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可能由肾病综合征引起的慢性硬膜下血肿:一例报告及文献复习

Chronic subdural hematoma that may be caused by nephrotic syndrome: a case report and literature review.

作者信息

Xue Hang, Xue Kun, Wang Xiaohui, Xu Weidong, Zhang Weitao, Xia Guangwen

机构信息

Department of Neurosurgery, Yantaishan Hospital Affiliated to Binzhou Medical University, Yantai, Shandong, China.

Department of Nephrology, Yantaishan Hospital Affiliated to Binzhou Medical University, Yantai, Shandong, China.

出版信息

Front Neurol. 2024 Aug 22;15:1454361. doi: 10.3389/fneur.2024.1454361. eCollection 2024.

Abstract

BACKGROUND

Chronic subdural hematoma (CSDH) is a common complication of neurosurgery. Craniocerebral trauma is the likely cause. There are no reports relating CSDH with nephrotic syndrome. Its pathogenesis is very rare, and there are no previous reports on treatments for this disease. We report a case of chronic subdural hematoma that may be caused by nephrotic syndrome and review the previous literature on this subject.

CASE SUMMARY

We report a rare case of chronic subdural hematoma that may be caused by nephrotic syndrome. After the patient was admitted to the hospital, relevant laboratory tests were conducted, and a large amount of protein was detected in the patient's urine, indicating hypoproteinaemia and hyperlipidemia. The patient was diagnosed with nephrotic syndrome. After the exclusion of related surgical contraindications, the patient underwent trepanation and drainage of the chronic subdural hematoma. Subsequent treatment with oral atorvastatin was provided after surgery. The patient was transferred to the nephrology department for further treatment of nephrotic syndrome if his neurological condition improved. No neurological sequelae were detected at the follow-up visit 3 months after the operation.

CONCLUSION

Chronic subdural hematomas are rarely caused by nephrotic syndrome. Trepanation and drainage may be considered for patients confirmed to have adequate hematoma liquefaction on imaging and who can tolerate craniotomy. Atorvastatin should be supplemented as prophylactic treatment after the operation. Nephrotic syndrome should be treated as soon as the patient's neurological condition is stable.

摘要

背景

慢性硬膜下血肿(CSDH)是神经外科常见的并发症。颅脑外伤可能是其病因。目前尚无关于CSDH与肾病综合征相关的报道。其发病机制非常罕见,此前也没有关于该病治疗的报道。我们报告一例可能由肾病综合征引起的慢性硬膜下血肿病例,并回顾此前关于该主题的文献。

病例摘要

我们报告一例罕见的可能由肾病综合征引起的慢性硬膜下血肿病例。患者入院后进行了相关实验室检查,发现患者尿液中存在大量蛋白质,提示低蛋白血症和高脂血症。患者被诊断为肾病综合征。在排除相关手术禁忌证后,患者接受了慢性硬膜下血肿钻孔引流术。术后给予口服阿托伐他汀后续治疗。如果患者神经状况改善,将转至肾内科进一步治疗肾病综合征。术后3个月随访未发现神经后遗症。

结论

慢性硬膜下血肿很少由肾病综合征引起。对于影像学证实血肿充分液化且能耐受开颅手术的患者,可考虑钻孔引流。术后应补充阿托伐他汀作为预防性治疗。患者神经状况稳定后应尽快治疗肾病综合征。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/10bc/11375511/c96261214a2a/fneur-15-1454361-g001.jpg

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