Strong man appears limb numbness, headache, the original is the sport caused by the disaster!

In today's case, we will take you to learn about spontaneous subdural hematoma (SDH) caused by exercise, especially when young, healthy men have SDH and have no recent history of trauma, we need to consider whether patients have done these exercises1 unexplained spontaneous sub-epidural hematomaa 37-year-old male with a blurred left vision due to seizures, each seizure for several minutes, accompanied by about 20 minutes of disappearance of the left upper limb numbness and inability to enter the hospitaltwo weeks before, he had intermittent headaches, pain from the back of the eyes to the head and teeth, but did not have sensory or motor dysfunctionHeadaches initially last 24 hours and increase in frequency and severityHe had not suffered trauma before the symptomshospital after the doctor carried out a simple examination of him, did not find abnormal, and then for his head CT (Figure 1) examination, found that the epidural bleeding, while other hematology, biochemical and clotting examinations are within the normal rangefigure 1 CT head flat sweep shows the apparent isodensity clump shadow and ventricle pressure under the right-hand epiduralThe width is up to 28 mm and the midline structure is offset 13 mm to the leftThe same side cortex disappearsthe man has no history of trauma, will there be no abnormalities in the intracranial blood vessels (such as venous malformations)? So the patient was given an angiography to eliminate the vascular risk factors for hematoma under the epidural, but no abnormality was foundalthough the exact cause has not been identified, the critical treatment cannot be delayedAfter the right forehead perforation induced bleeding swelling, the patient's symptoms were initially relievedBut after 2 weeks there was a recurring headache againA review of CT scans (Figure 2) revealed a recurrence of the underthehesis, so a small craniofacial surgery was performed from the original perforated site to drain the relapsed blood clots No new bleeding points were found during the operation After a period of careful care, he gradually recovered Figure 2 reviews the flat sweep of the head, showing the recurrence of hematoma under the isodensity subdural epidural on the right side, and evidence of a recent small amount of bleeding (arrow) 2 to find out the truth
the patient's sdh is rare in young men, what is the cause? In a review of 21 non-traumatic SDH patients, SDH risk factors included hypertension, vascular malformation, tumors (such as reduced platelets caused by malignant tumors in the blood system), epidural metastasis of solid tumors, infections, clotting disorders, and alcoholism SDH caused by brain aneurysms or cortical heorye is also reported is now mainly believed to be sDH is caused by bleeding in the position of the bridge vein spnea under the epidural, which is more vulnerable than the subcavity of the cobweb bridge veins refer to the pipe structure located in the subcavity of the cobweb, where blood flow into the epidural sinuses The current study includes three types of bridge veins: cerebellum hemispheric bridge veins, and temporal bridge veins and frontal back bridge veins The pipe wall thickness of the under-the-bridge vein of the epidural is about 10-600 m, and the pipe wall thickness of the under-cobweb cavity bridge vein is about 50-200 m The underthe cavity gap of the bridge vein is looser than the underthe cavity of the cobweb membrane figure 3 MRI T1 enhanced cross-sectional illustration of the bridge vein into the upper sinus (SSS) 4 brain tissue removal shows that the bridge vein into the sinuses in the trauma, the front and rear acceleration or deceleration of the head may lead to the bridge vein traction rupture The brain shrinks due to old age or alcohol ism, which also increases the traction of the bridge veins and without trauma, subdural bleeding may be caused by a sudden increase in intravenous pressure, especially some movements or movements, which can lead to a sudden increase in intravenous pressure when a forced exhalation occurs against closed vocal doors (such as Valsalva movements), such as during coughing or defecation this may also occur when playing musical instruments, and non-invasive measurements have found that some musicians have higher eye pressure that indirectly reflects an increase in venous pressure Our patient's illness may have something to do with playing saxophone in addition to playing musical instruments, the patient is also a fitness, running marathon enthusiasts, exercise may also cause a variety of ways to cause subdural bleeding SDH has been reported in in some long-term hormone-taking weightlifters Hormones can cause blood vessel seilife, which increases the risk of blood vessel rupture bleeding Other psychostimulant drugs, such as cocaine, are also associated with subdural hematoma Although the patient was not exposed to these drugs, the following two things can occur: athletes for weight training, which can cause subdural bleeding through Valsalva movements For example, in 'lift', when the weight is lifted from the floor to the chest, the athlete first squats and inhales, and then, when the weight moves above the top of the head, they exhale the closed sound valve (Valsalva action) This is followed by a low cranial pressure, which occurs when the barbell is quickly lowered, rapid exhalation and muscle relaxation, and then the intravenous pressure drops, and intracranial low blood pressure reduces brain capacity, causing the brain to retract, increasing the risk of bleeding in the bridge veins low cranial pressure occurs after exercise, accounting for 10% of all spontaneous subdural hematoma causes Some of the post-exercise hypocranial pressure is caused by low blood pressure caused by the dilation of blood vessels throughout the body after a vigorous exercise One study showed that systolic pressure was reduced by 20 mmHg after 10 minutes of vigorous exercise In addition, low cranial pressure may also be associated with lower systemic blood pressure due to reduced circulating blood volume, such as dehydration after exercise, a 5% reduction in the average weight of marathon runners during the race and a 6.5% reduction in plasma volume Although the patient was admitted to the hospital without dehydration symptoms, biochemical examination kidney function is also normal, but it is possible that running occurred in the emergency of an acute dehydration caused by a reduction in intracranial pressure, which caused the subdural bleeding This condition can reduce the risk of bleeding under the epidural by rehydration in addition to the reasons mentioned above, other potential causes of low craniofacial pressure, such as spontaneous epidural tearing and cerebrospinal fluid leakage, have also been reported However, patients with healthy health and no trauma are extremely unlikely to do so there is also a common clotting disorder Although the patient's blood routine is normal, but the hospital during the process did not detect platelet function, do not know how platelet function After a follow-up medical history, we patients often take nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve muscle pain In a study, NSAIDs secondary platelet aggregation disorder is an important risk factor for non-traumatic SDH, and nonsteroidal anti-inflammatory drugs produce thrombosis A2 by inhibiting epoxyase, thereby inhibiting platelet function and increasing the risk of bleeding general, there are many causes of SDH, sometimes a mixture of factors author: Cat Eye Source: