Background: Acute subdural hematoma (ASDH) is considered the most common traumatic brain mass lesion. Its prognosis is still grave despite the improvements in treatment modalities. Its mortality rate was reported to b...Background: Acute subdural hematoma (ASDH) is considered the most common traumatic brain mass lesion. Its prognosis is still grave despite the improvements in treatment modalities. Its mortality rate was reported to be around 60% until the 1990s. In the last decade, ASDH mortality rate was reduced to the level of 20% - 40%. Standard treatment to decrease intracranial tension via hematoma evacuation is associated with decompressive craniotomy and followed by ICU management. Objective: To evaluate the outcome and prognostic factors in patients of acute subdural hematoma treated by surgical evacuation and decompressive craniotomy. Also, outcome of cranioplasty by repositioning of patients own bone or by synthetic mesh methods is evaluated. Patients and Methods: It is one year retrospective study. It was conducted on 53 patients, in trauma unit, Assiut university hospitals. We report time lag between trauma and performed surgery, initial Glasgow coma scale (GCS), age, sex and presence of other intracranial pathologies. Outcome assessment is based on Glasgow outcome scale (GOS) and fol-low-up extended for 6 months. We include those patients with only (isolated) head trauma, shift of midline more than 5 mm in CT brain. We excluded pa-tients with GCS 3 and fixed dilated pupils as well as patients with GCS higher than 12. We did decompressive craniotomy and duraplasty in all patients. Bone flap of decompressive craniotomy is situated in the abdomen. All func-tionally recovered patients were submitted for cranioplasty with either re-placing patient own bone or by Titanium mesh. Results: We had 39 males and 14 females. Age ranged between 7 and 65 years old. 23 deaths, 10 persis-tent vegetative state, 10 severe disability, 8 moderate disability and 2 good recovery. The outcome analysis was based on 6 month follow-up. Conclu-sion: Acute subdural hematoma is a very serious condition. Mortality and morbidity is intimately related to GCS on admission. Presence of associated cerebral pathology increases mortality and morbidity of patients with post-traumatic acute subdural hematoma. Early evacuation of posttraumatic acute subdural hematoma with decompressive craniotomy is an important method to control raised intracranial tension, reduce shift of midline and very benefi-cial in decreasing mortality and morbidity. Regarding infection and avoiding bone flap resorption, Titanium mesh is better than patient own bone during cranioplasty after patient recovery.展开更多
Background: Traumatic Brain Injury (TBI) is a major health problem worldwide. It is the main cause of trauma mortality. Acute subdural hematoma (ASDH) has a reputation for being the most serious of all posttraumatic h...Background: Traumatic Brain Injury (TBI) is a major health problem worldwide. It is the main cause of trauma mortality. Acute subdural hematoma (ASDH) has a reputation for being the most serious of all posttraumatic head injuries. Its frequency is estimated to be 1% to 5% of all head injuries and 22% of severe head injuries. The aim of this study was to assess the epidemiological, clinical and prognosis aspects of ASDH in our department. Material and Methods: This prospective study, from January to December 2019, included 57 patients admitted to the Gabriel Touré Teaching Hospital for ASDH. Patients underwent detailed clinical and radiological evaluation and ASDH was diagnosed by non-contrast computed tomography (CT) scan. Functional outcome was evaluated 6 months after injury by Glasgow Outcome Scale. Results: During the study period, 662 patients were admitted for TBI including 57 (8.61%) cases of ASDH. The mean age was 34 years with extremes of 2 and 77 years. There was a male predominance with 52 (91.2%). The main cause of trauma was motor vehicle accidents in 38 (66.6%) patients. According to the Glasgow coma scale (GCS), 33 (57.9%) patients were classified mild (Table 2). The thickness of the hematoma was more than 1 cm in 13 (22.8%) patients and less than 1 cm in 44 (77%) patients. Surgical treatment was performed in 13 (22.8%) patients. The outcome was favorable in 30 (52.6%) patients and the mortality rate was 33.3%. Conclusion: ASDH remains a difficult challenge because of the high mortality. The mortality rate remains high particularly in patient with poor GCS score at admission.展开更多
