良性硬膜外出血:保守试验的范围

IF 0.7 Q4 CLINICAL NEUROLOGY
Sajad Hussain Arif, Kaiser Kareim, Mohsin Fayaz, Sarabjit Singh Chibber
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引用次数: 0

摘要

硬膜外血肿的治疗方法是紧急手术排空,以防止出现灾难性的神经系统后遗症和死亡。脑外伤基金会建议,无论 GCS 情况如何,硬膜外血肿体积超过 30 立方厘米都应进行手术清除。然而,由于头部受伤后接受脑CT检查的患者人数增加,越来越多的患者被发现患有EDH,且症状轻微。为了研究影响颅脑损伤硬膜外上血肿患者接受保守治疗的因素。我们的研究是对查谟和克什米尔斯利那加市 Sher-i-Kashmir 医学院 2018 年 8 月至 2020 年 7 月期间接受保守治疗的硬膜外上血肿进行的回顾性分析。共有 19 名 EDH 患者接受了保守治疗,并符合纳入标准(入院时 GCS 为 13-15 分,无神经功能缺损,ICP 有轻度升高迹象,EDH 厚度为 13。8 名患者住院一周,2 名患者因与 EDH 无关的问题分别住院 20 天和 25 天。其中一名患者因头痛加重、警觉性下降,在观察 6 天后不得不改为手术切除,因为重复造影显示 EDH 略有增加。对于经过仔细挑选的轻微头部损伤患者,可以通过放射学监测和密切的神经监测对 EDH 进行保守治疗。患者入院时 GCS 超过 13,中线移位小于 5 毫米,EDH 的位置和体积小于 30 毫升。因此,医院资源得到了最佳利用。因此,我们得出结论,即使是硬膜外出血这种可怕的疾病,也可以在严格的临床和放射学监测下,对选定的病例进行保守治疗。我们称之为 "良性硬膜外出血"。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Benign extradural haemorrhage: scope of conservative trial
Epidural hematomas have been treated with urgent surgical evacuation to prevent catastrophic neurological sequelae and death. Brain Trauma Foundation recommends EDH volume greater than 30 cm3 and warrants surgical evacuation irrespective of GCS. However, due to increase in number of patients undergoing brain CTs following head injuries, more patients have been detected with EDH causing minimal symptoms. To study factors influencing patients being treated conservatively for head injury with supratentorial epidural hematomas. Our study is a retrospective analysis of supratentorial epidural hematoma treated conservatively from august 2018 to July 2020 at Sher-i-Kashmir institute of medical sciences, Srinagar, Jammu and Kashmir. A total of 19 patients with EDH were treated conservatively and fulfilled the inclusion criteria.(GCS of 13–15 with no neurological deficit, mild signs of elevated ICP, EDH thickness < 1.5 cm on CT, EDH volume on CT < 30 ml, midline shift on CT less than or equal to 5 mm with no significant intradural pathology)Age ranged from 2 months to 70 years (average 27.15 yrs)males (89.47%) predominated females (10.53%). Motor vehicular accidents were the most common mode of injury (42.1%). EDH was localised 13 times on right side, 5 times on left side and bilateral in one, supratentorially. A midline shift of 5 mm was found in 3 of 19 patients; GCS was > 13 on admission. 8 patients were hospitalised for a week, whilst 2 patients stayed in the hospital for 20 and 25 days, respectively, due to problems not related to EDH. One patient in whom conservative treatment had to be changed to surgical evacuation after 6 days of observation because of worsening headache, impaired alertness repeated imaging showed slight increase in EDH. EDH can be managed conservatively in carefully selected patients of minor head injury with radiological surveillance and close neurological monitoring. Patients with GCS on admission more than 13, midline shift of less than 5 mm, location and volume of EDH less than 30 ml. Thus, leading to optimal utilisation of hospital resources. So, we conclude that even a dreaded entity like extradural haemorrhage can be managed conservatively in selected cases with strict clinical and radiological surveillance. We have called them ‘’Benign extradural haemorrhages’’.
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