[Frontal acute extradural hematoma due to contrecoup injury: a case report].
[Frontal acute extradural hematoma due to contrecoup injury: a case report].
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对冲损伤所致额部急性硬膜外血肿一例报告[J].
DOI：
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发表时间：
1995
期刊：
影响因子：
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通讯作者：
T. Abe
中科院分区：
文献类型：
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作者：
Y. Miyazaki;A. Isojima;M. Takekawa;S. Abe;H. Sakai;T. Abe
急性硬膜外血肿是指颅骨内侧盘与硬脑膜之间的血液聚集，常见于政府性颅脑损伤合并颅骨骨折。我们报告一例52岁女性发生交通事故的病例。她遭受了一次严重的创伤，包括皮下血肿和颅骨骨折，左枕部有所谓的战斗征，但其他任何部位都没有受伤。伤后即刻CT扫描显示左侧枕部皮下血肿下有一稀薄的急性硬膜外血肿伴颅内气体，右侧额部因对冲伤致蛛网膜下腔出血。我们用普通的点滴方式保守地对待她。在入院后的几个小时里，她有时会呕吐。6小时后CT扫描显示对侧硬膜外血肿扩大。立即行去骨瓣减压术清除血肿。她的头皮、头盖骨和额颅底硬膜外血肿没有损伤，从颅骨内侧分离出来的硬脑膜表面出现了多发性小出血。手术后，病人恢复了意识。急性硬膜外血肿是非常罕见的。在我们的病例中，血肿的出现似乎是由于撞击力引起的颅骨变形导致的额部硬脑膜分离，以及随后在几次呕吐刺激下血肿的逐渐扩大所致。
Acute extradural hematoma, a collection of blood between the inner table of the skull and the dura, generally occurs in coup craniocerebral trauma with skull fracture. We report here a case of a 52-year-old female who had had a traffic accident. She suffered a serious wound consisting of a subcutaneous hematoma with skull fracture and so called Battle's sign on the left occipital region but not wounded in any other region. CT scan obtained shortly after the injury demonstrated a thin acute extradural hematoma with intracranial air under the subcutaneous hematoma in the left occipital region, and another hematoma with subarachnoid hemorrhage due to contrecoup head trauma in the right frontal region. We treated her conservatively with a common drip. She sometimes vomited during the several hours after admission. CT scan six hours later showed that the contrecoup extradural hematoma had enlarged. Immediately, we carried out the evacuation of the hematoma with decompressive craniectomy. Her scalp, cranium and frontal skull base over the extradural hematoma were without injury, and multiple small haemorrhages were found to have occurred on the surface of the dura that had been separated from the inner table of the skull. After the operation, the patient recovered consciousness. Contrecoup acute extradural hematoma is very rare. It seems that the appearance of hematoma in our case resulted from the frontal dural separation due to distortion of the cranium brought on by the force of the impact and the subsequent gradual growth of the hematoma under the stimulation of several bouts of vomiting.