题名

Acute Subdural Hematoma Presented with Dizziness

并列篇名

以頭暈為初始表現的急性硬腦膜下血腫

DOI

10.3966/168232812020063002005

作者

高玄旻(Hsuan-Min Kao);張恩凡(En-Fan Chang);余亞倫(Ya-Lun Yu);許乃驊(Nai-Hua Hsu);葉俊濬(Jun-Jun Yeh)

关键词

acute subdural hematoma ; dizziness ; elder patient ; head trauma ; 老年患者 ; 頭部外傷 ; 頭暈 ; 急性硬腦膜下血腫

期刊名称

台灣家庭醫學雜誌

卷期/出版年月

30卷2期(2020 / 06 / 01)

页次

98 - 106

内容语文

英文

中文摘要

Population aging has become a trend in Taiwan, and dizziness is commonly reported by older adults. We present the case of a 66-year-old woman with a history of hypertension, diabetes mellitus, hyperlipidemia, and mitral valve prolapse who reported persistent dizziness for 3 hours just after syncope and hitting the back of her head on a table. On arrival, she was fully conscious and well oriented, and all results of neurological examination [including Glasgow Coma Scale (GCS), Mini-Mental State Examination (MMSE), cranial nerves test, muscle power, and Babinski sign] and physical examination were normal. However, because of her age (>60 years), she was at high risk for brain hemorrhage after the trauma. She underwent brain computed tomography, which revealed acute subdural hematoma (SDH). Thence, we report a case of acute SDH in an older patient that initially presented as only persistent dizziness after head trauma.

英文摘要

我們報告一位66歲的女性病人,她過去病史有高血壓,糖尿病,高血脂症和二尖瓣脫垂,來門診的主訴為在3小時前昏倒並撞到頭後的持續性頭暈。她意識清楚且定向良好,所有神經檢查結果(包括格拉斯哥昏迷量表、簡短智能測驗、顱神經檢查,肌力評估和巴賓斯基反射)和其他身體檢查均為正常。但由於年齡大於60歲,她在外傷後有相對高風險會發生腦出血。因此安排她做腦部電腦斷層,並發現了急性硬腦膜下血腫。在台灣,人口老齡化已成為一種趨勢,而頭暈為老年患者常見的主訴,且其原因也多樣化。因此藉由此病例分享,在面對老年患者頭部外傷後的頭暈時,須謹慎評估其伴隨的併發症。

主题分类 醫藥衛生 > 社會醫學
参考文献
  1. Bergstrom, M,Ericson, K,Levander, B,Svendsen, P,Larsson, S(1977).Variation with time of the attenuation values of intracranial hematomas.J Comput Assist Tomogr,1,57-63.
  2. Besenski, N(2002).Traumatic injuries: imaging of head injuries.Eur Radiol,12,1237-1252.
  3. de Moraes, SA,Soares, WJ,Rodrigue,s RA,Fett, WC,Ferriolli, E,Perracini, MR(2011).Dizziness in community-dwelling older adults: a population-based study.Braz J Otorhinolaryngol,77,691-699.
  4. Demetriades, Demetrios,Inaba, Kenji,Velmahos, George(2019).George Velmahos: Atlas of Surgical Techniques in Trauma.UK:Cambridge University Press.
  5. Haydel, MJ,Preston, CA,Mills, TJ,Luber, S,Blaudeau, E,DeBlieux, PM(2000).Indications for computed tomography in patients with minor head injury.N Engl J Med,343,100-105.
  6. Jagoda, AS,Bazarian, JJ,Bruns, JJ Jr(2008).Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting.Ann Emerg Med,52,714.
  7. Lawler, KA,Terregino, CA(1996).Guidelines for evaluation and education of adult patients with mild traumatic brain injuries in an acute care hospital setting.J Head Trauma Rehabil,11,18.
  8. Lee, KS(2004).Natural history of chronic subdural haematoma.Brain Inj,18,351-358.
  9. Lee, KS,Shim, JJ,Yoon, SM,Doh, JW,Yun, IG,Bae, HG(2011).Acute-on-chronic subdural hematoma: not uncommon events.J Korean Neurosurg Soc,50,512-516.
  10. Maarsingh, OR1,Dros, J,Schellevis, FG(2010).Causes of persistent dizziness in elderly patients in primary care.Ann Fam Med,8,196-205.
  11. Mitsunaga, MM,Yoon, HC(2015).Journal Club: Head CT scans in the emergency department for syncope and dizziness.AJR Am J Roentgenol,204,24-28.
  12. Szeto, V,Kosirog, J,Eilbert, W(2018).Intracranial subdural hematoma after epidural anesthesia: a case report and review of the literature.Int J Emerg Med,11,36.
  13. Taiwan Neurosurgery Society: Guidelines for the Treatment of Mild and Severe Head Injuries-Taiwan Edition: Computed Tomography Rules for Mild traumatic brain injury. 2006. https://www.neurosurgery.org.tw/nsr/tbi/page2.htm. Accessed December 1, 2019.
  14. Victor, M,Ropper, A(2014).Adams and Victor's Principles of Neurology.New York:McGraw-Hill Education / Medical.
  15. Wasay, M,Dubey, N,Bakshi, R(2005).Dizziness and yield of emergency head CT scan: Is it cost effective?.Emerg Med J,22,312.