J.Jpn. Surg. Soc.. 57(8): 1441-1455, 1956

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ANALYTICAL REVIEW ON TREATMENT OF POSTTRAUMATIC ENCEPHALOPATHY

Treatment of posttraumatic encephalopathy are very troublesome work, and are poorly successful. The authors have studied about 1000 cases of the patients suffering from this malady. The results obtained by the treatment are as follows.
1) Treatment of early stage of posttraumatic encephalopathy. Therapeutic. results of this stage are very successful, one should treat the patients as early as possible. Of them, excluding the rest, available methods are (1) sedativa as iodine, bromide derivatives, aspirin, migrenin, caffein, and barbiturates ; (2) intracarotid injection of benzylimidazoline ; (3) blockade with 1% procaine solution of the stellate ganglion or superior cervical ganglia ; (4) intravenous injection of 100 cc of 20% glucose solution with Vitamin B₁,C,K; (5) CO₂- O₂ inhalation therapy; (6) hibernotherapeutic agents; and (7) mental encouragement.
2) Treatment of late stage. Comparing the treatment of early stage, treatments of this stage are rather unsatisfactory. We suggest that the treatment must be differentiated the following 5 clinical groups of these patients
a) Treatment of the group of only neuropsychiatric symptomes without metabolic disturbances.
Sedativa, repeated Stellate ganglion blockade with 1% procaine solution, repeated intravenous injection of 20% glucose solution, Vitamin B₁,C,K, or adds of 500 cc of 5% glucose solution, physiologic saline, Ringer's solution, small amount of blood, pneumoencephalography, were available.
b) Treatment of the group with metabolic disturbances. The importance of the replacement therapy must be emphasized, including blood transfusion, intravenous injection of Ringer's solution and 20% glucose solution added by Vitamin B₁,C,K.
c) Treatment of group with hormonal disturbances. The experimences of the authors show that there exists clear out well known endocrinological syndromes caused by head injury such as diabetes incipidus, adiposogenital dystrophy, Addision's syndrome, Graves' disease, etc. It is, therefore, natural to treat these cases with the special endocrinological remedy.
d) Treatment of the group with the autonomic disturbances. Stellate ganglion block and hibernotherepeutic agents are effective. Mild degree of physical training is also available.
e) Treatment of the group of so-called "traumatic neurosis" According to our clinical analysis, these cases are very rare. Psychotherapy must be undertaken.
3) After-care or rehabilitation. Though this type of treatment is out of the scope of surgical field, yet the importance should be emphasized.
(authors'abstract)

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