Fujioka S, Hamada J, Kaku M, Ushio Y
Department of Neurosurgery, Shin-Beppu Hospital, Oita.
Neurol Med Chir (Tokyo). 1990;30(11 Spec No):827-31. doi: 10.2176/nmc.30.827.
The authors report two cases of rapid resolution of acute subdural hematoma. Case 1, a 78-year-old male, sustained head trauma and became unconscious for a few minutes, but on arrival he was alert and neurological examination was normal. A computed tomography (CT) scan taken 5 hours after the injury showed a high-dense subdural hematoma partly containing low-density area over the right cerebral hemisphere. He was conservatively treated. A CT scan taken 33 hours after the injury disclosed diminution of the hematoma and appearance of a thin high-density layer in the subdural space adjacent to the tentorium. The high-density layer disappeared on a CT scan taken 7 days after the injury. Case 2, an 84-year-old female, struck her head in the occipital region. On arrival she was drowsy but otherwise had no neurological abnormality. A CT scan taken 1 hour after the injury demonstrated a high-dense subdural hematoma partly containing low-density area over the right cerebral hemisphere. She was conservatively managed and became asymptomatic. A CT scan taken 14 hours after the injury disclosed complete resolution of the hematoma and appearance of a thin high-density layer in the subdural space adjacent to the falx and the tentorium. This high-density layer also completely disappeared on a CT scan taken 14 days after the injury. It was suggested that a mechanism of rapid resolution of the acute subdural hematoma was attributable to washing-out by cerebrospinal fluid.
作者报告了两例急性硬膜下血肿快速消退的病例。病例1,一名78岁男性,头部外伤后昏迷了几分钟,但入院时意识清醒,神经系统检查正常。受伤后5小时进行的计算机断层扫描(CT)显示右大脑半球有高密度硬膜下血肿,部分包含低密度区域。对其进行了保守治疗。受伤后33小时进行的CT扫描显示血肿缩小,在小脑幕附近的硬膜下间隙出现了一层薄的高密度层。受伤后7天进行的CT扫描显示高密度层消失。病例2,一名84岁女性,枕部头部受伤。入院时她昏昏欲睡,但其他方面无神经功能异常。受伤后1小时进行的CT扫描显示右大脑半球有高密度硬膜下血肿,部分包含低密度区域。对其进行了保守治疗,之后她无症状。受伤后14小时进行的CT扫描显示血肿完全消退,在大脑镰和小脑幕附近的硬膜下间隙出现了一层薄高密度层。在受伤后14天进行的CT扫描中,这层高密度层也完全消失了。有人提出,急性硬膜下血肿快速消退的机制归因于脑脊液的冲洗作用。