Imamoto Toshiro, Sawano Makoto, Murase Makoto
Department of Emergency Medicine and Critical Care, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN.
Cureus. 2023 May 31;15(5):e39801. doi: 10.7759/cureus.39801. eCollection 2023 May.
Massive subdural hematomas are known to cause hemorrhagic shock in infants and young children. Traumatic cerebral aneurysms are rare and are often noticed in the subacute phase with disorientation due to the rupture of a pseudoaneurysm. No previous studies appear to have clarified the diagnosis of and therapeutic interventions for traumatic cerebral aneurysms identified from computed tomography (CT) on admission. The present case involved an open skull fracture resulting in hemorrhagic shock due to subcutaneous extravasation from an anterior cerebral artery (ACA) pseudoaneurysm. A seven-year-old boy was accidentally struck by a car after running out into a road. He had an open fracture of the skull and contrast-enhanced CT of the head showed subcutaneous extravasation from the ACA. The patient developed hemorrhagic shock that resolved following the embolization of the ACA with n-butyl-2-cyanoacrylate. Head trauma can cause hemorrhagic shock in the presence of an open wound due to a skull fracture. Contrast-enhanced CT of the head on admission is useful for diagnosis.
已知巨大硬膜下血肿会导致婴幼儿出现失血性休克。创伤性脑动脉瘤较为罕见,常在亚急性期因假性动脉瘤破裂而出现定向障碍时被发现。此前似乎没有研究阐明入院时通过计算机断层扫描(CT)发现的创伤性脑动脉瘤的诊断及治疗干预措施。本病例为开放性颅骨骨折,因大脑前动脉(ACA)假性动脉瘤导致皮下渗血而引发失血性休克。一名七岁男孩跑到马路上时被汽车意外撞倒。他颅骨开放性骨折,头部增强CT显示ACA有皮下渗血。患者出现失血性休克,在使用正丁基-2-氰基丙烯酸酯栓塞ACA后休克得到缓解。头部外伤在存在因颅骨骨折导致的开放性伤口时可引起失血性休克。入院时的头部增强CT有助于诊断。