Department of Neurosurgery, Northwell Health, Manhasset, NY 11030, USA.
Department of Neurology, Northwell Health, Manhasset, NY 11030, USA.
Clin Neurol Neurosurg. 2021 Jan;200:106318. doi: 10.1016/j.clineuro.2020.106318. Epub 2020 Oct 17.
It is widely known that some patients surgically treated for subdural hematoma (SDH) experience neurologic deficits not clearly explained by the acute brain injury or known sequelae like seizures. There is increasing evidence that cortical spreading depolarization (CSD) may be the cause. A recent article demonstrated that CSD occurred at a rate of 15 % and was associated with neurological deterioration in a subset of patients following chronic subdural hematoma evacuation. Furthermore, CSD can lead to ischemia leading to worsening neurologic deficits. CSD is usually detected on electrocorticography (ECoG) and needs cortical strip electrode placement with equipment and expertise that may not be readily available.
We report three cases of patients with subdural hematoma (SDH) not undergoing ECoG in whom CSD was suspected to be the cause of their neurologic deficits post evacuation. Extensive workup including neuroimaging and electroencephalography (EEG) were inconclusive. Patients were subsequently treated with ketamine infusion and had resultant neurological recovery.
Ketamine infusion can help reverse neurologic deficits in patients with SDH in whom the deficits are not explained by neuroimaging or electrographic seizure. CSD is a known phenomenon that can result in neurological injury and must remain in the differential diagnosis of such patients. Though only limited cases are discussed (n = 3), this small case series provides the basis for conducting clinical trials evaluating the efficacy of ketamine in improving functional outcome in brain-injured patients demonstrating evidence of CSD.
众所周知，一些接受过慢性硬膜下血肿（SDH）手术治疗的患者会出现神经功能缺损，这些缺损无法用急性脑损伤或已知的后遗症（如癫痫）来明确解释。越来越多的证据表明皮质扩散性抑制（CSD）可能是其病因。最近的一篇文章表明，CSD 的发生率为 15%，并且与慢性硬膜下血肿清除术后的一部分患者的神经功能恶化有关。此外，CSD 可导致缺血，从而导致神经功能缺损恶化。CSD 通常在皮质脑电图（ECoG）上检测到，需要使用设备和专业知识进行皮质条带电极放置，但这些设备和专业知识可能无法随时获得。
我们报告了三例未行 ECoG 的 SDH 患者，这些患者疑似 CSD 是其清除术后神经功能缺损的原因。广泛的检查包括神经影像学和脑电图（EEG）均无明确结果。随后，患者接受氯胺酮输注治疗，神经功能得到恢复。
氯胺酮输注可以帮助逆转神经影像学或脑电图癫痫无法解释的 SDH 患者的神经功能缺损。CSD 是一种已知的现象，可导致神经损伤，必须作为此类患者的鉴别诊断之一。尽管只讨论了有限的病例（n=3），但本小型病例系列为进行临床试验提供了基础，以评估氯胺酮在改善有 CSD 证据的脑损伤患者的功能结局方面的疗效。
