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Abstract: A 42-year-old male patient complained of dizziness and headache accompanied by nausea after a car accident, and perfected a cranial CT, which showed cerebral contusion, and was admitted to the hospital with confusion and coma. The patient was treated with epidural hematoma removal and intracranial hematoma removal surgery.
Basic information】Male, 42 years old
Type of disease】Intracranial injury
Hospital】Liaoning Provincial People’s Hospital
Date of consultation】May 2022
Treatment plan】Surgical treatment (epidural hematoma removal + intracranial hematoma removal) + intravenous infusion (olanzapine injection)
Treatment period】Inpatient treatment for 14 days, 1 month of outpatient follow-up
Treatment effect] The patient’s mental state improved significantly, and the intracranial hematoma was basically cleared.
I. Initial interview
The patient was admitted to the hospital with the chief complaint of headache and dizziness for 7 hours after trauma. The patient was traumatized after a car accident and woke up in a coma for 1 hour after the injury. Head CT: the results showed epidural hematoma and cerebral contusion. The main reason for the patient’s coma was the appearance and increase of epidural hematoma due to skull fracture, which led to the increase of cranial pressure and gradual brain herniation formation.
II. Treatment history
The patient was in coma again, which was consistent with the typical manifestation of epidural hematoma: coma-awake – coma. The patient’s family was informed of the risks and the necessity of surgery, and they agreed to the surgery. The patient was operated under emergency general anesthesia to remove the right epidural hematoma and intracranial hematoma, and the frontal bone was fractured and formed about 10×8 cm bone flap, and the old epidural clot was removed from the skull.
After returning to the ward, the patient was given intravenous infusion of olanzapine injection to nourish the nerves and control the brain injury, and the patient became conscious in the evening of the operation.
III. Treatment effect
The patient’s intracranial hematoma was basically cleared after surgery, and after systematic symptomatic treatment, the incision healed well without blood leakage or infection. After about 14 days of hospitalization, the patient said that he had no headache symptoms and occasionally had slight dizziness. The patient was clear, the questions and answers were reasonable, and the limbs moved freely. The patient was discharged and asked to come back to the hospital for a review in one month.
IV. Notes
Because of the pressure of the epidural hematoma on the brain tissue and the brain contusion, the patient is prone to epilepsy, so it is recommended that the patient rest for the last month, do not do heavy physical labor and dangerous work and movements, and review the head CT one month after discharge to clarify the condition. However, do not panic about epileptic events because not all patients with epidural hematoma accompanied by cerebral contusion will develop epilepsy, so there is no need for anxiety.
Patients are also instructed to be discharged from the hospital mainly with high protein as well as liquid food, eat more light and easily digestible food, and strengthen functional exercise to recover strength quickly.
V. Personal insight
Epidural hematoma accompanied by cerebral contusion is a common intracranial injury in clinical practice. The formation of epidural hematoma is closely related to skull fracture, and most of them have the same coma-awake – coma period as this patient, while some patients with epidural hematoma progress rapidly without an intermediate awake period and will enter brain herniation directly, and the patient will die within a short time, so the disease deserves the attention of patients and their families.
Secondly, when a patient has a skull fracture due to trauma, even if there are no adverse symptoms, do not take it lightly, it is best to review the head CT after 6-8 hours except for epidural hematoma, and if a skull fracture occurs and coma occurs within a short period of time, the epidural hematoma should also be considered, and the patient should go to the hospital in time.