Miyata I, Masaoka T, Nishiura T, Harada Y, Ishimitsu H, Mano S
Department of Neurosurgery, Iwakuni National Hospital, Yamaguchi.
Neurol Med Chir (Tokyo). 1990;30(11 Spec No):832-7. doi: 10.2176/nmc.30.832.
A 17-month-old boy was admitted to our hospital in a semicomatose state after a minor head injury. Computed tomography (CT) scans revealed a posterior interhemispheric and a thin convexity subdural hematoma. Two and a half hours later, repeated CT scans disclosed a development of the right hemispheric diffuse low density and an enlargement of the interhemispheric subdural hematoma. Decompressive craniectomy and removal of the hematoma was performed immediately. On the second postoperative day, the diffuse low density areas developed in the contralateral frontal and temporal lobes. On the 14th postoperative day, the gyri which had been low in density were markedly enhanced with contrast enhancement. On the 16th postoperative day, CT scans showed a diffuse hemispheric gyral high density with bleeding in the right parieto-occipital lobe. A right occipital lobectomy and removal of the hematoma was performed. Histological examination suggested cerebral infarction probably due to venous congestion. It is also suggested that the diffuse hemispheric gyral high density observed on the 16th postoperative day was the hemorrhagic cerebral infarction.
一名17个月大的男孩在轻微头部受伤后以半昏迷状态被收治入院。计算机断层扫描(CT)显示大脑半球间后部及凸面有一薄层硬膜下血肿。两个半小时后,重复CT扫描显示右半球出现弥漫性低密度影,大脑半球间硬膜下血肿增大。立即进行了减压颅骨切除术并清除血肿。术后第二天,对侧额叶和颞叶出现弥漫性低密度区。术后第14天,密度减低的脑回在增强扫描时明显强化。术后第16天,CT扫描显示半球弥漫性脑回高密度影,右侧顶枕叶有出血。遂行右枕叶切除术并清除血肿。组织学检查提示可能因静脉淤血导致脑梗死。也提示术后第16天观察到的半球弥漫性脑回高密度影为出血性脑梗死。