Traumatic acute subdural hematoma is one of the most lethal causes of head injuries,which leads to high mortality.While combined diseases always make it more intractable for the treatment.We present a case of a 68-yea...Traumatic acute subdural hematoma is one of the most lethal causes of head injuries,which leads to high mortality.While combined diseases always make it more intractable for the treatment.We present a case of a 68-year-old female patient with traumatic acute subdural hematoma combined with hydrocephalus after ventriculoperitoneal shunt assisted by the neuronavigation system in January 12,2017.She was undergone ventriculoperitoneal shunt 6 years and 5 months ago on two sides respectively because of hydrocephalus,with the ventriculoperitoneal shunt device on the right side out of work.The initial neurological examination showed a Glasgow Coma Scale of E2V1M5 with no papillary defect.A CT scan of the head revealed a left homogeneously hyperdense and subdural hematoma,with compression of the lateral ventricle(2.6 cm thick)and a 0.5 cm midline shift.To protect the ventriculoperitoneal shunt device,we used neuronavigation system to precisely mark the relative location of the device and“invisible”subdural hematoma,thus to design a perfect incision preoperatively.Subsequently,evacuation of the subdural hematoma was performed via craniotomy without damaging the ventriculoperitoneal shunt device.Postoperative CT of the head showed totally removing of the subdural hematoma.The patient recovered three months later.With the assistant of neuronavigation system,it is much easier for the preoperative planning and to reduce the surgical risk.Our case gives a clue that more approaches can be considered when encountering acute head trauma with the complicated combined diseases.展开更多
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 genera...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.CASE SUMMARY 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.CONCLUSION Neurosurgeons should address SDHs,especially ASDHs,with discretion and individualization due to their highly diversified features.展开更多
Objective:To study the intervention effect of Peiyuan Huayu Decoction on the neuron damage in model rats with acute subdural hematoma (ASDH).Methods: 160 SD rats were randomly divided into four groups, and the ASDH mo...Objective:To study the intervention effect of Peiyuan Huayu Decoction on the neuron damage in model rats with acute subdural hematoma (ASDH).Methods: 160 SD rats were randomly divided into four groups, and the ASDH model rats were made by stereotactic autoblood injection, and sham operation group received craniotomy without blood injection. Sham operation group and model group were normally bred after model establishment, and 6 h after model establishment, the treatment group received intragastric administration of Peiyuan Huayu Decoction, and control group received intragastric administration of Piracetam Tablets, 1 time a day. On the 1d, 3d, 5d and 7d after model establishment, the general conditions of rats (activity, food intake and mental state) were observed, blood was collected via auricula dextra, ELISA method was used to determine peripheral plasma NSE and S100β protein contents, routine HE staining was conducted after perfusion fixation, the neurons in blood injection side of brain tissue were counted, and the neuron damage was observed.Results: 26 rats were dead in the experiment. The general conditions of sham operation group were significantly better than those of other groups, treatment group was significantly better than model group and control group on the 5d group (P<0.05), and there was no significant difference on the 1d, 3d and 7d (P>0.05);neuron count of sham operation group was basically stable, treatment group was not different from model group and control group on the 1d (P>0.05), treatment group was better than model group (P<0.05), and not different from control group (P>0.05) on the 3d, and treatment group was better than model group and control group on the 5d and 7d (P<0.05);peripheral plasma S100β protein and NSE contents of sham operation group were at lower levels, treatment group was not significantly different from model group and control group on the 1d (P>0.05), S100β protein and NSE contents decreased significantly on the 3d, and treatment group was significantly different from model group and control group (P<0.05), S100β protein and NSE contents increased on the 5d and 7d, the increase in treatment group was slower than that in model group and control group, and there was significant difference (P<0.05).Conclusion:Peiyuan Huayu Decoction has obvious protective effect on the neurons in ASDH model rats, and this effect may be based on the inhibition of secondary neuron damage.展开更多
Both delayed posttraumatic intracerebral hemorrhage and epidural hematoma have been well described in the neurosurgical literatures. However, delayed posttraumatic acute subdural hematoma which happens more than a wee...Both delayed posttraumatic intracerebral hemorrhage and epidural hematoma have been well described in the neurosurgical literatures. However, delayed posttraumatic acute subdural hematoma which happens more than a week with a rapid progress after mild traumatic brain injury and causes death of patient is rarely reported. We show two such cases and briefly review the literature and discuss the probable pathogenesis of their rapid progress.展开更多
