Koneri Nick, Muck Andrew, Adams Bruce D
Kendall Regional Medical Center, Miami, FL, USA.
Department of Emergency Medicine, University of Texas Health San Antonio, San Antonio, TX, USA. Email:
J Fam Pract. 2017 Oct;66(10):635-637.
A 77-year-old woman presented to the emergency department complaining of a headache following a syncopal episode (while standing) earlier that day. She said that she'd lost consciousness for several minutes, and then experienced several minutes of mild confusion that resolved spontaneously. On physical exam, she was oriented to person and place, but not time. She had a contusion in her left occipitoparietal region without extensive bruising or deformity. The patient had normal cardiopulmonary, abdominal, and neurologic exams. Her past medical history included hypertension and normal pressure hydrocephalus, and her vital signs were within normal limits. She was taking aspirin once daily. The patient's initial head and neck computerized tomography (CT) scans were normal, but she was hospitalized because of her confusion. During her hospitalization, the patient had mild episodic headaches that resolved with acetaminophen. The next day, her confusion resolved, and repeat CT scans were unchanged. She was discharged within 24 hours. Two weeks later, the patient returned to the hospital after her daughter found her on the toilet, unable to stand up from the sitting position. She was confused and experienced a worsening of headache during transport to the hospital. No recurrent falls or additional episodes of trauma were reported. A CT scan was performed. WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?
一名77岁女性因当日早些时候(站立时)晕厥发作后出现头痛而就诊于急诊科。她说自己失去意识几分钟,随后经历了几分钟轻度意识模糊,之后自行缓解。体格检查时,她对人物和地点定向正常,但对时间定向异常。她左枕顶部有一处挫伤,无广泛瘀伤或畸形。患者心肺、腹部及神经系统检查均正常。她既往有高血压和正常压力脑积水病史,生命体征在正常范围内。她每天服用一次阿司匹林。患者最初的头部和颈部计算机断层扫描(CT)结果正常,但因意识模糊而住院。住院期间,患者有轻度发作性头痛,服用对乙酰氨基酚后缓解。第二天,她的意识模糊症状消失,复查CT结果无变化。她在24小时内出院。两周后,患者女儿发现她坐在马桶上无法从坐姿站起来,之后患者返回医院。她意识模糊,在送往医院途中头痛加重。未报告有再次跌倒或其他外伤事件。进行了CT扫描。你的诊断是什么?你会如何治疗该患者?