Nakayama Yosuke, Yamana Satoshi, Nogami Ryo, Fuga Michiyasu, Sano Tohru, Kawamura Daichi, Murayama Yuichi, Ohashi Hiroki
Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
J Neurosurg Case Lessons. 2024 Dec 23;8(26). doi: 10.3171/CASE24525.
Postoperative subdural hematoma (SDH) typically presents with headache, impaired consciousness, hemiplegia, gait disturbance, and aphasia but can also present with visual impairment.
A 52-year-old woman diagnosed with Chiari malformation type I and syringomyelia underwent foramen magnum decompression. Cerebrospinal fluid was lost due to arachnoid injury during the procedure. Postoperatively, a small acute SDH was apparent in the posterior convexity on head computed tomography but was managed conservatively because no neurological deficits were present. Visual impairment developed 2 weeks postoperatively. Ophthalmological examination showed right lower quadrantanopia with normal anterior ocular segment and fundoscopic findings. Magnetic resonance imaging demonstrated SDH in the left posterior convexity with direct compression of the visual cortex. Conservative treatment reduced the hematoma and improved visual impairment.
SDH in the posterior convexity can cause visual impairment via direct compression of the visual cortex. SDH should be included in the differential diagnosis for patients presenting with visual impairment following craniotomy. https://thejns.org/doi/10.3171/CASE24525.
术后硬膜下血肿（SDH）通常表现为头痛、意识障碍、偏瘫、步态障碍和失语，但也可能出现视力障碍。
一名52岁诊断为I型Chiari畸形和脊髓空洞症的女性接受了枕骨大孔减压术。手术过程中因蛛网膜损伤导致脑脊液流失。术后，头部计算机断层扫描显示后凸有一个小的急性硬膜下血肿，但由于没有神经功能缺损，采取了保守治疗。术后2周出现视力障碍。眼科检查显示右眼象限盲，眼前节和眼底检查结果正常。磁共振成像显示左后凸有硬膜下血肿，直接压迫视觉皮层。保守治疗使血肿缩小，视力障碍得到改善。
后凸硬膜下血肿可通过直接压迫视觉皮层导致视力障碍。对于开颅术后出现视力障碍的患者，应将硬膜下血肿纳入鉴别诊断。https://thejns.org/doi/10.3171/CASE24525 。
