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Spontaneous intracranial hypotension can frequently result in several complications including subdural hygroma, subdural hematoma and cerebral venous thrombosis, but coma rarely. A case of spontaneous intracranial hypotension presented with orthostatic headaches was described. He experienced somnolence, disorientation, incontinence, and then coma, though received conservative treatment. Brain imaging demonstrated acute-on-chronic subdural hematoma, magnetic resonance myelography using heavily T 2-weighted fast spin-echo pulse sequences showed spinal longitudinal extradural collection, and magnetic resonance myelography with intrathecal gadolinium revealed cerebrospinal fluid leak at the level of T 6, T 7. The patient recovered consciousness after surgical evacuation of the hematoma, and the headache disappeared after a targeted epidural blood patch. The hematoma resolved 2 months later and the patient kept free from headache during follow-up.
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OBJECTIVE:To investigate the effects of Butylphthalide and sodium chloride injection on neurological function and prognosis of elderly patients with hypertensive intracerebral hemorrhage(HICH)after trepanation and drainage surgery. METH-ODS:During Jan. 2015 to Jun. 2016,80 elderly HICH patients were selected from our hospital and then divided into control group and observation group according to random number table,with 40 cases in each group. Both group received trepanation and drain-age surgery. Control group was given routine treatment. Observation group was given Butylphthalide and sodium chloride injection 100 mL,ivgtt,bid,on the fifth day after surgery,on the basis of control group. Both groups received treatment for 14 d. Clinical efficacies of 2 groups were observed. CSS scores were compared between 2 groups before surgery and 28 d after operation;volume of encephaledema,serum levels of homocysteine(HCY)and substance P(SP)were compared between 2 groups before surgery and 14 d after operation. RESULTS:The total response rate of observation group was 87.5％,which was significantly higher than 67.5％ of control group, with statistical significance (P0.05). CSS scores 28 d after operation, SP levels 14 d after operation were significanthy increased,volume of encephaledema and serum levels of HCY in 2 groups were significantly decreased,and the observation group was significantly better than the control group,with statistical significance(P<0.05). CONCLUSIONS:Butylphthalide and sodium chloride injection can significantly improve clinical efficacy and hepatic func-tion damage,relieve postoperative encephaledema,reduce serum levels of HCY and increase SP levels in elderly HICH patients af-ter trepanation and drainage surgery.
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Objective To investigate the curative efficacy of adjuvant therapy of atorvastatin in chronic subdural haematoma ( CSDH ) patients treated with trepanation and drainage and its effects on level of serum neuron specific enolase ( NSE ) .Methods 98 patients of CSDH who received therapy in our hospital from January 2014 to April 2016 were selected as research objects.Retrospectively analyzing their clinic materials,those patients were divided into the control group(n=46)and the observation group(n=52)according to therapeutic schemes.The control group were given therapy of trepanation and drainage.Besides that,the observation group were given atorvastatin additionally.2 months later,curative efficacy,China stroke scale (CSS)score and ability of daily life(ADL)score were compared between the two groups.And level of serum NSE between the two groups before treatment and after 7 days were compared.Results The total therapeutic efficacy ratio of CSDH in the observation group was 88.5%,which was statistically higher than that of 71.7% in the control group(P<0.05).2 months after the treatment,in comparison with the control group,the observation group has lower CSS score(15.89 ±3.24 points vs.19.21 ±4.17 points)and higher ADL score(95.24 ±11.36 points vs.89.05 ±10.12 points)with both statistical differences( P<0.05 ) .7 days after the treatment, level of serum NSE in the observation group was statistically lower than that in the control group (10.38 ±2.35 U/mL vs.14.06 ±2.68 U/mL,P <0.05).Conclusion Adjuvant therapy of atorvastatin is effective for CSDH patients treated with trepanation and drainage,and it could improve neurologic function,ability of daily life and reduce level of serum NSE.
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Objective To explore the operative modes of the chronic subdural hematoma in the old people. Methods The three approaches that the trepanation and drainage,the trepanation and irrigation and the bipunctate trepanation and irrigation were performed to treat the chronic subdural hematoma in the old people. The efficacy was analyzed through the clinical observation and CT inspection. Results All the three approaches were very efficacious,but the trepanation and drainage was the best one among them. Conclusion The trepanation and drainage of the chronic subdural hematoma in the old people is very efficacious and simple. For the low density or equal density hematoma,the best choice is the direct trepanation and drainage.