Caruso Riccardo, Pesce Alessandro, Martines Valentina
Neurology and Psychiatry Department, Neurosurgery Division, "Sapienza" University, Roma, Italy.
NESMOS Department Neurosurgery Department, "Sapienza" University, Roma, Italy.
World Neurosurg. 2017 Oct;106:1049.e5-1049.e6. doi: 10.1016/j.wneu.2017.07.059. Epub 2017 Jul 20.
The patient is a 79-year-old male, suffering from advanced metastatic prostate cancer, who developed a progressively worsening ideomotor slowing and was therefore referred to the emergency department of our institution. A plain axial computed tomography (CT) scan revealed a vast hemispheric subdural fluid collection, apparently a subdural hematoma. On closer inspection, and most of all, in hindsight, a tenuously isohyperdense signal irregularity at the frontal aspect of the fluid collection appears. Because of the declined general medical conditions and the paucity of the neurologic impairment, a high-dose, corticosteroid-based conservative strategy was performed. The total body CT scan for the routine oncologic follow-up of the prostate cancer scan fell at 20 days from the first CT of the emergency department. A second contrast-enhanced axial CT scan demonstrated the presence of 2 subdural metastases, presumably the initial pathogenesis of the subdural fluid collection.
患者为一名79岁男性，患有晚期转移性前列腺癌，出现进行性加重的观念运动迟缓，因此被转诊至我院急诊科。普通轴向计算机断层扫描（CT）显示大脑半球有大量硬膜下积液，显然是硬膜下血肿。仔细观察，尤其是事后看来，积液额叶处出现微弱的等高密度信号不规则影。由于患者总体健康状况下降且神经功能损害较轻，因此采取了以高剂量皮质类固醇为基础的保守治疗策略。前列腺癌常规肿瘤学随访的全身CT扫描是在急诊科首次CT检查20天后进行的。第二次增强轴向CT扫描显示存在2个硬膜下转移灶，推测是硬膜下积液的初始发病机制。
