慢性硬膜下血肿急性发作：并非罕见事件。
Acute-on-Chronic Subdural Hematoma: Not Uncommon Events.
作者信息
Lee Kyeong-Seok, Shim Jae-Jun, Yoon Seok-Mann, Doh Jae-Won, Yun Il-Gyu, Bae Hack-Gun
机构信息
Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
出版信息
J Korean Neurosurg Soc. 2011 Dec;50(6):512-6. doi: 10.3340/jkns.2011.50.6.512. Epub 2011 Dec 31.
OBJECTIVE
Patients with asymptomatic chronic subdural hematoma (SDH) are prone to fall or slip. Acute trauma on these patients may develop acute subdural bleeding over the chronic SDH. We recently experienced 9 patients with acute-on-chronic SDH. We report the clinical and radiological features of this lesion.
METHODS
We retrospectively examined the computed tomographic (CT) scans of 107 consecutive patients who diagnosed as chronic SDH from January 2008 to December 2010. All cases of CSDH were diagnosed on CT with or without MRI scan.
RESULTS
Acute-on-chronic SDH is not rare, being 8% of chronic SDH. The most common cause of trauma was a slip in drunken state. Alcoholism with multiple episodes of trauma was one of the prominent histories. Acute-on-chronic SDH appeared as a hyperdense layer of clot with irregular blurred margin or lumps in liquefied hematoma. Single or two burr holes was usually effective to remove the hematoma.
CONCLUSION
Repeated trauma may cause acute bleeding over the chronic SDH. It will be helpful to understand the role of repeated trauma as a mechanism of hematoma enlargement.
目的
无症状慢性硬膜下血肿（SDH）患者容易跌倒或滑倒。这些患者遭受急性创伤可能会在慢性SDH基础上发生急性硬膜下出血。我们最近收治了9例慢性硬膜下血肿急性发作患者。我们报告该病变的临床和影像学特征。
方法
我们回顾性分析了2008年1月至2010年12月期间连续诊断为慢性SDH的107例患者的计算机断层扫描（CT）图像。所有慢性硬膜下血肿病例均通过CT诊断，部分病例结合了MRI扫描。
结果
慢性硬膜下血肿急性发作并不罕见，占慢性硬膜下血肿的8%。最常见的创伤原因是醉酒状态下滑倒。有多次创伤发作史的酗酒是突出病史之一。慢性硬膜下血肿急性发作表现为血凝块的高密度层，边缘不规则模糊或在液化血肿中呈肿块状。单孔或双孔钻孔引流通常能有效清除血肿。
结论
反复创伤可能导致慢性硬膜下血肿发生急性出血。了解反复创伤作为血肿扩大机制的作用将有所帮助。
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