Athanasiou Alkinoos, Balogiannis Ioannis, Magras Ioannis
Department of Neurosurgery, AHEPA, University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Lab of Medical Physics, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Surg Neurol Int. 2017 Sep 26;8:229. doi: 10.4103/sni.sni_299_17. eCollection 2017.
Lasting bilateral mydriasis and absence of pupillary light reflex following severe traumatic brain injury (TBI) are considered signs of irreversible brainstem damage and have been strongly associated with poor outcome.
A young female patient presented with severe TBI, contusions, and diffuse brain edema. She was initially treated medically, but developed delayed secondary refractory intracranial hypertension and bilaterally dilated, non-reactive pupils for 12 h. Wide decompressive craniectomy and dural incisions were performed. The patient presented gradual improvement in her clinical condition [Glasgow Coma Scale (GCS) 13/15]. Delayed recurring infections lead to the patient's death due to sepsis after 3 months.
In light of recent studies, lasting bilateral mydriasis may not always be considered a decisive factor for non-escalation of treatment, as variability among TBI patients and outcomes has been demonstrated. Wide decompressive craniectomy is viable for controlling refractory intracranial hypertension in hemodynamically stable patients.
重度创伤性脑损伤（TBI）后持续双侧瞳孔散大且无瞳孔对光反射被认为是不可逆脑干损伤的征象，且与不良预后密切相关。
一名年轻女性患者出现重度TBI、脑挫伤和弥漫性脑水肿。她最初接受药物治疗，但出现了延迟性继发性难治性颅内高压以及双侧瞳孔散大、无反应达12小时。进行了广泛的减压性颅骨切除术和硬脑膜切开术。患者的临床状况逐渐改善[格拉斯哥昏迷量表（GCS）评分为13/15]。3个月后，延迟复发的感染导致患者因败血症死亡。
根据最近的研究，鉴于TBI患者及其预后存在变异性，持续双侧瞳孔散大可能并不总是被视为不升级治疗的决定性因素。广泛的减压性颅骨切除术对于控制血流动力学稳定患者的难治性颅内高压是可行的。