From July 2003 to July 2009, 15 cases of subdural hematoma with swirl signs were treated in our hospital and their clinical data were retrospectively analysed. The mortality was compared between these patients and tho...From July 2003 to July 2009, 15 cases of subdural hematoma with swirl signs were treated in our hospital and their clinical data were retrospectively analysed. The mortality was compared between these patients and those with typical acute subdural hematoma who were treated at the same time in our hospital. Among the 15 cases, full recovery was achieved in 4 cases, slight disability in 2, grave disability in 2 and death in 7 （46.7%）. The mortality of these patients was conspicuously higher than that of typical sub- dural hematoma （14/83, 16.9%, P〈0.01）. Subdural hematoma with swirl signs is often suggestive of hazardous pathogenetic condition and early diagnosis and prompt surgical intervention is essential to reduce mortality.展开更多
Background:A large craniotomy is usually the first choice for removal of traumatic acute subdural hematoma (TASDH).To date,few studies have reported that TASDH could be successfully treated by twist drill craniostomy ...Background:A large craniotomy is usually the first choice for removal of traumatic acute subdural hematoma (TASDH).To date,few studies have reported that TASDH could be successfully treated by twist drill craniostomy (TDC) alone or combined with instillation of urokinase.We aimed to define the TDC for the elderly with TASDH and performed literature review.Case presentation:A total of 7 TASDH patients,who were presented and treated by TDC in this retrospective study between January 2009 and May 2017,consisted of 5 men and 2 women,ranging in age from 65 to 89 (average,78.9) years.The patients' baseline characteristics,including age,sex,medical history,received ventriculoperitoneal shunt for hydrocephalus or not,reason for avoiding or refusing large craniotomy,preoperative Glasgow Coma Scale (GCS),suffered from cerebral herniation or not,the location of TASDH,imaging characteristics of TASDH in CT scan,injury/surgery time interval,midline shift,preoperative neurologic deficit,operation time,and infusions of urokinase or not,were collected.The postoperative GCS,postoperative neurologic deficit,rebleeding or not,intracranial infection,and modified Rankin Scale (mRS) at 6 months after surgery were analyzed to access the safety and efficacy of evacuation with TDC.The results showed that the mean time interval from injury to TDC was 68.6 min (30-120 min).The mean distance of midline shift was 14.6 mm (10-20 mm).The preoperative GCS in all patients ranged from 4 to 13(median,9).The mean duration of the operation was 14.4 min (6-19 min).Postoperative CT scan showed that hematoma evacuation rate was more than 70% in all cases.There were no cases of acute rebleeding and intracranial infection after TDC.No cases presented with chronic SDH at the ipsilateral side within 6 months after being treated by TDC alone or combined with instillation of urokinase.Favorable outcomes were shown in all cases (mRS scores 0-2) at 6 months after surgery.Conclusions:TASDH in the elderly could be safely and effectively treated by TDC alone or combined with instillation of urokinase,which was a possible alternative for the elderly.展开更多
BACKGROUND Elevated levels of cardiac troponin and abnormal electrocardiogram changes are the primary basis for clinical diagnosis of acute coronary syndrome(ACS).Troponin levels in ACS patients can often be more than...BACKGROUND Elevated levels of cardiac troponin and abnormal electrocardiogram changes are the primary basis for clinical diagnosis of acute coronary syndrome(ACS).Troponin levels in ACS patients can often be more than 50 times the upper reference limit.Some patients with subarachnoid hemorrhage(SAH)also show electrocardiogram abnormalities,myocardial damage,and elevated cardiac biomarkers.Unlike ACS patients,patients with SAH only have a slight increase in troponin,and the use of anticoagulants or antiplatelet drugs is prohibited.Because of the opposite treatment modalities,it is essential for clinicians to distinguish between SAH and ACS.CASE SUMMARY A 56-year-old female patient was admitted to the emergency department at night with a sudden onset of severe back pain.The final diagnosis was intraspinal hematoma in the thoracic spine.We performed an emergency thoracic spinal canal hematoma evacuation procedure with the assistance of a microscope.Intraoperatively,diffuse hematoma formation was found in the T7-T10 spinal canal,and no obvious spinal vascular malformation changes were observed.Postoperative head and spinal magnetic resonance imaging(MRI)showed a small amount of SAH in the skull,no obvious abnormalities