J Cochrane Timothy, Ranger Gurpreet Singh
Whipps Cross Hospital, London, England.
Department of Surgery Dalhousie University, Nova Scotia, Canada.
Caspian J Intern Med. 2017 Spring;8(2):123-125. doi: 10.22088/cjim.8.2.123.
Occult dural injuries are rare and can occur as a result of major or minor head injury. These injuries usually manifest with cerebrospinal fluid rhinorrhea alone, or with meningitis and cerebral abscess, sometimes many years after the original injury.
We present a case of occult dural injury with endocranial complications which occurred in a 34 year old man, with a history of head injury forty-three years ago. The patient presented with a triad of findings; meningitis, CSF rhinorrhoea and pneumocephalus. He was managed conservatively with intravenous antibiotics and observation and made a full recovery. The presence of acute endocranial symptoms and particularly these three findings in a patient with a previous history of head injury, no matter how long it had been should raise suspicion of the presence of an occult dural injury.
It need to retain a high index of suspicion for occult dural injury in patients who present with endocranial symptoms of unknown origin, especially if there is a previous history of head injury.
隐匿性硬脑膜损伤较为罕见，可由严重或轻微的头部损伤引起。这些损伤通常仅表现为脑脊液鼻漏，或伴有脑膜炎和脑脓肿，有时在原发损伤多年后才出现。
我们报告一例隐匿性硬脑膜损伤合并颅内并发症的病例，患者为一名34岁男性，43年前有头部受伤史。患者出现了一组三联征表现：脑膜炎、脑脊液鼻漏和气颅。对其采用静脉注射抗生素及观察的保守治疗方法，患者完全康复。对于有头部受伤史的患者，无论受伤时间多久，出现急性颅内症状，尤其是这三种表现，应怀疑存在隐匿性硬脑膜损伤。
对于出现不明原因颅内症状的患者，尤其是有头部受伤史者，需要高度怀疑隐匿性硬脑膜损伤。
