Department of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore 169608.
Singapore Med J. 2011 Apr;52(4):e66-9.
Subdural haematomata (SDH) are usually traumatic in aetiology. Non-traumatic instances of SDH are uncommon, and can rarely be due to metastases involving the dura. Computed tomography or magnetic resonance imaging can be misleading, as the underlying aetiology may be masked by the SDH, or the appearance can simulate meningiomas. A high index of suspicion for SDH is thus required. Under such circumstances, when no overt cause is identified, dural tissue should be sent for histological analysis and blood clot for cytology, even if the appearances are grossly normal at surgery. We present a rare case of a 42-year-old woman who was previously well, but presented with progressive weakness due to acute spontaneous SDH. She required repeated surgical evacuations for SDH and for subsequent recurrent extradural haematomata. After extensive investigations, the cause was identified to be secondary dural metastases from a primary lung carcinoma.
硬脑膜下血肿（SDH）通常是外伤性的。非外伤性的 SDH 并不常见，而且很少是由于脑膜转移引起的。计算机断层扫描或磁共振成像可能会产生误导，因为 SDH 可能掩盖了潜在的病因，或者外观可能模拟脑膜瘤。因此，需要对 SDH 保持高度怀疑。在这种情况下，如果没有明显的原因，即使在手术时外观明显正常，也应将硬脑膜组织送检进行组织学分析，将血凝块送检进行细胞学检查。我们报告了一例罕见的病例，一名 42 岁女性既往健康，但突发急性自发性 SDH 导致进行性无力。她需要多次手术清除 SDH，并随后再次发生硬膜外血肿。经过广泛的检查，病因被确定为原发性肺癌的继发性脑膜转移。
