Mahmooth Zayan, Malcolm James G, Wetzel Jeremy S, Ahmad Faiz U
School of Medicine, Emory University, Atlanta, Georgia, USA.
Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
BMJ Case Rep. 2017 Dec 1;2017:bcr-2017-222253. doi: 10.1136/bcr-2017-222253.
For patients who have had a recent neurosurgical procedure, a visit to the emergency department for encephalopathy may automatically prompt a neurosurgical consult. We present a case of a patient with a history of Chiari malformation decompressed 6 months prior who presented with a 2-week history of slowly progressive altered mental status, headache and imbalance-symptoms consistent with her initial Chiari symptoms, so neurosurgery was consulted. Imaging showed no acute abnormality, but laboratory results revealed metabolic acidosis with high salicylate levels. When reporting medication use, this patient initially left out that she had been taking Goody's powder (845 mg aspirin) for headaches, and long-term use led to metabolic encephalopathy. Despite a recent history of surgery, it is important to keep the differential diagnosis broad especially when there are signs of metabolic derangement.
对于近期接受过神经外科手术的患者，因脑病前往急诊科就诊可能会自动促使进行神经外科会诊。我们介绍一例患者，该患者6个月前因 Chiari 畸形接受减压手术，此次因出现2周缓慢进展的精神状态改变、头痛和失衡症状前来就诊，这些症状与她最初的 Chiari 症状相符，因此咨询了神经外科。影像学检查未发现急性异常，但实验室检查结果显示代谢性酸中毒且水杨酸盐水平升高。在报告用药情况时，该患者最初遗漏了她一直在服用古迪氏粉（845毫克阿司匹林）治疗头痛，长期使用导致了代谢性脑病。尽管有近期手术史，但保持广泛的鉴别诊断很重要，尤其是当存在代谢紊乱迹象时。
