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一例因疟疾诱发凝血病导致复发性颅内出血的复杂病例:病例报告及文献综述

A complex case of recurrent intracranial bleeds due to malaria-induced coagulopathy: A case report and literature review.

作者信息

Zaidi Syeda Mahrukh Fatima, Amjad Ayesha, Sohail Kainat, Rehman Faizan Ur

机构信息

Department of Neurosurgery, Dow University of Health Sciences, Karachi, Pakistan.

Department of Neurosurgery, Jinnah Sindh Medical University, Karachi, Pakistan.

出版信息

Surg Neurol Int. 2024 Aug 30;15:304. doi: 10.25259/SNI_553_2024. eCollection 2024.

Abstract

BACKGROUND

Malaria, a prevalent disease in the developing world, is a significant cause of morbidity and mortality. Infection with , although uncommon, can lead to severe brain injury, including intracranial hemorrhages, resulting in serious neurological deficits. Malaria-induced coagulopathy, while rarely reported, poses a challenge in understanding the exact mechanisms behind the development of intracranial bleeds. Proposed mechanisms include sequestration of parasitized erythrocytes in the brain's microvasculature, leading to capillary occlusion, endothelial damage, cytokine activation, and dysregulation of the coagulation cascade.

CASE DESCRIPTION

We present the case of a 53-year-old male rapidly deteriorating following a history of traumatic brain injury (TBI). Upon admission, a computed tomography scan revealed bilateral acute on chronic hematomas, necessitating a lifesaving craniotomy. Subsequently, the patient experienced three consecutive recurrent intracranial bleeds post-surgery, attributed to -induced coagulopathy. Prompt recognition and intervention stabilized the patient's condition, leading to discharge on the 4 post-operative day.

CONCLUSION

This case underscores the challenges posed by consecutive recurrent intracranial bleeds following TBI exacerbated by infection. It highlights the obstinate nature of malaria-induced coagulopathy and underscores the importance of timely and aggressive interventions in managing such cases.

摘要

背景

疟疾是发展中世界的一种常见疾病,是发病和死亡的重要原因。感染[病原体名称未给出],虽然不常见,但可导致严重脑损伤,包括颅内出血,从而导致严重的神经功能缺损。疟疾诱发的凝血病虽然鲜有报道,但在理解颅内出血发生的确切机制方面构成挑战。提出的机制包括寄生红细胞在脑微血管系统中的滞留,导致毛细血管阻塞、内皮损伤、细胞因子激活和凝血级联反应失调。

病例描述

我们报告一例53岁男性病例,该患者在有创伤性脑损伤(TBI)病史后病情迅速恶化。入院时,计算机断层扫描显示双侧急性加慢性血肿,需要进行挽救生命的开颅手术。随后患者在术后连续出现三次复发性颅内出血,归因于[病原体名称未给出]诱发的凝血病。及时识别和干预使患者病情稳定,术后第4天出院。

结论

本病例强调了创伤性脑损伤后因[病原体名称未给出]感染而加剧的连续复发性颅内出血所带来的挑战。它突出了疟疾诱发凝血病的顽固性,并强调了在处理此类病例时及时和积极干预的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d19a/11380894/a4342b3d5547/SNI-15-304-g001.jpg

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