Pipolo Derek O, Guevara Sara, Vasiljevic Lana, Pietrantonio Andres E Di, Brennan Walter, Asmus Humberto, McCann-Molmenti Alexia, Cho Young Min, Shinozaki Koichiro, Hayashida Kei, Okuma Yu, Shoaib Muhammad, Becker Lance B, Decker Mary E, Worku Hermoon A, Majdak Petra, Donzelli Grace, Patel Akash, Davoud Sherwin, Vaca-Zorrilla Andres, Beutler Sascha S, Molmenti Ernesto P, Miyara Santiago J
Department of Surgery, North Shore University Hospital, Manhasset, New York.
Department of Neurological Surgery, Trauma and Emergency Hospital Dr. Federico Abete, Buenos Aires, Argentina.
Int J Angiol. 2023 Mar 9;32(3):188-192. doi: 10.1055/s-0043-1763252. eCollection 2023 Sep.
In this case study, we describe a 25-year-old male who was admitted due to a severe traumatic brain injury, requiring invasive intracranial pressure monitoring. At 48 hours posttrauma, he developed intracranial hypertension refractory to medical treatment without tomographic changes in the brain. Subsequently, intra-abdominal hypertension and tomographic signs of abdominal surgical pathology were observed. An exploratory laparotomy was performed with an intraoperative diagnosis of acute mesenteric ischemia. After surgical intervention for the abdominal pathology, intracranial pressure was restored to physiological values with a favorable recovery of the patient. In this report, the relationship between intracranial pressure and intra-abdominal pressure is discussed, highlighting the delicate association between the brain, abdomen, and thorax. Measures should be taken to avoid increases in intra-abdominal pressure in neurocritical patients. When treating intracranial hypertension refractory to conventional measures, abdominal causes and multiple compartment syndrome must be considered. The cranial compartment has physiological interdependence with other body compartments, where one can be modified by variations from another, giving rise to the concept of multiple compartment syndrome. Understanding this relationship is fundamental for a comprehensive approach of the neurocritical patient. To the best of our knowledge, this is the first report of a comatose patient post-traumatic brain injury, who developed medically unresponsive intracranial hypertension secondary to acute mesenteric ischemia, in which surgical resolution of intra-abdominal pathology resulted in intracranial pressure normalization and restitutio ad integrum of neurological status.
在本病例研究中，我们描述了一名25岁男性，因严重创伤性脑损伤入院，需要进行有创颅内压监测。创伤后48小时，他出现了药物治疗难以控制的颅内高压，而脑部断层扫描无变化。随后，观察到腹腔内高压及腹部手术病理的断层扫描征象。进行了剖腹探查术，术中诊断为急性肠系膜缺血。对腹部病变进行手术干预后，颅内压恢复到生理值，患者恢复良好。在本报告中，讨论了颅内压与腹腔内压之间的关系，强调了脑、腹和胸之间的微妙联系。应采取措施避免神经重症患者腹腔内压升高。在治疗常规措施难以控制的颅内高压时，必须考虑腹部病因和多腔隙综合征。颅腔与身体其他腔隙存在生理上的相互依存关系，其中一个腔隙的变化可引起另一个腔隙的改变，从而产生了多腔隙综合征的概念。理解这种关系对于全面治疗神经重症患者至关重要。据我们所知，这是首例创伤性脑损伤后昏迷患者的报告，该患者因急性肠系膜缺血继发药物治疗无效的颅内高压，腹部病变的手术解决导致颅内压正常化和神经功能完全恢复。