in the cervical and thoracic spinal canals,and no abnormal signals in the lumbar spinal canal.Thoracoab-dominal aorta computed tomography angiography showed no vascular malfor-mation.Postoperative motor system examination showed Medical Research Council Scale grade 1/5 strength in both lower extremities,and the patient experienced decreased sensation below the T12 rib margin and reported a Visual Analog Scale score of 3.CONCLUSION Extremely elevated troponin levels(more than 50 times the normal range)are not unique to coronary artery disease.SAH can also result in extremely high troponin levels,and antiplatelet drugs are contraindicated in such cases.Emergency MRI can help in the early differential diagnosis,as a misdiagnosis of ACS can lead to catastrophic neurological damage in patients with spontaneous spinal SAH.展开更多
文摘Background: Acute subdural hematoma (ASDH) is considered the most common traumatic brain mass lesion. Its prognosis is still grave despite the improvements in treatment modalities. Its mortality rate was reported to be around 60% until the 1990s. In the last decade, ASDH mortality rate was reduced to the level of 20% - 40%. Standard treatment to decrease intracranial tension via hematoma evacuation is associated with decompressive craniotomy and followed by ICU management. Objective: To evaluate the outcome and prognostic factors in patients of acute subdural hematoma treated by surgical evacuation and decompressive craniotomy. Also, outcome of cranioplasty by repositioning of patients own bone or by synthetic mesh methods is evaluated. Patients and Methods: It is one year retrospective study. It was conducted on 53 patients, in trauma unit, Assiut university hospitals. We report time lag between trauma and performed surgery, initial Glasgow coma scale (GCS), age, sex and presence of other intracranial pathologies. Outcome assessment is based on Glasgow outcome scale (GOS) and fol-low-up extended for 6 months. We include those patients with only (isolated) head trauma, shift of midline more than 5 mm in CT brain. We excluded pa-tients with GCS 3 and fixed dilated pupils as well as patients with GCS higher than 12. We did decompressive craniotomy and duraplasty in all patients. Bone flap of decompressive craniotomy is situated in the abdomen. All func-tionally recovered patients were submitted for cranioplasty with either re-placing patient own bone or by Titanium mesh. Results: We had 39 males and 14 females. Age ranged between 7 and 65 years old. 23 deaths, 10 persis-tent vegetative state, 10 severe disability, 8 moderate disability and 2 good recovery. The outcome analysis was based on 6 month follow-up. Conclu-sion: Acute subdural hematoma is a very serious condition. Mortality and morbidity is intimately related to GCS on admission. Presence of associated cerebral pathology increases mortality and morbidity of patients with post-traumatic acute subdural hematoma. Early evacuation of posttraumatic acute subdural hematoma with decompressive craniotomy is an important method to control raised intracranial tension, reduce shift of midline and very benefi-cial in decreasing mortality and morbidity. Regarding infection and avoiding bone flap resorption, Titanium mesh is better than patient own bone during cranioplasty after patient recovery.
文摘Background: Traumatic Brain Injury (TBI) is a major health problem worldwide. It is the main cause of trauma mortality. Acute subdural hematoma (ASDH) has a reputation for being the most serious of all posttraumatic head injuries. Its frequency is estimated to be 1% to 5% of all head injuries and 22% of severe head injuries. The aim of this study was to assess the epidemiological, clinical and prognosis aspects of ASDH in our department. Material and Methods: This prospective study, from January to December 2019, included 57 patients admitted to the Gabriel Touré Teaching Hospital for ASDH. Patients underwent detailed clinical and radiological evaluation and ASDH was diagnosed by non-contrast computed tomography (CT) scan. Functional outcome was evaluated 6 months after injury by Glasgow Outcome Scale. Results: During the study period, 662 patients were admitted for TBI including 57 (8.61%) cases of ASDH. The mean age was 34 years with extremes of 2 and 77 years. There was a male predominance with 52 (91.2%). The main cause of trauma was motor vehicle accidents in 38 (66.6%) patients. According to the Glasgow coma scale (GCS), 33 (57.9%) patients were classified mild (Table 2). The thickness of the hematoma was more than 1 cm in 13 (22.8%) patients and less than 1 cm in 44 (77%) patients. Surgical treatment was performed in 13 (22.8%) patients. The outcome was favorable in 30 (52.6%) patients and the mortality rate was 33.3%. Conclusion: ASDH remains a difficult challenge because of the high mortality. The mortality rate remains high particularly in patient with poor GCS score at admission.
