非创伤性、自发性消退的急性硬脑膜下血肿病例中瞳孔持续固定散大的手术意义。
Surgical significance of prolonged fixed and dilated pupils in a case of non-traumatic, spontaneously regressing, acute subdural haemorrhage.
机构信息
Medical School, Faculty of Medical Sciences, University College London, London, UK.
Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
出版信息
BMJ Case Rep. 2022 Apr 26;15(4):e247388. doi: 10.1136/bcr-2021-247388.
Bilaterally fixed and dilated pupils (BFDP) in traumatic acute subdural haematoma (ASDH) patients represent an ominous sign that portends irreversible brainstem injury and death. Whether patients with spontaneous ASDH and BFDP follow similar outcomes is unknown. We present a mid-60s man, found unconscious, with a Glasgow Coma Scale (GCS) of 4 following 8 days of headaches. Emergency CT imaging demonstrated a large right ASDH and the patient exhibited BFDP for >3 hours despite sedation and mannitol. Neurological improvement and spontaneously reduced SDH thickness were observed 10 hours postadmission, and he was later transferred for craniotomy and ASDH evacuation. His long-term outcomes were good: achieving independence in his activities of daily living and a GCS of 15. To the best of our knowledge, this is the first reported patient with a spontaneous, regressing ASDH and prolonged BFDP who clinically improved. This case raises important questions regarding factors used to determine prognosis and surgical viability for ASDH.
创伤性急性硬脑膜下血肿（ASDH）患者双侧固定和扩大的瞳孔（BFDP）是预示不可逆脑干损伤和死亡的不祥之兆。自发性 ASDH 伴 BFDP 的患者是否具有相似的结局尚不清楚。我们报告了一位 60 多岁的男性，头痛 8 天后昏迷，格拉斯哥昏迷评分（GCS）为 4。紧急 CT 成像显示右侧 ASDH 较大，尽管给予镇静和甘露醇治疗，但 BFDP 持续了>3 小时。入院后 10 小时观察到神经功能改善和 SDH 厚度自发减少，随后转科行开颅术和 ASDH 清除术。他的长期预后良好：日常生活活动能力独立，GCS 为 15。据我们所知，这是首例报告的自发性、消退性 ASDH 和延长的 BFDP 患者，其临床状况改善。该病例提出了关于用于确定 ASDH 预后和手术可行性的因素的重要问题。
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