Xiang Tangtang, Zhang Xinjie, Wei Yingsheng, Feng Dongyi, Gong Zhitao, Liu Xuanhui, Yuan Jiangyuan, Jiang Weiwei, Nie Meng, Fan Yibing, Chen Yupeng, Feng Jiancheng, Dong Shiying, Gao Chuang, Huang Jinhao, Jiang Rongcai
Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China.
Front Neurol. 2022 Jul 22;13:900145. doi: 10.3389/fneur.2022.900145. eCollection 2022.
Subdural hematoma (SDH) is one of the most lethal types of traumatic brain injury. SDH caused by Intracranial Pressure Reduction (ICPR) is rare, and the mechanism remains unclear. Here, we report three cases of SDH that occurred after substandard cupping therapy and are conjected to be associated with ICPR. All of them had undergone cupping treatments. On the last cupping procedure, they experienced a severe headache after the cup placed on the occipital-neck junction (ONJ) was suddenly removed and were diagnosed with SDH the next day. In standard cupping therapy, the cups are not usually placed on the ONJ. We speculate that removing these cups on the soft tissue over the cisterna magna repeatedly created localized negative pressure, caused temporary but repeated ICPR, and eventually led to SDH development. The Monro-Kellie Doctrine can explain the mechanism behind this - it states that the intracranial pressure is regulated by a fixed system, with any change in one component causing a compensatory change in the other. The repeated ICPR promoted brain displacement, tearing of the bridging veins, and development of SDH. The literature was reviewed to illustrate the common etiologies and therapies of secondary ICPR-associated SDH. Despite the popularity of cupping therapy, its side effects are rarely mentioned. This case is reported to remind professional technicians to fully assess a patient's condition before cupping therapy and ensure that the cups are not placed at the ONJ.
硬膜下血肿（SDH）是创伤性脑损伤中最致命的类型之一。因颅内压降低（ICPR）导致的硬膜下血肿较为罕见，其机制尚不清楚。在此，我们报告3例在不规范拔罐治疗后发生的硬膜下血肿病例，推测与颅内压降低有关。所有患者均接受过拔罐治疗。在最后一次拔罐过程中，当置于枕颈交界处（ONJ）的罐子突然移除后，他们均出现严重头痛，并于次日被诊断为硬膜下血肿。在标准拔罐治疗中，罐子通常不会放置在枕颈交界处。我们推测，反复在枕大池上方软组织上移除这些罐子会产生局部负压，导致暂时性但反复的颅内压降低，最终导致硬膜下血肿形成。孟罗-凯利学说可以解释其背后的机制——该学说指出，颅内压由一个固定系统调节，其中任何一个组成部分的变化都会导致其他部分的代偿性变化。反复的颅内压降低促使脑移位、桥静脉撕裂以及硬膜下血肿的形成。我们回顾了相关文献以阐述继发性颅内压降低相关硬膜下血肿的常见病因和治疗方法。尽管拔罐疗法很流行，但其副作用却很少被提及。报告此病例是为提醒专业技术人员在拔罐治疗前要充分评估患者病情，并确保罐子不放置在枕颈交界处。
