Threlkeld Zachary D, Kottapally Mohan, Aysenne Aimee, Ko Nerissa
Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
Department of Neurology, University of Miami, Clinical Research Building, Miami, FL, USA.
Neurohospitalist. 2016 Oct;6(4):157-160. doi: 10.1177/1941874416641465. Epub 2016 Apr 5.
Intracranial pressure (ICP) monitoring frequently guides key decisions in the management of diseases causing intracranial hypertension. Although typically measured by invasive means, contraindications may leave the clinician with little recourse for dynamic ICP evaluation-particularly when the patient's mental status is compromised. We describe here a healthy 18-year-old woman who subacutely progressed to coma due to diffuse cerebral venous sinus thrombosis. Heparinization precluded the use of invasive ICP monitoring, and electroencephalography (EEG) was used novelly as a surrogate ICP monitor. She responded well to anticoagulation and hyperosmolar therapy guided by qualitative EEG and was later discharged with a nearly normal neurologic examination. She was found to have Salmonella bacteremia, heterozygous prothrombin and factor V Leiden mutations, and hemoglobin H disease.
颅内压（ICP）监测常常指导颅内高压相关疾病治疗中的关键决策。虽然通常通过侵入性手段测量，但存在的禁忌症可能使临床医生在进行动态ICP评估时几乎无计可施——尤其是当患者的精神状态受损时。我们在此描述一名健康的18岁女性，她因弥漫性脑静脉窦血栓形成而亚急性进展为昏迷。肝素化使得无法使用侵入性ICP监测，脑电图（EEG）被创新性地用作替代ICP监测手段。在定性EEG指导下进行抗凝和高渗治疗后，她反应良好，后来出院时神经系统检查几乎正常。她被发现患有沙门氏菌血症、凝血酶原杂合突变和因子V莱顿突变以及血红蛋白H病。
