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首页> 外文期刊>Acute and critical care. >Selection of Treatment for Large Non-Traumatic Subdural Hematoma Developed during Hemodialysis
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Selection of Treatment for Large Non-Traumatic Subdural Hematoma Developed during Hemodialysis

机译：血液透析过程中发生的大型非创伤性硬脑膜下血肿的治疗选择

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A 49-year-old man with end-stage renal disease was admitted to the hospital with a severe headache and vomiting. On neurological examination the Glasgow Coma Scale (GCS) score was 15 and his brain CT showed acute subdural hematoma over the right cerebral convexity with approximately 11-mm thickness and 9-mm midline shift. We chose a conservative treatment of scheduled neurological examination, anticonvulsant medication, serial brain CT scanning, and scheduled hemodialysis (three times per week) without using heparin. Ten days after admission, he complained of severe headache and a brain CT showed an increased amount of hemorrhage and midline shift. Emergency burr hole trephination and removal of the hematoma were performed, after which symptoms improved. However, nine days after the operation a sudden onset of general tonic-clonic seizure developed and a brain CT demonstrated an increased amount of subdural hematoma. Under the impression of persistent increased intracranial pressure, the patient was transferred to the intensive care unit (ICU) in order to control intracranial pressure. Management at the ICU consisted of regular intravenous mannitol infusion assisted with continuous renal replacement therapy. He stayed in the ICU for four days. Twenty days after the operation he was discharged without specific neurological deficits.
机译：一名患有终末期肾脏疾病的49岁男子因严重头痛和呕吐入院。在神经系统检查中，格拉斯哥昏迷量表（GCS）得分为15，他的脑部CT显示右硬脑膜上方出现急性硬膜下血肿，厚度约11毫米，中线移位约9毫米。我们选择了不进行肝素检查的保守治疗，如计划神经系统检查，抗惊厥药物，连续脑部CT扫描和计划血液透析（每周3次）。入院十天后，他主诉严重头痛，脑部CT显示出血量和中线移位增加。进行了紧急钻头钻孔脱色和血肿清除，之后症状得到改善。然而，手术后九天，突然出现一般性强直-阵挛性癫痫发作，并且脑部CT显示硬膜下血肿数量增加。在颅内压持续升高的印象下，患者被转移到重症监护病房（ICU）以控制颅内压。重症监护病房的管理包括定期静脉甘露醇输注和持续肾脏替代治疗。他在重症监护室住了四天。手术后二十天，他出院了，没有特定的神经系统缺陷。

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