Takayama K, Manaka S, Koide K, Suzuki H, Sashida J
Department of Neurological Surgery, Ichihara Hospital, Teikyo University School of Medicine, Chiba.
No Shinkei Geka. 1990 Aug;18(8):741-4.
The authors report a case of intracranial hematoma associated with AIDS. A male aged 21 had been treated with infusion of factor VIII to control hemophilia A. He fell down and hit his right occipital region. Immediately after the impact, he became comatose. When he was hospitalized 30 minutes after the injury, a herniation sign was recognized. CT scan revealed right acute subdural hematoma that showed mixed density. This hematoma was successfully removed with HITT (hematoma irrigation with trephination therapy) and he recovered almost completely. However he died when the intracerebral hematoma bled suddenly on the 20th day after surgery. We assumed the hematoma was related to vasculitis induced by AIDS. Three points in this case impressed us. First, HITT is very useful for treating acute subdural hematoma associated with AIDS. Second, the patient's condition may deteriorate suddenly through intracerebral hematoma originating from AIDS-related vasculitis, although the coagulation factors are well maintained. Third, a manual for management of cases of AIDS is necessary to avoid confusion among the medical staff.
作者报告了一例与艾滋病相关的颅内血肿病例。一名21岁男性曾接受输注凝血因子VIII治疗甲型血友病。他摔倒后撞到了右枕部。撞击后立即昏迷。受伤30分钟后住院时，发现有脑疝迹象。CT扫描显示右侧急性硬膜下血肿，密度混合。通过钻孔冲洗引流术（HITT）成功清除了该血肿，他几乎完全康复。然而，术后第20天，脑内血肿突然出血，他死亡。我们推测该血肿与艾滋病诱发的血管炎有关。该病例有三点给我们留下了深刻印象。第一，钻孔冲洗引流术对治疗与艾滋病相关的急性硬膜下血肿非常有用。第二，尽管凝血因子维持良好，但患者的病情可能因源自艾滋病相关血管炎的脑内血肿而突然恶化。第三，需要一本艾滋病病例管理手册，以避免医护人员之间的混乱。
