高原地区急性进展型硬膜外血肿致脑疝1例  

Brain herniation caused by acute progressive epidural hematoma in plateau area:a case report

作　　者：桑布 旦增 桑杰 尊珠曲宗 齐洪武 SANG Bu;DAN Zeng;SANG Jie;ZUNZHU Qu-zong;QI Hong-wu(Department of Surgery,Luozha County People's Hospital,Shannan 851200,China;Department of Neurosurgery,The 980st Hospital of the PLA Joint Logistics Support Force,Shijiazhuang 050082,China)

机构地区：[1]洛扎县人民医院外科,西藏山南851200 [2]联勤保障部队第九八〇医院神经外科,石家庄050082

出　　处：《中国临床神经外科杂志》2024年第2期126-128,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：急性硬膜外血肿(AEDH)是颅脑损伤后3 d内在硬脑膜和颅骨内板之间的潜在空间中出现的血肿。部分AEDH病例为进展型,早期症状较轻或被对冲伤症状掩盖,首次头颅CT检查未发现硬膜外血肿或血肿量较小,经过一段时间后复查头颅CT出现血肿或血肿增大,病情严重者,甚至出现脑疝,危及病人生命。本文报道1例高原地区的AEDH,为50岁男性,因高处坠落伤致头痛、头晕伴恶心呕吐0.5 h入院,GCS评分14分,首次头颅CT示左侧侧裂区片状高密度影,左侧颞枕部颅板下气体影,其内夹杂少量硬膜外血肿,右侧颞底硬膜下弧形高密度影。入院后6h发生病情变化,GCS评分7分,左侧瞳孔散大至5mm、对光反射消失,复查头颅CT示左侧颞枕部大面积硬膜外血肿形成,中线明显右移,左侧侧脑室受压变形。急诊全麻下行开颅血肿清除术。术后2 h复查头颅CT示左侧颞枕部硬膜外血肿清除彻底。术后6个月随访,病人GOS评分5分。这提示颅脑损伤病人,具有手术指征时要及早行开颅减压和血肿清除术。Acute epidural hematoma(AEDH)is a type of hematoma that develops in the potential space between the dura mater and the inner plate of the skull within 3 days following cranial trauma.Some cases of AEDH are progressive,with initial symptoms being mild or obscured by contusion symptoms;the first head CT scan may not detect the epidural hematoma or it may be small,but upon reexamination after some time,the hematoma may become apparent or increase in size.In severe cases,brain herniation may occur,posing a life-threatening risk to the patient.This paper reported a case of AEDH in a plateau area involving a 50-year-old male who presented to the hospital 0.5 hours after falling from a height with headaches,dizziness,nausea,and vomiting.The patient had a GCS score of 14 on admission.The initial head CT scan showed linear high-density in the left fissure area,gas shadow below the left temporal-occipital skull plate,along with a small amount of epidural hematoma,and curved high-density below right temporal base dura.Six hours after admission,the patient's condition deteriorated with GCS score dropping to 7 and dilated left pupil up to 5 mm with loss of light reflex.A repeat head CT revealed formation of large epidural hematoma in left temporal-occipital region,significant midline shift,and deformation of left lateral ventricle.An emergency craniotomy for hematoma evacuation was performed under general anesthesia.Postoperative CT scan 2 hours after surgery showed complete clearance of left temporal-occipital epidural hematoma.At six-month follow-up visit,the patient had a GOS score of 5.This suggests that patients with traumatic brain injury should undergo decompression and hematoma evacuation as soon as possible when the patients have the indication of surgery.

关 键 词：颅脑损伤 急性硬膜外血肿 高原地区 脑疝 显微手术 疗效 

分 类 号：R651.15[医药卫生—外科学] R651.11[医药卫生—临床医学]