Takamura Y, Morimoto S, Uede T, Yamaki T, Minamida Y, Yamamura A, Nakagawa T
Department of Neurosurgery, Kushiro City General Hospital, Hokkaido.
Neurol Med Chir (Tokyo). 1996 Sep;36(9):650-3. doi: 10.2176/nmc.36.650.
A 35-year-old male was admitted with headache, nausea, and vomiting persisting for 2 days. Computed tomography (CT) revealed a left chronic subdural hematoma. Cerebral angiography demonstrated cerebral venous sinus thrombosis (CVST). He had presented with a subcutaneous mass involving the neck at age 2 years, which was shown to be a cavernous angioma, and thereafter shown signs of consumptive coagulopathy with systemic multiple hemangiomas. Burr hole aspiration of the hematoma was performed. Seventy-two-hours later, he developed clouding of consciousness and right hemiparesis. CT revealed a fresh hematoma in the operated subdural cavity and hemorrhagic diathesis manifested. A frontotemporoparietal large craniotomy was performed to remove the hematoma. Extensive electrocauterization was required. He had a satisfactory postoperative course. Collateral venous pathways, resulting from the CVST due to systemic multiple hemangiomas, may have caused hemodynamic stress in the bridging veins which subsequently induced chronic subdural hematoma.
一名35岁男性因头痛、恶心和呕吐持续2天入院。计算机断层扫描(CT)显示左侧慢性硬膜下血肿。脑血管造影显示脑静脉窦血栓形成(CVST)。他在2岁时出现颈部皮下肿块,经证实为海绵状血管瘤,此后出现消耗性凝血病伴全身多发血管瘤的体征。对血肿进行了钻孔抽吸。72小时后,他出现意识模糊和右侧偏瘫。CT显示手术的硬膜下腔内有新鲜血肿,并出现出血素质。进行了额颞顶大骨瓣开颅术以清除血肿。需要广泛电灼。他术后恢复过程顺利。由于全身多发血管瘤导致的CVST所形成的侧支静脉通路,可能在桥静脉中引起血流动力学压力,随后诱发了慢性硬膜下血肿。