创伤性穿透性脑损伤与电击伤并发的综合管理：病例说明
Integrated management of concurrent traumatic penetrating brain injury and electrical injury: illustrative case.
作者信息
Raelly-Muze Laureen K, Vega Rafael A, Hutchins Leslie M
机构信息
University of Texas Health San Antonio, San Antonio, Texas.
Divison of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
出版信息
J Neurosurg Case Lessons. 2024 Dec 16;8(25). doi: 10.3171/CASE24418.
BACKGROUND
Transorbital penetrating brain injury (PBI) accompanied by electrical injury is an extremely rare presentation. This type of traumatic injury has a unique set of diagnostic and therapeutic challenges due to the potential multiple organ system involvement and severe neurological complications.
OBSERVATIONS
A 50-year-old male experienced a high-impact injury from a welding spike that penetrated the orbit just above the eyeball with a concurrent electrical injury; the electricity exited through the great toe. Initial assessments revealed extensive subarachnoid pneumocephalus and a linear hemorrhage extending from the left medial orbital wall through the ethmoid air cells to the right thalamic nucleus. Remarkably, the eye itself was not injured given the superior trajectory of the spike within the orbit.
LESSONS
PBIs and electrical injuries usually cause serious sequelae, but the welding spike and electrical current managed to avoid major neuroanatomical structures and visceral organs, allowing the patient to recover with minimal deficits. https://thejns.org/doi/10.3171/CASE24418.
背景
经眶穿透性脑损伤（PBI）合并电损伤是一种极为罕见的情况。由于可能涉及多个器官系统以及严重的神经并发症，这种创伤性损伤具有一系列独特的诊断和治疗挑战。
观察结果
一名50岁男性遭受了一次高冲击力损伤，一根焊接钉穿透眼球上方的眼眶，同时伴有电损伤；电流从大脚趾穿出。初步评估显示广泛的蛛网膜下腔积气和一条线性出血，从左眼眶内侧壁延伸穿过筛窦气房至右侧丘脑核。值得注意的是，鉴于钉在眼眶内的轨迹较高，眼睛本身未受损伤。
经验教训
穿透性脑损伤和电损伤通常会导致严重的后遗症，但此次焊接钉和电流避开了主要的神经解剖结构和内脏器官，使患者得以以最小的功能缺损康复。https://thejns.org/doi/10.3171/CASE24418 。
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