Occurrence of malignant cerebral infarction following intracranial hematoma evacuation in traumatic brain injury: A case report.

Surgical neurology international Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI:10.25259/SNI_629_2024
Vega Pangaribuan, Tedy Apriawan, Agus Turchan
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Abstract

Background: Traumatic brain injury-related cerebral infarctions are well-documented in the literature. We want to report a case of malignant cerebral infarction that occurred at the contralateral location of evacuated epidural hematoma 3 days after surgery. The early-onset cerebral infarction's clinical presentation was already evident during the initial clinical examination, and it resembled "Kernohan's Notch Syndrome."

Case description: A 57-year-old male Indonesian was taken to our Academic General Hospital's emergency room following a motorcycle accident. His primary complaints were reduced consciousness and left-sided hemiparesis. A head computed tomography (CT) scan revealed an intracerebral hematoma beneath an epidural hematoma (EDH) at the left temporal area. The EDH was surgically removed promptly. The patient's Glasgow coma scale improved, and they were able to follow commands afterwards. The patient had a decreased consciousness 3 days after the surgery. A malignant infarction of the right middle cerebral artery region was identified from the head CT scan evaluation. He immediately had an emergency decompressive craniectomy and had an improvement of consciousness following the surgery.

Conclusion: It is imperative to reassess the initial clinical signs of Kernohan's notch phenomenon to determine whether the offending mass was able to generate this clinical phenomenon. Initial cerebral infarction, which occurs concomitantly with traumatic intracranial hematoma, is a possible cause of clinical deterioration following the surgery.

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脑外伤患者颅内血肿清除后发生恶性脑梗塞:病例报告。
背景:与脑外伤相关的脑梗塞在文献中有大量记载。我们要报告的是一例恶性脑梗死病例,发生在手术后 3 天硬膜外血肿排空的对侧位置。该早发性脑梗死的临床表现在最初的临床检查中就已经很明显,类似于 "克诺汉缺口综合征":一名 57 岁的印尼籍男性因摩托车事故被送往我院综合医院急诊室。他的主诉是意识减退和左侧偏瘫。头部计算机断层扫描(CT)显示,左颞部硬膜外血肿(EDH)下方有一个脑内血肿。硬膜外血肿被及时手术切除。患者的格拉斯哥昏迷量表有所改善,之后能够听从命令。术后 3 天,患者的意识有所减退。头部 CT 扫描评估发现右侧大脑中动脉区域恶性梗死。他立即接受了急诊减压开颅手术,术后意识有所改善:结论:当务之急是重新评估克诺汉切迹现象的初始临床症状,以确定病变肿块是否能够导致这一临床现象。与外伤性颅内血肿同时发生的初期脑梗塞可能是导致术后临床症状恶化的原因之一。
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