被診斷為壓力性頭痛的慢性硬腦膜下血腫－病例報告

Chronic Subdural Hematoma Diagnosed as Tension Headache: Case Report

林錦龍(Chin-Jung Lin) ； 鍾嫈嫈(Jin-Jin Tjung) ； 黃福昭(Fu-Chao Huang)

《中華民國家庭醫學雜誌》 10卷2期 (2000/06) Pp. 102-108

https://doi.org/10.7023/CJFM.200006.0102

摘要

頭痛是基層醫療很尚見的主訴，在生活壓力大的現今社會，壓力引起之壓力性頭痛(tension headache)是頭痛病患中最常被診斷的。雖然如此，頭痛也有可能是會致死之慢性硬腦膜下血腫(chronic subdural hematoma, CSH)唯一的臨床症狀。本篇報告一位五十三歲經理級高血壓控制良好的男性病患，經過數年無症狀的頭部被硬物敲到之後，病人開始出現間歇性時好時壞的頭痛，之後很快的在一個月內進展成為兩側顳側如爆炸性之劇烈的頭痛。因為從頭痛開始到接受手術前病人都沒有任何其它神經學的異繯表現，加上景氣不好，高級主管之工作壓力大，連神經內科專科醫師之兩次門貢都被誤診為壓力性顯痛，幸好經過及時的腦部斷層掃描之後發現病患已有很嚴重的硬膜下血腫併腦部中線移位，經過外科穿洞清除血塊併引流手術後，病患頭痛完全消失，恢復正常的生活，無任何的後遺症。本篇報告的目的是希望能夠藉著本篇差一點就造成不幸的病例報告及回顧，再一次提醒家庭醫學科的基層醫療同仁們在忙碌的診療工中，不要忘了在眾多頭痛的病人中有慢性硬腦膜下血腫存在的可能性，隨時提高警覺，即時正確的診淫及即時轉診至有絘經外科的醫院治療，以免引起不必要的遺憾及醫療糾紛。

並列摘要

Headache is a common complaint observed in general practice. Under the stressful life in this modern society, tension headache is the most common diagnosis among patients suffered from headache. However, headache may be the only clinical symptom complained in chronic subdural hematoma. We here in report a 53-year-old male manager under good blood pressure control who suffered from rapid progressive headache from attackwise mild headache to severe explosive type headache after long silent period following a mild head injury. Because of no any abnormal neurologic sign dinically, but in a stressful life, the life-threatening subdural hematoma was misdiagnosed as tension headache. Cranial CT scan showed a big slight hypodense right frontoparietal chronic subdural hematoma with marked right to left midline shift. The severe explosive headache subsided after a burr hole evacuation and postoperative drain performed. The patient regained his good life without any sequela. The purpose of this case report is to remind us as family doctors of the possibility of life-threatening chronic subdural hematoma presented with the common symptom of headache in daily practice.

並列關鍵字

headache ； chronic subdural hematoma