Kuroki T, Matsumoto M, Kushida T, Ohtsuka T, Uchino M, Nishikawa H
Department of Neurosurgery, Sakura Hospital of Toho University School of Medicine.
No Shinkei Geka. 1994 Sep;22(9):857-62.
In this paper, a case of nontraumatic subdural hematoma secondary to dural metastasis of lung cancer was presented and 43 cases in the literature were reviewed. A 75-year-old man who had been affected with lung tuberculosis for the previous 7 years was admitted to our hospital because of right hemiparesis and aphasia. No history of head injury was discovered. On admission, he was fully conscious and no other neurological abnormalities were noticed except for right hemiparesis and motor aphasia. The chest X-ray revealed abnormal shadows on the right lung, which were most suggestive of tuberculosis. Laboratory studies including prothrombin time, platelet count and fibrinogen were normal. The CT scans taken at that time demonstrated a large subdural hematoma over the left hemisphere. Under a diagnosis of chronic subdural hematoma, emergency evacuation through a small burr hole was performed. However, because of its low liquidity, the hematoma was insufficiently removed. Postoperatively, hemiparesis gradually disappeared. On the 20th hospital day, he suddenly became unconscious and CT scans showed recurrence of the subdural hematoma. Temporo-parietal craniotomy was immediately carried out. The dura was thickened and hyperemic. Although the underlying brain was apparently normal, the exploration performed after removal of the hematoma revealed a soft grayish mass extruding into the subdural space from the dura. The bleeding point was not identified. Both the dura and the abnormal tissue were biopsied for histological examination.(ABSTRACT TRUNCATED AT 250 WORDS)
本文报告1例肺癌硬脑膜转移继发非创伤性硬膜下血肿的病例，并复习了文献中的43例病例。一名75岁男性，既往患肺结核7年，因右侧偏瘫和失语入住我院。未发现头部受伤史。入院时，他意识清醒，除右侧偏瘫和运动性失语外，未发现其他神经系统异常。胸部X线显示右肺有异常阴影，最提示为肺结核。包括凝血酶原时间、血小板计数和纤维蛋白原在内的实验室检查均正常。当时的CT扫描显示左半球有一大块硬膜下血肿。在诊断为慢性硬膜下血肿后，通过小骨孔进行了紧急血肿清除术。然而，由于血肿流动性低，清除不充分。术后偏瘫逐渐消失。住院第20天，他突然昏迷，CT扫描显示硬膜下血肿复发。立即进行颞顶开颅手术。硬脑膜增厚、充血。虽然其下方的脑表面看似正常，但清除血肿后进行的探查发现有一柔软的灰色肿块从硬脑膜挤入硬膜下间隙。未发现出血点。对硬脑膜和异常组织均进行了活检以做组织学检查。（摘要截选于250字）
