外伤性急性硬膜下血肿后迟发性脑血管痉挛1例

Kaima Suzuki, M. Lepić, Hiroki Sato, Shinya Tabata, Tatsuki Kimura, Hiroki Kobayashi, Keiji Yoshida, Masayoshi Fukuoka, Nobuyuki Yahagi, T. Maeda, H. Ooigawa, H. Kurita
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摘要

简介:创伤后血管痉挛是一种罕见但已知的严重创伤性脑损伤后的缺血性损伤,可独立预测患者的预后。虽然发病机制和危险因素尚未阐明,但一些报道描述了血管痉挛的发生与外伤性蛛网膜下腔出血之间的关系。在此,我们报告一例急性硬膜下血肿患者的血管痉挛,其中外伤性蛛网膜下腔出血在外科和放射学上都没有被发现。病例报告:一名60岁男性因头部外伤入院。神经学上,他嗜睡并表现出左偏瘫。计算机断层扫描(CT)显示左侧大急性硬膜下血肿伴中线移位。他接受了紧急开颅和血肿清除术。术后患者恢复良好,神经系统症状缓解。随访CT显示血肿完全清除。然而,他的意识水平在手术后第5天恶化。CT未见缺血性病变,3D-CT血管造影显示右侧大脑中动脉弥漫性血管痉挛。随后,患者神经系统状况逐渐恢复,于术后第9天出院。随访血管造影显示痉挛完全消失。结论:创伤后血管痉挛无外伤性SAH。病因学和发病机制esta相当罕见的情况下,与头部创伤讨论。
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Delayed cerebral vasospasm following traumatic acute subdural hematoma: case report
Introduction: Post-traumatic vasospasm is a rare but known ischemic damage after severe traumatic brain injury that independently predicts patients’ outcome. Although the pathogenesis and risk factors have not been elucidated, some reports describe relationship between the occurrence of vasospasm and traumatic subarachnoid haemorrhage. Here, we report a case of vasospasm in a patient with acute subdural hematoma in which traumatic subarachnoid haemorrhage was not recognized both surgically and radiologically.Case Report: A 60-year-old male was admitted for head trauma. Neurologically, he was somnolence and showed left hemiparesis. Computerized tomography (CT) revealed large acute subdural hematoma in the left side associated with midline-shift. He underwent urgent craniotomy and hematoma evacuation. Postoperatively, he recovered well with resolution of neurological symptoms. Follow-up CT revealed complete removal of hematoma. However, his level of consciousness deteriorated on the 5th day after surgery. CT showed no ischemic lesion, but 3D-CT angiography revealed diffuse vasospasm in the right middle cerebral artery. Subsequently, his neurological condition recovered gradually and he was discharged ambulatory on the 9th day after the surgery. Follow-up angiography showed the spasm had disappeared completely.Conclusion: Post-traumatic vasospasm without traumatic SAH was described. The etiology and pathogenesis of this fairly rare condition associated with head trauma is discussed.
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