late. The most widely used indicator of the severity of head trauma is the Glasgow Coma Scale score at the first visit. However, because accurate diagnosis is difficult in elderly patients due to brain atrophy, the measurement of blood biomarkers has attracted attention. The authors have reported that it is possible to evaluate brain damage using the serum D-dimer value. Measurement using D-dimer is inexpensive and can be measured during daily medical care. Furthermore, it is known that elderly patients are more likely to be taking antithrombotic drugs. According to a multi-center observational study in Japan, patients taking antithrombotic drugs are more likely to develop severe symptoms even in low-energy trauma such as falls. Patients taking antithrombotic drugs are more likely to have hemorrhagic lesions and delayed deterioration. Early reversal therapy is recommended for this patient group. In recent years, there have been occasional reports of hematoma removal using an endoscope via a small craniotomy. With the development of aggressive treatment methods tailored to the pathology of elderly head trauma, it is expected that the outcome of elderly head trauma will improve in the future. Due to the aging of Japanese society, elderly head trauma can now be said to be a common disease. The key to elderly head trauma is to take appropriate measures before the delayed deterioration of intracranial lesions occurs.

Neurocritical care for subarachnoid hemorrhage: up to date
1108 10:40-10:50
Cerebrovascular/304B
In cases of subarachnoid hemorrhage due to ruptured cerebral aneurysms, attention is often focused on cerebral aneurysm treatment as an initial treatment. Even if cerebral aneurysm treatment is completed without any problems, delayed cerebral ischemia (DCI), which appears a few days to two weeks after onset, is also one of the factors that determine the outcome. Previously, DCI was believed to be caused by cerebral vasospasm. However, pathological conditions that present with DCI without cerebral vasospasm have been identified, and the pathology of DCI itself is being reconsidered. The mechanism of DCI is thought to involve not only cerebral vasospasm but also early brain injury (EBI), failure of autoregulation due to vascular endothelial cell damage, microvascular spasm, microthrombus, and cortical spreading depolarization (CSD). Neurocritical care is required as a preventive measure against DCI. Specifically, this includes intracranial pressure management, nutritional management to avoid infection and low albumin, blood glucose management, prevention of anemia, intravascular dehydration and hyponatremia, body temperature management, and convulsion prevention. In addition, cerebrospinal fluid drainage and administration of various drugs are performed. Drugs such as fasudil hydrochloride, cilostazol, and statins are administered, but there is no sufficient evidence. As the importance of neurocritical care increases, clazosentan, a fast-acting endothelin A receptor antagonist, was approved in Japan in April 2022, marking a major turning point in the treatment of cerebral vasospasm in Japan. Clazosentan has a strong inhibitory effect on the onset of cerebral vasospasm. At the same time, it has a side effect of causing fluid retention, which can lead to respiratory problems due to pleural effusion and pulmonary edema. We will explore how neurointensive therapy should be practiced in the postoperative management of subarachnoid hemorrhage, where clazosentan is becoming the mainstream.