Admission history collection Patient: Wang Dekui, male, 21 years old, native of Tongliao Zalut Banner, Inner Mongolia, a famous barber in the performing arts circle in Beijing Complaint: hydrocephalus with malignant brain expansion after traumatic decompression of the greater trochanter for more than one month Pre-admission history: [Onset]: 2011-6-26 was admitted to a famous tertiary hospital in Beijing by the emergency room due to a car accident, when the patient fell into coma, [Figure-1]. A left-sided decompression surgery with a large bone flap was performed in this hospital. The next day, a routine head CT examination revealed another hematoma in the right parieto-occipital region, and the surgeon performed a borehole drainage procedure [Figure-2]. The patient did not awaken after surgery and was admitted to the ICU (Intensive Care Unit) of the hospital. The patient gradually woke up from the coma more than 10 days later (total coma 14 days) and was transferred out of the ICU on 2011-7-11
The patient was accompanied by his family. At this time, the patient was drowsy and not fully conscious. Although he could open his eyes by himself, he did not focus his eyes or gaze at his relatives for a long time, and his right limb was completely paralyzed. Eating through the mouth is possible, but drinking water causes choking and coughing. The left frontotemporal skull had been removed at this time, and the scalp and slight elevation at the bone window did not extend beyond the surrounding bone margin, nor was there any obvious depression (no obvious hydrocephalus). After being transferred out of ICU, the patient was admitted to the neurosurgery department of this famous tertiary hospital in Beijing】 After being transferred out of ICU, the patient’s drowsiness gradually worsened (worse than when he first came out of coma), both semi-liquid and liquid diets triggered obvious choking and coughing (the gag reflex was aggravated), and it was extremely difficult to eat through the mouth, and he was increasingly irritable. The partially removed skull window gradually bulged during this time and protruded beyond the bone edge. On 2011-07-28, a repeat head CT showed significant hydrocephalus and malignant brain bulge [Figure-3], and the family was told that the hydrocephalus was “self-absorbing” and was treated with mannitol dehydration only. All treatments failed to prevent the scalp (and subcutaneous brain tissue) in the bone window from continuing to bulge outward, and the patient’s condition continued to deteriorate.