Algaly Gufran, Ahmed Sara M I, Abdelrahman Amro, Elgassim Mohamad Abdelgadir, Parveen Ayesha
Emergency Department, Hamad Medical Corporation, Doha, Qatar.
Medical Education Department, Hamad Medical Corporation, Doha, Qatar.
Oxf Med Case Reports. 2024 Aug 26;2024(8):omae094. doi: 10.1093/omcr/omae094. eCollection 2024 Aug.
A transient female passenger in her 40s presented to the emergency department (ED) exhibiting drowsiness post-scuba diving. Despite normal initial vitals, she reported dizziness, sleepiness, and occipital headache. A computed tomography (CT) scan showed a severe posterior circulation acute infarction affecting various brain regions, resulting in significant mass effects and complications like 4th ventricle compression, cerebellar tonsillar herniation, and hydrocephalus. Extensive diagnostic tests, blood workup, and stroke evaluations revealed normal findings, except for an incidental patent foramen ovale (PFO). Collaboration with neurosurgery led to her transfer for life-saving extraventricular drain (EVD) insertion and posterior fossa decompression. Treatment included right-side EVD insertion, suboccipital craniectomy, and foramen magnum decompression. Postoperatively, she was extubated the next day, alert, without focal neurological deficits. Upon EVD removal, a repeat CT head scan showed regression of mass effect. She was discharged home safely after 16 days, fully ambulating.
一名40多岁的临时女性乘客因潜水后出现嗜睡症状前往急诊科就诊。尽管初始生命体征正常，但她自述头晕、困倦和枕部头痛。计算机断层扫描（CT）显示严重的后循环急性梗死，影响多个脑区，导致明显的占位效应以及第四脑室受压、小脑扁桃体疝和脑积水等并发症。广泛的诊断检查、血液检查和中风评估显示，除了偶然发现的卵圆孔未闭（PFO）外，其他检查结果均正常。与神经外科协作后，她被转院进行挽救生命的脑室外引流（EVD）置入和后颅窝减压手术。治疗措施包括右侧EVD置入、枕下颅骨切除术和枕骨大孔减压术。术后第二天她拔除气管插管，意识清醒，无局灶性神经功能缺损。拔除EVD后，头部CT复查显示占位效应消退。16天后，她安全出院，能够完全独立行走。