基金This work was supported by the Program for Health and Family Planning Commission of Hangzhou Municipality,China(2017A73)Medicine and Health Science and Technology Projects of Zhejiang Province,China(2018270408)+1 种基金National Natural Science Foundation of China(81402044)Natural Science Foundation of Zhejiang Province of China(LY14H160017,LY14H160025).
文摘Traumatic acute subdural hematoma is one of the most lethal causes of head injuries,which leads to high mortality.While combined diseases always make it more intractable for the treatment.We present a case of a 68-year-old female patient with traumatic acute subdural hematoma combined with hydrocephalus after ventriculoperitoneal shunt assisted by the neuronavigation system in January 12,2017.She was undergone ventriculoperitoneal shunt 6 years and 5 months ago on two sides respectively because of hydrocephalus,with the ventriculoperitoneal shunt device on the right side out of work.The initial neurological examination showed a Glasgow Coma Scale of E2V1M5 with no papillary defect.A CT scan of the head revealed a left homogeneously hyperdense and subdural hematoma,with compression of the lateral ventricle(2.6 cm thick)and a 0.5 cm midline shift.To protect the ventriculoperitoneal shunt device,we used neuronavigation system to precisely mark the relative location of the device and“invisible”subdural hematoma,thus to design a perfect incision preoperatively.Subsequently,evacuation of the subdural hematoma was performed via craniotomy without damaging the ventriculoperitoneal shunt device.Postoperative CT of the head showed totally removing of the subdural hematoma.The patient recovered three months later.With the assistant of neuronavigation system,it is much easier for the preoperative planning and to reduce the surgical risk.Our case gives a clue that more approaches can be considered when encountering acute head trauma with the complicated combined diseases.
文摘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.CASE SUMMARY 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.CONCLUSION Neurosurgeons should address SDHs,especially ASDHs,with discretion and individualization due to their highly diversified features.
文摘Objective:To study the intervention effect of Peiyuan Huayu Decoction on the neuron damage in model rats with acute subdural hematoma (ASDH).Methods: 160 SD rats were randomly divided into four groups, and the ASDH model rats were made by stereotactic autoblood injection, and sham operation group received craniotomy without blood injection. Sham operation group and model group were normally bred after model establishment, and 6 h after model establishment, the treatment group received intragastric administration of Peiyuan Huayu Decoction, and control group received intragastric administration of Piracetam Tablets, 1 time a day. On the 1d, 3d, 5d and 7d after model establishment, the general conditions of rats (activity, food intake and mental state) were observed, blood was collected via auricula dextra, ELISA method was used to determine peripheral plasma NSE and S100β protein contents, routine HE staining was conducted after perfusion fixation, the neurons in blood injection side of brain tissue were counted, and the neuron damage was observed.Results: 26 rats were dead in the experiment. The general conditions of sham operation group were significantly better than those of other groups, treatment group was significantly better than model group and control group on the 5d group (P<0.05), and there was no significant difference on the 1d, 3d and 7d (P>0.05);neuron count of sham operation group was basically stable, treatment group was not different from model group and control group on the 1d (P>0.05), treatment group was better than model group (P<0.05), and not different from control group (P>0.05) on the 3d, and treatment group was better than model group and control group on the 5d and 7d (P<0.05);peripheral plasma S100β protein and NSE contents of sham operation group were at lower levels, treatment group was not significantly different from model group and control group on the 1d (P>0.05), S100β protein and NSE contents decreased significantly on the 3d, and treatment group was significantly different from model group and control group (P<0.05), S100β protein and NSE contents increased on the 5d and 7d, the increase in treatment group was slower than that in model group and control group, and there was significant difference (P<0.05).Conclusion:Peiyuan Huayu Decoction has obvious protective effect on the neurons in ASDH model rats, and this effect may be based on the inhibition of secondary neuron damage.
文摘Both delayed posttraumatic intracerebral hemorrhage and epidural hematoma have been well described in the neurosurgical literatures. However, delayed posttraumatic acute subdural hematoma which happens more than a week with a rapid progress after mild traumatic brain injury and causes death of patient is rarely reported. We show two such cases and briefly review the literature and discuss the probable pathogenesis of their rapid progress.
