Watanabe Arata, Omata Tomohiro, Kinouchi Hiroyuki
Department of Neurosurgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan.
Neurol Med Chir (Tokyo). 2010;50(10):924-7. doi: 10.2176/nmc.50.924.
An 88-year-old woman presented with acute subdural hematoma (ASDH) which showed rapid resolution on computed tomography (CT) and magnetic resonance (MR) imaging. She was transferred to our hospital after falling out of bed. On admission, she was comatose with Japan Coma Scale score of 200 and Glasgow Coma Scale score of E1V1M2. Brain CT showed a thick left frontotemporal ASDH. Conservative treatment consisted of 200 ml of glycerol administered intravenously twice a day, and maintenance in the approximately 20 degree head-up position to reduce intracranial pressure. Three days later, her consciousness recovered to Japan Coma Scale score of 30 and Glasgow Coma Scale score of E2V4M5. CT showed obvious reduction of the hematoma without brain or scalp swelling. Spinal MR imaging detected no redistribution of hematoma to the spine. The present case illustrates that rapid spontaneous reduction of ASDH may occur by redistribution of hematoma, mainly to the supratentorial subdural space because of brain atrophy.
一名88岁女性因急性硬膜下血肿（ASDH）就诊，其在计算机断层扫描（CT）和磁共振成像（MR）上显示血肿迅速消退。她因从床上跌落被转送至我院。入院时，她昏迷，日本昏迷量表评分为200，格拉斯哥昏迷量表评分为E1V1M2。脑部CT显示左侧额颞部有一厚层急性硬膜下血肿。保守治疗包括每天两次静脉注射200毫升甘油，并将床头抬高约20度以降低颅内压。三天后，她的意识恢复，日本昏迷量表评分为30，格拉斯哥昏迷量表评分为E2V4M5。CT显示血肿明显缩小，无脑或头皮肿胀。脊柱磁共振成像未检测到血肿向脊柱的再分布。本病例表明，急性硬膜下血肿可能通过血肿再分布而迅速自发消退，主要是由于脑萎缩导致血肿主要再分布到幕上硬膜下间隙。
