神经外科英语病例1

神经外科英语病例(1)2010-12-2816:14来源爱爱医U盘分享到：\o"分享到QQ空间"\o"分享到新浪微博"\o"分享到开心网"\o"分享到人人网"

Case1:Braintrauma:epiduralhematoma脑外伤：硬膜外血肿A65-year-oldright-handedmanwastransferredtothehospital

approximately16hoursaftersufferingheadtraumawithlossofconsciousnessinamotor-vehicleaccident.Examination.Generalexaminationwasremarkableforaleftparietalscalplaceration,lefthemotympanum,andrightperiorbitalhematoma（眶周血肿）.

Funduscopic

examination（眼底检查）waswithinnormallimits.Neurologicalexaminationrevealedanalertpatientorientedtotimeandpersonbutnottoplace.Amixedaphasiawaspresentwithexpressiveandconductiveelements.Sensoryexaminationwasnormal.Therewasleft-sidedweakness;however;thepatientdidhaveapositiveBabinskisignontheleft.Theremainderoftheneurologicalexaminationwasnormal.Skullfilmsrevealedaleftparietallinearskullfracture.Course.

Thepatientwasadmittedtothehospitalforobservation,andoverthenext24hourshadmodestbutdefiniteimprovementinhisaphasia.ACTscanwasobtainedapproximately24hoursafterinjury,andthisrevealsaleftepiduralhematomawitha3-mmshiftofmidlinestructuresfromlefttoright,andeffacementoftheleftlateralventricle.Becausethepatienthadbeenimprovingneurologically,surgerywaswithheldpendinganyevidenceofneurologicaldeterioration.Bythe2ndday,thepatienthadcompleteresolutionofhisaphasiaexceptforaverymilddysnomiccomponent.Follow-upCTscanonthe4thhospitaldaydemonstratednosignificantchangefromtheperformed24hoursafteradmission.Thepatientcontinuedtoimproveandwasdischargedasymptomaticfollowingcompleteresolutionofhisneurologicaldeficitsandheadachesonthe6thhospitalday.RepeatCTscanswereobtainedonthe17thand30thpostinjuryday.Theseshowedgradualbutcompleteresolutionoftheepiduralhematoma.Case2:Braintrauma:epiduralhematoma脑外伤：硬膜外血肿A21-year-oldmanwastransferredtothehospital3daysaftersufferingaclosed-headinjurywithlossofconsciousness.Onadmission,thepatientwascomplainingofsevereright-sidedheadaches.Examination.Thegeneralexaminationdemonstratedarightparietallaceration.Neurologicalexaminationshowedamildabnormalityofrecentmemory，butwasotherwisewithinnormallimits.Plainfilmsdemonstratedalinearrighttemporal-parietalskullfracture.Course.ThepatientunderwentCTscanonthedayofadmission.Thisrevealedarighttemporal-parietalepiduralhematomaassociatedwitha4-to4.5-mm

shiftfromrighttoleft.Becausethepatientdemonstratednoneurologicaldeficit,hewastreatednonoperatively.Duringthehospitalcourse,thepatienthadsteadyandcompleteresolutionofhisheadache.RepeatCTscan,1weekafteradmission,demonstratedpersistentrightepiduralhematoma,withlessshiftthannotedpreviously.Thepatientwasdischargedwithoutneurologicaldeficit,Athirdscan,repeated7weeksafterinjury,demonstratedcompleteresolutionoftheepiduralhematoma.

Case3:Braintrauma:chronicsubduralhematoma脑外伤：慢性硬膜下血肿Youareaskedtoseea27-year-oldwoman,asuccessfulcorporatelawyer,becauseofincreasingheadacheswhichbeganapproximately1monthago.Shefirstnotedheadacheseveraldaysafterreturningfromaskitripwithherhusbandandtwochildren.Theheadachesarebifrontal,throbbing,andincreasinginseverity.Duringthepastweekshehasawakedfromsleeponseveraloccasionswithheadacheandvomiting.Inaddition,herhusbanddescribesherasmoreapatheticandless"sharp"atworkthanusual.OneweekagoshesawalocalphysicianwhoprescribedValium.Therehavebeennovisual,motor,orsensorycomplaints.Sheisnotonanymedications,hasnoothermedicalillnesses,andhassufferednorecenttrauma.On

examination,shewastearfulandcomplainedofseveresteadyheadacheandaninabilitytosleepforseveraldays.Shereliedonherhusbandformostofthedetailsofherillness.Onseveraloccasions,shedidnotrespondtoquestionsaskeddirectlytoherandthequestionshadtoberepeated.Therewasnoaphasia,butdetailedmentalstatustestingwasimpossiblebecauseofheragitatedstate.Examinationoftheopticfundirevealedanabsenceofvenouspulsationsandblurringofthediscmargins.Theremainderofthecranialnerveexaminationwasnormal.Therewasamildpronatordriftoftherightarmbutpowerwasotherwisenormal.

Therewasreflexasymmetry(3/5ontheright,2/5ontheleft)andplantarresponseswereflexorontheleftandequivocalontheright.Tone,sensory,andcerebellarexaminationswerewithinnormallimits,andhergaitwasnormal.ACTscanwasperformed.Thescanshowsalarge,left-sided,isodense?chronicsubduralhematoma.Onthenonenhancedscan,

thesubduralhematomaitselfwasnotvisiblebecauseofitsisodensecharacter,butashiftofthelateralventriclesduetomasseffectwasseen.Withcontrastenhancement9themembranouswallofthesubduralhematomacanbe

seenandthesizeofthesubduralcollectionisclearlyoutlined.Thetreatmentforsymptomatic,chronicsubduralhematomasissurgicalevacuation.Inpatientswithsmall,stablesubduralhematomas,orinthoseforwhomsurgeryis

contraindicated,medicalmanagementwithcorticosteroidsanddehydratingagents(mannitol)maybesuccessful.Inthispatientsurgicalevacuationwasperformedwithexcellentresults.Case4:Posteriorfossasubduralhematoma(PFSDH)inneonate新生儿后颅窝硬膜下血肿Thisnewbornfemalewasbornatagestationalageof40weeks,weighing3780g,toagravida2para1mother.Forcepswereappliedtothefetalheadforfailuretoprogress.Apgarscoreswere6and9.

Withinthe1stdayoflife,thebabywasobservedtobelistlessandlethargicandtohaveapoor

suck.Theanteriorfontanellewastense.Seizuresdeveloped.

Endotrachealintubationandventilationwererequiredforbradycardiaandapneicepisodes.Thehemogramwasnormal.Alumbarpuncturewasperformedtoruleout

centralnervoussystemsepsis,andbloodycerebrospinalfluid(CSF)wasobtained.CTwasthenperformed，

andalargePFSDHwasobservedinadditiontomoderateventriculomegaly.Aneurosurgicalconsultationwasobtained.Theneonatewasquadriplegiconaventilator,makingonlytheoccasionalrespiratoryeffort.Theneonatewastakenurgen