Maeshima S, Matsumoto T, Ueyoshi A, Kitayama M, Nakao N, Nakai K, Itakura T
Department of Physical Medicine and Rehabilitation, Wakayama Medical University, Japan.
Brain Inj. 2001 Apr;15(4):371-6. doi: 10.1080/02699050010005878.
A 69-year-old right-handed man who exhibited unilateral spatial neglect in association with a chronic subdural haematoma, presented with mild left arm and leg weakness first noted 4 weeks prior to admission. Neurologic examination on admission revealed a mild left hemiparesis, including the face. Neuropsychologic examination revealed left unilateral spatial neglect, but no language disturbance. Minimal support was necessary to maintain activities of daily living. Computed tomography revealed a large right temporoparietal, extraaxial hypodense fluid collection containing scattered hypodense foci. The haematoma was evacuated via a right parietal burr hole. Following surgery, the patient dramatically improved neurologically and neuropsychologically, as well as in independent performance of daily activities. It is suggested that the improvement in ADL provides a behavioural correlate of improvement in the latter, represented a behavioural correlate of improved cerebral function, and that either direct compression by the chronic subdural haematoma or an interhemispheric pressure difference had caused unilateral spatial neglect. Such neglect is an unusual consequence of chronic subdural haematoma.
一名69岁的右利手男性,因慢性硬膜下血肿出现单侧空间忽视,入院前4周首次发现轻度左臂和左腿无力。入院时的神经系统检查发现轻度左侧偏瘫,包括面部。神经心理学检查发现左侧单侧空间忽视,但无语言障碍。维持日常生活活动只需极少的帮助。计算机断层扫描显示右侧颞顶叶有一个大的轴外低密度液性聚集区,内有散在的低密度灶。通过右侧顶骨钻孔将血肿清除。术后,患者在神经、神经心理学以及日常生活活动的独立表现方面均有显著改善。提示日常生活活动能力的改善是后者改善的行为相关因素,代表了脑功能改善的行为相关因素,并且慢性硬膜下血肿的直接压迫或半球间压力差导致了单侧空间忽视。这种忽视是慢性硬膜下血肿的一种不寻常后果。