PDF(Pubmed)
Abstract：
BACKGROUND: Determining a subdural hematoma (SDH) to be chronic by definition takes 3 wk, whereas organized chronic SDH (OCSDH) is an unusual condition that is believed to form over a much longer period of time, which generally demands large craniotomy. Therefore, it is a lengthy process from the initial head trauma, if any, to the formation of an OCSDH. Acute SDH (ASDH) with organization-like, membranaceous appearances has never been reported.
METHODS: A 56-year-old woman presented to our hospital with a seizure, and computed tomography (CT) on admission was negative for signs of intracranial hemorrhage. She had clear consciousness and unimpaired motor functions on arrival and remained stable for the following week, during which she underwent necessary examinations. On the morning of day 10 of hospitalization, she accidentally hit her head hard against the wall in the bathroom and promptly lapsed into complete coma within 2 h. Therefore, we performed emergency CT and identified a left supratentorial SDH that was an absolute indication for surgery. However, the intraoperative findings were surprising, with no liquefaction observed. Instead, a solid hematoma covered with a thick membrane was noted that strongly resembled an organized hematoma. Evacuation was successful, but the family stopped treatment the next day due to financial problems, and the patient soon died.
CONCLUSIONS: Neurosurgeons should address SDHs, especially ASDHs, with discretion and individualization due to their highly diversified features.
METHODS: A 56-year-old woman presented to our hospital with a seizure, and computed tomography (CT) on admission was negative for signs of intracranial hemorrhage. She had clear consciousness and unimpaired motor functions on arrival and remained stable for the following week, during which she underwent necessary examinations. On the morning of day 10 of hospitalization, she accidentally hit her head hard against the wall in the bathroom and promptly lapsed into complete coma within 2 h. Therefore, we performed emergency CT and identified a left supratentorial SDH that was an absolute indication for surgery. However, the intraoperative findings were surprising, with no liquefaction observed. Instead, a solid hematoma covered with a thick membrane was noted that strongly resembled an organized hematoma. Evacuation was successful, but the family stopped treatment the next day due to financial problems, and the patient soon died.
CONCLUSIONS: Neurosurgeons should address SDHs, especially ASDHs, with discretion and individualization due to their highly diversified features.
摘要：
背景：根据定义确定硬膜下血肿（SDH）为慢性需要3周，而有组织的慢性SDH（OCSDH）是一种不寻常的情况，被认为是在更长的时间内形成的，一般需要开颅手术.因此,从最初的头部创伤开始，这是一个漫长的过程，如果有的话,OCSDH的形成。急性SDH（ASDH）与组织样，膜质外观从未被报道。
方法：一名56岁的妇女因癫痫发作来到我们医院，入院时计算机断层扫描（CT）对颅内出血的征象阴性。她到达时意识清晰，运动功能未受损，并在接下来的一周保持稳定，在此期间，她接受了必要的检查。在住院的第10天早上，她不小心将头撞到浴室的墙壁上，并在2小时内迅速陷入完全昏迷。因此，我们进行了急诊CT检查,发现左侧幕上SDH是手术的绝对指征.然而,术中发现令人惊讶，没有观察到液化。相反，发现有厚膜覆盖的固体血肿，与有组织的血肿非常相似。疏散成功了,但是由于经济问题，第二天这家人停止了治疗，病人很快就死了.
结论：神经外科医生应该解决SDH，尤其是ASDHs,由于其高度多样化的特点，具有谨慎和个性化。
方法：一名56岁的妇女因癫痫发作来到我们医院，入院时计算机断层扫描（CT）对颅内出血的征象阴性。她到达时意识清晰，运动功能未受损，并在接下来的一周保持稳定，在此期间，她接受了必要的检查。在住院的第10天早上，她不小心将头撞到浴室的墙壁上，并在2小时内迅速陷入完全昏迷。因此，我们进行了急诊CT检查,发现左侧幕上SDH是手术的绝对指征.然而,术中发现令人惊讶，没有观察到液化。相反，发现有厚膜覆盖的固体血肿，与有组织的血肿非常相似。疏散成功了,但是由于经济问题，第二天这家人停止了治疗，病人很快就死了.
结论：神经外科医生应该解决SDH，尤其是ASDHs,由于其高度多样化的特点，具有谨慎和个性化。
