神经外科英语病例1

神经外科英语病例(1)

2010-12-28 16:14 来源 爱爱医U盘

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Case 1: Brain trauma: epidural hematoma

脑外伤：硬膜外血肿

A 65-year-old right-handed man was transferred to the

hospital approximately 16 hours after suffering head trauma with loss

of consciousness in a motor-vehicle accident.

Examination. General examination was remarkable for a left parietal

scalp laceration, left hemotympanum, and right periorbital hematoma（眶周血肿）. Funduscopic examination（眼底检查） was within normal

limits. Neurological examination revealed an alert patient oriented to

time and person but not to place. A mixed aphasia was present with

expressive and conductive elements. Sensory examination was normal. There

was left-sided weakness; however; the patient did have a positive Babinski

sign on the left. The remainder of the neurological examination was normal.

Skull films revealed a left parietal linear skull fracture.

Course. The patient was admitted to the hospital for observation,

and over the next 24 hours had modest but definite improvement in his

aphasia. A CT scan was obtained approximately 24 hours after injury, and

this reveals a left epidural hematoma with a 3-mm shift of midline

structures from left to right, and effacement of the left lateral

ventricle. Because the patient had been improving neurologically, surgery

was withheld pending any evidence of neurological deterioration. By the

2nd day, the patient had complete resolution of his aphasia except for

a very mild dysnomic component. Follow-up CT scan on the 4th hospital day

demonstrated no significant change from the performed 24 hours after

admission. The patient continued to improve and was discharged

asymptomatic following complete resolution of his neurological deficits

and headaches on the 6th hospital day. Repeat CT scans were obtained on

the 17th and 30th postinjury day. These showed gradual but complete

resolution of the epidural hematoma.

Case 2: Brain trauma: epidural hematoma

脑外伤：硬膜外血肿

A 21-year-old man was transferred to the hospital 3 days after

suffering a closed-head injury with loss of consciousness. On admission,

the patient was complaining of severe right-sided headaches.

Examination. The general examination demonstrated a right parietal

laceration. Neurological examination showed a mild abnormality of recent memory， but was otherwise within normal limits. Plain films demonstrated

a linear right temporal-parietal skull fracture.

Course. The patient underwent CT scan on the day of admission. This

revealed a right temporal-parietal epidural hematoma associated with a

4-to 4. 5-mm shift from right to left. Because the patient demonstrated

no neurological deficit, he was treated nonoperatively. During the

hospital course, the patient had steady and complete resolution of his

headache. Repeat CT scan, 1 week after admission, demonstrated persistent

right epidural hematoma, with less shift than noted previously. The

patient was discharged without neurological deficit, A third scan,

repeated 7 weeks after injury, demonstrated complete resolution of the

epidural hematoma.

Case 3: Brain trauma: chronic subdural hematoma

脑外伤：慢性硬膜下血肿

You are asked to see a 27-year-old woman, a successful corporate

lawyer, because of increasing headaches which began approximately 1 month

ago. She first noted headache several days after returning from a ski trip

with her husband and two children. The headaches are bifrontal, throbbing,

and increasing in severity. During the past week she has awaked from sleep

on several occasions with headache and vomiting. In addition, her husband

describes her as more apathetic and less "sharp" at work than usual. One

week ago she saw a local physician who prescribed Valium. There have been

no visual, motor, or sensory complaints. She is not on any medications,

has no other medical illnesses, and has suffered no recent trauma.

On examination , she was tearful and complained of severe steady

headache and an inability to sleep for several days. She relied on her

husband for most of the details of her illness. On several occasions, she

did not respond to questions asked directly to her and the questions had

to be repeated. There was no aphasia, but detailed mental status testing

was impossible because of her agitated state.

Examination of the optic fundi revealed an absence of venous

pulsations and blurring of the disc margins. The remainder of the cranial

nerve examination was normal. There was a mild pronator drift of the right

arm but power was otherwise normal. There was reflex asymmetry (3/5 on

the right, 2/5 on the left) and plantar responses were flexor on the left