Vaz R, Duarte F, Oliveira J, Cerejo A, Cruz C
Department of Neurology and Neurosurgery, Hospital S. João, Oporto, Portugal.
Acta Neurochir (Wien). 1991;111(3-4):128-31. doi: 10.1007/BF01400500.
According to reports in the literature traumatic interhemispheric subdural haematomas (I.S.H.) are supposed to present acutely or subacutely with contralateral monoparesis of a lower extremity or hemiparesis or in bilateral haematomas even with paraparesis, and to need early operative evacuation. In our series of 5 cases none of them followed this "classical" clinical picture, and three of them recovered without operation. We conclude that the indication for operative evacuation depends on the clinical course and that in patients with spontaneously improving symptomatology non-surgical management under close supervision may be the better solution. Also the C.T. finding of open convexity cisterns may be possible indication for conservative management.
根据文献报道，创伤性大脑半球间硬膜下血肿（I.S.H.）被认为会急性或亚急性出现，伴有下肢对侧单瘫或偏瘫，双侧血肿时甚至会出现截瘫，且需要早期手术清除血肿。在我们的5例病例系列中，没有一例呈现这种“经典”临床表现，其中3例未经手术即康复。我们得出结论，手术清除血肿的指征取决于临床病程，对于症状自发改善的患者，在密切监测下进行非手术治疗可能是更好的解决方案。此外，脑池开放的CT表现也可能是保守治疗的指征。
