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伪装成颅内血流分流器原位血栓形成的颈段硬膜外血肿:一个诊断和治疗难题。

Cervical epidural hematoma masquerading as thrombosis of intracranial flow diverter in situ: A diagnostic and therapeutic conundrum.

作者信息

Khandelwal Ankur, Kakati Arindom, Ali Asman

机构信息

Associate Professor (Anaesthesiology, Critical Care & Pain Medicine), All India Institute of Medical Sciences (AIIMS), Guwahati, Assam, India.

Senior Neurosurgeon (Neurosciences), Hayat Superspeciality Hospital, Guwahati, Assam, India.

出版信息

Med J Armed Forces India. 2024 Jan-Feb;80(1):98-101. doi: 10.1016/j.mjafi.2022.12.015. Epub 2023 Feb 8.

Abstract

Cervical epidural hematoma (EDH) is a rare but very serious cause of acute neurologic compression that needs early diagnosis and rapid intervention. Acute hemiparesis is an infrequent presentation of cervical EDH and often mimics cerebrovascular accident. In this case, we describe the management of a case of cervical EDH presenting as acute hemiparesis in an elderly female patient which mimicked as thrombosis of intracranial flow diverter in situ. The report emphasizes that cervical EDH should be considered as differential diagnosis in patients who present with acute hemiparesis especially, who are on antiplatelets or anticoagulants. Also, in a patient considered high-risk for surgery, conservative management can be considered under close supervision and intensive monitoring, especially, in non-expanding hematoma and non-progressive neurological deterioration.

摘要

颈椎硬膜外血肿(EDH)是一种罕见但非常严重的急性神经压迫病因,需要早期诊断和迅速干预。急性偏瘫是颈椎EDH的一种不常见表现,常类似脑血管意外。在此病例中,我们描述了一名老年女性患者以急性偏瘫为表现的颈椎EDH的治疗情况,该病例最初被误诊为原位颅内血流分流器血栓形成。该报告强调,对于出现急性偏瘫的患者,尤其是正在服用抗血小板药物或抗凝剂的患者,应将颈椎EDH视为鉴别诊断之一。此外,对于手术风险高的患者,在密切监测和强化监护下,尤其是在血肿无扩大且神经功能无进行性恶化的情况下,可考虑保守治疗。

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