文摘From July 2003 to July 2009, 15 cases of subdural hematoma with swirl signs were treated in our hospital and their clinical data were retrospectively analysed. The mortality was compared between these patients and those with typical acute subdural hematoma who were treated at the same time in our hospital. Among the 15 cases, full recovery was achieved in 4 cases, slight disability in 2, grave disability in 2 and death in 7 （46.7%）. The mortality of these patients was conspicuously higher than that of typical sub- dural hematoma （14/83, 16.9%, P〈0.01）. Subdural hematoma with swirl signs is often suggestive of hazardous pathogenetic condition and early diagnosis and prompt surgical intervention is essential to reduce mortality.
文摘Background:A large craniotomy is usually the first choice for removal of traumatic acute subdural hematoma (TASDH).To date,few studies have reported that TASDH could be successfully treated by twist drill craniostomy (TDC) alone or combined with instillation of urokinase.We aimed to define the TDC for the elderly with TASDH and performed literature review.Case presentation:A total of 7 TASDH patients,who were presented and treated by TDC in this retrospective study between January 2009 and May 2017,consisted of 5 men and 2 women,ranging in age from 65 to 89 (average,78.9) years.The patients' baseline characteristics,including age,sex,medical history,received ventriculoperitoneal shunt for hydrocephalus or not,reason for avoiding or refusing large craniotomy,preoperative Glasgow Coma Scale (GCS),suffered from cerebral herniation or not,the location of TASDH,imaging characteristics of TASDH in CT scan,injury/surgery time interval,midline shift,preoperative neurologic deficit,operation time,and infusions of urokinase or not,were collected.The postoperative GCS,postoperative neurologic deficit,rebleeding or not,intracranial infection,and modified Rankin Scale (mRS) at 6 months after surgery were analyzed to access the safety and efficacy of evacuation with TDC.The results showed that the mean time interval from injury to TDC was 68.6 min (30-120 min).The mean distance of midline shift was 14.6 mm (10-20 mm).The preoperative GCS in all patients ranged from 4 to 13(median,9).The mean duration of the operation was 14.4 min (6-19 min).Postoperative CT scan showed that hematoma evacuation rate was more than 70% in all cases.There were no cases of acute rebleeding and intracranial infection after TDC.No cases presented with chronic SDH at the ipsilateral side within 6 months after being treated by TDC alone or combined with instillation of urokinase.Favorable outcomes were shown in all cases (mRS scores 0-2) at 6 months after surgery.Conclusions:TASDH in the elderly could be safely and effectively treated by TDC alone or combined with instillation of urokinase,which was a possible alternative for the elderly.
文摘BACKGROUND Elevated levels of cardiac troponin and abnormal electrocardiogram changes are the primary basis for clinical diagnosis of acute coronary syndrome(ACS).Troponin levels in ACS patients can often be more than 50 times the upper reference limit.Some patients with subarachnoid hemorrhage(SAH)also show electrocardiogram abnormalities,myocardial damage,and elevated cardiac biomarkers.Unlike ACS patients,patients with SAH only have a slight increase in troponin,and the use of anticoagulants or antiplatelet drugs is prohibited.Because of the opposite treatment modalities,it is essential for clinicians to distinguish between SAH and ACS.CASE SUMMARY A 56-year-old female patient was admitted to the emergency department at night with a sudden onset of severe back pain.The final diagnosis was intraspinal hematoma in the thoracic spine.We performed an emergency thoracic spinal canal hematoma evacuation procedure with the assistance of a microscope.Intraoperatively,diffuse hematoma formation was found in the T7-T10 spinal canal,and no obvious spinal vascular malformation changes were observed.Postoperative head and spinal magnetic resonance imaging(MRI)showed a small amount of SAH in the skull,no obvious abnormalities in the cervical and thoracic spinal canals,and no abnormal signals in the lumbar spinal canal.Thoracoab-dominal aorta computed tomography angiography showed no vascular malfor-mation.Postoperative motor system examination showed Medical Research Council Scale grade 1/5 strength in both lower extremities,and the patient experienced decreased sensation below the T12 rib margin and reported a Visual Analog Scale score of 3.CONCLUSION Extremely elevated troponin levels(more than 50 times the normal range)are not unique to coronary artery disease.SAH can also result in extremely high troponin levels,and antiplatelet drugs are contraindicated in such cases.Emergency MRI can help in the early differential diagnosis,as a misdiagnosis of ACS can lead to catastrophic neurological damage in patients with spontaneous spinal SAH.
