Patient: Chang Moumou, male, 44 years old, Datong, Shanxi Province, work unit: Datong Railway Section Date of admission 2009-10-21 Date of discharge 2009-12-24; total hospitalization 64 days Complaint: half a month after aneurysm clamping, fever for 6 days. History: The patient underwent “aneurysm clamping” in the Third Hospital of Datong City, Shanxi Province for aneurysm half a month ago, and woke up after one day of post-operative coma without nausea and vomiting, and without physical activity disorder; however, he developed persistent fever and fuzzy consciousness 6 days ago, and his body temperature was constantly above 39 degrees, and the use of antipyretic drugs and physical cooling measures were almost ineffective. The use of antipyretic drugs and physical cooling measures were almost ineffective. A cranial CT examination at a local hospital showed that the ventricles were slightly enlarged bilaterally, and he came to our hospital for treatment today. Admission: level of consciousness: blurred consciousness; orientation (uncooperative); memory (uncooperative); calculation (uncooperative); language (uncooperative); right eye inversion and limited up and down vision (oculomotor nerve palsy); muscle strength: left upper limb: grade IV; left lower limb: grade IV; right upper limb: grade II; right lower limb: grade IV. Pathological reflexes: left/right
Babinski’s sign was positive; left/right Chaddock’s sign was positive. Meningeal irritation sign: term strength: absent; kernig’s sign: negative. Supplementary investigations: 2009-10-6
Cephalometric CT: enlarged lateral ventricles; right frontotemporal hypointense shadow, right post-craniotomy manifestation; admission diagnosis: 1. right post-aneurysm clamping 2. hydrocephalus, 3. hypertensive disease grade 1 Status at admission (October 21, 2009): body temperature 39.5 degrees. Can open eyes automatically, but confused, non-verbal, limited right eye inversion and up-and-down vision, right pupil larger than left (3.5:2.5 mm) (actinic nerve palsy), little voluntary activity of both lower limbs, grade 3 muscle strength when stimulated; grade 4 muscle strength of both upper limbs. Intracerebroventricular cerebrospinal fluid decompression and cerebrospinal fluid decontamination were started the day after hospitalization, and the body temperature began to drop significantly to below 38 degrees the day after surgery, and dropped to about 37 degrees on the third day of treatment. His mental status also improved significantly. After roughly one month of treatment, the function of voluntary movement of both lower and upper extremities basically returned to a normal level. On December 4, 2009
On December 4, 2009, a ventriculo-abdominal shunt was performed under general anesthesia, and the postoperative recovery was smooth. Discharge follow-up: He returned to work in his original unit 2 months after discharge and was fully competent to do his original job as a senior accountant. 2010 November 22, 2010 when he was rechecked that he resumed his original job 10 months after recovery: expert commentary by Professor Li Xiaoyong, founder of cerebrospinal fluid neurosurgery There are three main aspects of treatment for ruptured intracranial aneurysm subarachnoid hemorrhage: 1), prevention of rebleeding of the aneurysm prevention of re The treatment of hemorrhagic brain injury is currently treated by cranial aneurysm clamping or endovascular aneurysm spring coil filling; 2), because ruptured aneurysm bleeding can cause secondary cerebral ischemic damage due to cerebral vasospasm, so the use of anti-vasospasm and improve cerebral blood perfusion drug treatment is not necessary; 3), the treatment of secondary subarachnoid hemorrhagic hydrocephalus.