救急外来で開頭血腫除去術を施行した非外傷性急性硬膜下血腫の1例

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  • Craniotomy in the emergency department for the management of non-traumatic acute subdural hematoma: a case report
  • キュウキュウ ガイライ デ カイトウ ケッシュ ジョキョジュツ オ シコウ シタ ヒガイショウ セイキュウセイコウマク カケッシュ ノ 1レイ

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<p>Introduction: We report a case of craniotomy performed in the emergency department (ED) for a non-traumatic acute subdural hematoma.</p><p>Case: An 84-year-old man with long-term psychiatric hospitalization independently performed activities of daily living.</p><p>History: While watching TV, he vomited and started losing consciousness. Head computed tomography (CT) revealed a left-sided acute subdural hematoma, and he was transferred to our hospital via ambulance. On admission, his Glasgow Coma Scale (GCS) (E1, V1, and M4) showed pupils 2.0 mm/3.0 mm, sluggish light reflexes bilaterally, and right hemiplegia. Following head CT, his consciousness level deteriorated to GCS (E1, V1, M2), pupils 2.0 mm/5.0 mm, and bilateral loss of the light reflex. He developed a non-traumatic acute subdural hematoma without cerebral contusion. The ED performed a craniotomy for hematoma removal. On postoperative day 27, he was transferred to psychiatric care.</p><p>Conclusion: Since non-traumatic acute subdural hematoma does not cause brain contusion, an early craniotomy may improve its prognosis. Prompt interprofessional coordination between a neurosurgeon, anesthesiologist, and operating theater nurse for emergency craniotomies and hematoma removal in the ED may be a useful therapeutic strategy in such cases. </p>

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