Motor and neurocognitive recovery in the syndrome of the trephined: A case report.
Motor and neurocognitive recovery in the syndrome of the trephined: A case report.
复制标题
环锯综合征的运动和神经认知恢复：病例报告。
DOI：
10.1016/j.rehab.2014.11.003
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发表时间：
2015
影响因子：
4.6
通讯作者：
Im,Brian
中科院分区：
文献类型：
--
作者：
Abdou,Andrew;Liu,Jackson;Carroll,Michelle;Vivaldi,Giselle;Rizzo,John-Ross;Im,Brian
在美国，每年大约有140万例创伤性脑损伤。在这些事件中，有110万起导致急诊，235 000起导致住院，50 000起导致死亡。这还不包括另外约20万在门诊接受治疗的人，也不包括在国内外军事设施接受治疗的人[1]。去骨瓣减压术（DC）常用于治疗重度创伤性脑损伤（TBI）患者的难治性颅内高压[2]。此外，已发现DC可降低恶性大脑中动脉梗死患者的死亡率并改善预后，恶性大脑中动脉梗死占卒中患者的10%[3]。环钻综合征（ST），也称为“下沉皮瓣综合征”，是一种迟发性神经功能恶化的疾病[4]。按照惯例，ST是指颅骨成形术后可逆症状的发展[5]。这是一种并发症，发生在DC后有较大颅骨缺损的患者中。相关的临床恶化发生在手术后数周至数月。病理学和临床体征可包括：局灶性神经功能缺损、失语症、头痛、头晕、嗜睡、易怒、注意力不集中、记忆问题、抑郁、焦虑、情绪波动、行为障碍、癫痫发作、缄默症、偏瘫恶化、偏侧忽视和尿崩症[4]，[5]，[6]，[7]由于这些症状是非特异性的，因此难以建立早期诊断，这会导致严重的神经功能衰退
Approximately, 1.4 million traumatic brain injuries occur each year in the United States. Among these incidents, 1.1 million result in emergency department visits, 235,000 result in hospitalizations and 50,000 result in death. This does not include an additional estimated 200,000 who are treated in outpatient settings, nor those treated at military facilities both domestic and abroad [1]. Decompressive craniectomy (DC) is frequently used for the treatment of medically refractory intracranial hypertension for patients with severe traumatic brain injury (TBI)[2]. Additionally, DC has been found to reduce mortality rates and improve outcomes in patients with malignant middle cerebral artery infarction, which accounts for 10% of stroke patients [3].The syndrome of the trephined (ST), also known as the “sinking skin flap syndrome”, is a disorder of delayed neurological deterioration [4]. By convention, ST refers to the development of those symptoms that are reversible after cranioplasty [5]. This is a complication that occurs in patients with large cranial defects following a DC. Related clinical deterioration occurs weeks to months after the surgery. The symptomatology and clinical signs can include: focal neurological deficits, aphasia, headache, dizziness, lethargy, irritability, inattention, memory problems, depression, anxiety, mood swings, behavioral disturbances, seizures, mutism, worsening hemiplegia, hemi-neglect, and diabetes insipidus [4],[5],[6],[7] As these symptoms are non-specific, early diagnosis is difficult to establish, which can lead to significant neurological decline.