Yanagawa Youichi, Hirano Kazuoki, Hayashida Arisa, Nakazato Tomoko
Department of Emergency and Disaster Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
BMJ Case Rep. 2013 Aug 2;2013:bcr2013010321. doi: 10.1136/bcr-2013-010321.
A 67-year-old woman developed a sudden onset headache and left hemiparesis. Emergency medical technicians found that she was conscious, but had left hemiparesis. On arrival, she had an isolated headache without any neurological deficits, however, suddenly became comatose during a head CT examination, which demonstrated a subarachnoid haemorrhage. The head CT angiography on the second day revealed a cerebral aneurysm at the right middle cerebral artery, which was clipped on the same day. The patient demonstrated left haemiplegia and total aphasia after the operation, however, the neurological deficit gradually subsided and discharged on foot in 4 months without any deficits. Some patients with a subarachnoid haemorrhage may demonstrate transient neurological deficits, like those occurring during an ischaemic stroke, so emergency medical technicians and physicians should pay attention to treat such patients gently to avoid the re-rupture of a cerebral aneurysm, especially if the patient has headache symptoms.
一名67岁女性突发头痛和左侧偏瘫。急救医疗人员发现她意识清醒，但有左侧偏瘫。到达时，她仅有头痛，无任何神经功能缺损，但在头部CT检查期间突然昏迷，CT显示蛛网膜下腔出血。第二天的头部CT血管造影显示右侧大脑中动脉有一个脑动脉瘤，当天进行了夹闭手术。术后患者出现左侧偏瘫和完全失语，但神经功能缺损逐渐消退，4个月后步行出院，无任何后遗症。一些蛛网膜下腔出血患者可能会出现短暂的神经功能缺损，类似于缺血性中风时出现的情况，因此急救医疗人员和医生应注意轻柔地治疗此类患者，以避免脑动脉瘤再次破裂，尤其是当患者有头痛症状时。
