McKean Andrew Roy, Kumar Shankar, McKean Greg Michael, Tzias Demitrios
Department of Plastic Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Centre for Medical Imaging, University College London, London, UK.
BMJ Case Rep. 2018 Mar 28;2018:bcr-2017-223160. doi: 10.1136/bcr-2017-223160.
A man in his mid-50s with a history of bladder carcinoma presented to the Emergency Department (ED) following a witnessed tonic-clonic seizure. Computed Tomography (CT) scanning of his brain revealed an indeterminate mass lesion in the left parietal region. The patient described bilateral shoulder pain prompting plain film radiographs with axial views, but no obvious abnormality was identified by the ED staff. Staging CT scanning did not reveal any evidence of underlying malignancy but revealed dislocation of the left humeral head with a large reverse Hill-Sachs lesion and posteriorly displaced reverse Bankart lesion. Manipulation under anaesthesia and closed reduction of the left shoulder was undertaken successfully. This case report reminds the clinician to maintain a high index of suspicion for posterior dislocation of the shoulder following seizures and to perform appropriate imaging promptly.
一名50多岁、有膀胱癌病史的男性，在目睹其发生强直阵挛性癫痫发作后被送往急诊科。脑部计算机断层扫描（CT）显示左顶叶区域有一个性质不明的肿块病变。患者自述双侧肩部疼痛，因此拍摄了肩部正位X线片，但急诊科工作人员未发现明显异常。分期CT扫描未发现潜在恶性肿瘤的任何证据，但显示左肱骨头脱位，伴有巨大的反Hill-Sachs损伤和后移位的反Bankart损伤。在麻醉下进行了手法复位并成功闭合复位了左肩。本病例报告提醒临床医生，对于癫痫发作后肩部后脱位要保持高度怀疑，并及时进行适当的影像学检查。
