Delayed contralateral epidural hematoma before traumatic acute subdural hematoma evacuation- a surgical dilemma

延遲性對側硬腦膜上出血在急性硬腦膜下出血移除前發生：手術困境

甘錦康(Kam-Hong Kam) ； 孫瑞明(Jui-Ming Sun) ； 謝政達(Cheng-Ta Hsieh) ； 黃國倉(Kuo-Chang Huang)

《輔仁醫學期刊》 19卷4期 (2021/12) Pp. 23-29

https://doi.org/10.3966/181020932021121904003

摘要

Delayed contralateral epidural hematoma is a rare but well-documented complication in patients following decompressive surgery for acute subdural hematoma. However, instances of delayed contralateral epidural hematoma with an overlying skull fracture before acute subdural hematoma evacuation have rarely been documented. In this report, we present the case of a 15-year-old girl with a left-sided acute subdural hematoma and right-sided skull fracture after sustaining a head trauma. Forty- nine minutes after the initial computed tomography scan, dilation of the right pupil occurred and a large delayed right-sided epidural hematoma was confirmed through a subsequent computed tomography scan. We review and discuss the possible mechanism.

關鍵字

acute subdural hematoma ； delayed epidural hematoma ； decompressive surgery ； skull fracture ； head injury

並列摘要

對側延遲性硬腦膜上出血在急性硬腦膜下出血病患接受減壓手術後，是罕見但是已知的併發症。但是，急性硬腦膜下出血病患接受減壓手術前，發生對側延遲性硬腦膜上出血在骨折處上，是很少被報導過。因此，我們報告一名15歲女孩在頭部外傷後，產生左側急性硬膜下血腫和右側顱骨骨折。49分鐘後，出現了右瞳孔擴大，再次追蹤的電腦斷層檢查確認有一個大片，右側對側延遲性硬腦膜外出血。本篇文章討論可能發生的機轉。

並列關鍵字

急性硬腦膜下出血 ； 延遲性硬腦膜上出血 ； 減壓手術 ； 頭骨骨折 ； 頭部外傷