中度创伤性脑损伤伴中脑挫伤导致的无眼外肌损伤的瞳孔不等大：一例报告。
Anisocoria without extraocular muscle impairment due to moderate traumatic brain injury with midbrain contusion: a case report.
机构信息
Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, 596-8686, Osaka, Japan.
出版信息
BMC Neurol. 2023 Jul 15;23(1):270. doi: 10.1186/s12883-023-03331-2.
BACKGROUND
New-onset anisocoria is an important clinical clue to life-threatening intracranial injury. Anisocoria alone without impairment of extraocular muscles is a rare presentation of moderate traumatic brain injury (TBI).
CASE PRESENTATION
A 79-year-old woman was transported to hospital soon after falling off a bicycle. Glasgow Coma Scale score on arrival was 11 (E3V3M5). On examination at admission, she was found to be drowsy. Bruising was seen around the right eye and pupil diameters differed (right, 4.5 mm; left, 3.0 mm; both reactive to light). Computed tomography of the head revealed hemorrhagic contusion in the left temporal lobe and left pretectal area of the midbrain, right clavicular fracture, and pulmonary contusion with fractures of the 3rd and 4th ribs. Magnetic resonance imaging confirmed hemorrhagic contusion of the midbrain. The patient achieved full recovery of motor and mental functions with conservative treatment and was discharged on hospital day 17.
CONCLUSION
We encountered a case of anisocoria without major extraocular muscle impairment due to moderate TBI with midbrain contusion.
背景
新出现的瞳孔不等大是危及生命的颅内损伤的重要临床线索。单纯的瞳孔不等大而没有眼外肌损害是中度创伤性脑损伤（TBI）的罕见表现。
病例介绍
一位 79 岁的女性在从自行车上摔下后很快被送往医院。到达时格拉斯哥昏迷评分（Glasgow Coma Scale，GCS）为 11 分（E3V3M5）。入院时检查发现患者嗜睡。右眼周围有瘀伤，瞳孔直径不同（右侧 4.5mm，左侧 3.0mm，均对光反应）。头部计算机断层扫描（computed tomography，CT）显示左颞叶和中脑左侧动眼神经核周围出血性挫伤、右侧锁骨骨折、肺挫伤和第 3、4 肋骨骨折。磁共振成像（magnetic resonance imaging，MRI）证实中脑出血性挫伤。患者经保守治疗后运动和精神功能完全恢复，并在入院第 17 天出院。
结论
我们遇到了一例因中脑挫伤导致中度 TBI 而出现的单纯瞳孔不等大但无明显眼外肌损害的病例。
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