Kamezaki Takao, Yanaka Kiyoyuki, Fujita Keishi, Nakamura Kazuhiro, Nagatomo Yasushi, Nose Tadao
Department of Neurosurgery, Ibaraki Seinan Medical Center, Sashima, Ibaraki 306-0433, Japan.
J Clin Neurosci. 2004 Apr;11(3):311-3. doi: 10.1016/j.jocn.2003.10.013.
Subdural hygroma is a frequent delayed complication of head trauma. Most hygromas are clinically 'silent' and a few cases have shown slow deterioration in the chronic stage. We report a case of subdural hygroma showing unique radiological findings and rapid deterioration. A 74-years-old female presented with a mild headache and consciousness disturbance after head injury. Computed tomography showed a midline shift as a result of two components piling up in the subdural space; the outer components showed low density, the inner components high density. Magnetic resonance imaging demonstrated that these two subdural components were subdural hygroma and subarachnoid hematoma. Simple burr hole irrigation, rather than large craniotomy, was thought to be more appropriate treatment to reduce the mass effect. Simple burr hole irrigation was performed to remove the subdural hygroma and the patient showed an excellent recovery. Careful examination of the radiological findings prevented an unnecessary procedure in this case. A possible mechanism of this phenomenon is discussed.
硬膜下积液是头部外伤常见的迟发性并发症。大多数积液在临床上是“无症状的”，少数病例在慢性期显示出缓慢恶化。我们报告一例硬膜下积液病例，其具有独特的影像学表现且病情迅速恶化。一名74岁女性在头部受伤后出现轻度头痛和意识障碍。计算机断层扫描显示，由于硬膜下间隙内两种成分堆积导致中线移位；外侧成分呈低密度，内侧成分呈高密度。磁共振成像显示这两种硬膜下成分分别为硬膜下积液和蛛网膜下腔出血。认为简单的钻孔冲洗而非大的开颅手术是减轻占位效应更合适的治疗方法。进行了简单的钻孔冲洗以清除硬膜下积液，并使患者恢复良好。仔细检查影像学表现避免了该病例中不必要的手术。本文讨论了这种现象可能的机制。
