2 cases of acute diffuse brain swelling.

Case 1: A 34-year-old male who was admitted to hospital with a consciousness of about 1 h after a head injury.
physical examination when admitted to hospital: mind drowsiness, double-sided pupils and other large circles, diameter of 3 mm, sensitive to light reflection, right top skin swelling, normal limb activity.
brain CT see the left temporal pillow under the epidural hematoma, cerebral bruising.
2 h, the patient is irritable, the left pupil is scattered large, the light reflection disappears, review the brain CT found that the left armatum pillow epidural hematoma, the middle line is right.
line open craniofacial hematoma removal surgery, the operation found a bone line fracture on the left temporal roof, the removal of epidural hematoma, found that the temporal lobe cerebral bruising is not heavy, brain pressure is not high, brain fluctuations are good, brain tissue soft, visible blood vessels on the surface of the brain fluctuate well.
after surgery, the left pupil returned to normal size, review the brain CT see the midline structure back, the saddle pool is still fuzzy, but more obvious than before surgery, the left frontal leaf has a small hematoma, the forehead is pressured.
9.5 h after surgery, sudden irritability, followed by coma, both sides of the pupil is not large, 6 mm on the left side, 4 mm on the right, the reflection of light disappeared.
the skull CT see the frontal hematoma slightly larger than before, saddle on the pool, ring pool disappeared, the middle line of the forehead slightly shifted, diffuse brain swelling.
emergency surgery, preoperative self-breathing disappeared, heart rate 35 times, the appearance of chamber fibrillation, give defibrillation, double-sided open skull and internal and external decompression.
visible gray-black brain tissue in the operation of double-sided bone windows, ligament, no vascular throbbing and brain fluctuations.
self-breathing resumed after surgery, with a 100% oxygen saturation in the outer week.
the patient died of respiratory and circulatory failure.
2:50-year-old male who was admitted to hospital with 1 h after head trauma.
fall injuries, pillows on the ground, 20min short coma history.
after admission to the hospital physical examination: clear mind, irregular skin cleavage on the pillow, limb activity is normal.
brain CT shows multiple brain bruises, intracranial gas accumulation, the middle line structure is centered, the ring pool, saddle on the pool clear.
1.5 h hospital admission, conscious, review the brain CT show brain bruising, saddle pool than before the change is not much.
7 h, conscious, review the brain CT show brain bruising is more obvious than before, the brain chamber is pressed, saddle on the pool to move back.
about 17 h after the trance, review the brain CT saddle on the pool disappeared, the brain chamber was pressured, the ring pool, side cleavage pool pressure disappeared, diffuse brain swelling formed.
Emergency surgery, before anesthesia, patient coma, irregular breathing, given two-sided open skull and internal and external decompression, surgery to see higher brain pressure, normal color of brain tissue, soft quality, removal of necrotized brain tissue and hematoma, brain throbbing and brain surface fluctuations of small arteries fluctuate well.
after surgery to review the brain CT ring pool, side cleavage pool is still small, the saddle pool is not clear, but diffuse brain swelling did not further aggravate.
recovers well after surgery.
2. Discuss the rapid change of diffuse brain swelling, surgical signs are difficult to judge, and the death rate is high.
Case 1 of this paper due to epidural hematoma after the first surgery to remove hematoma, brain pressure is not high, brain throbbing and cerebrovascular throbbing is good; Secondary surgery, found that the brain tissue is gray black, ligament, brain-free throbbing and cerebrovascular fluctuations, should be the cerebrovascular has been fully dilated, excessive congestion, cerebral blood flow slowly or even stop, at this time, even if the double-forehead open cranial decompression on the patient's prognosis can not be improved.
Case 2 consecutive craniofacial CT examination found that the saddle pool gradually compressed back to become smaller, diffuse brain swelling gradually aggravated, before the start of anesthesia, consciousness disorders increased, and irregular breathing, emergency cranial surgery found that the color of brain tissue is normal, soft, brain throbbing and cerebral surface arterial vessels throbbing well.
The reason may be that before the cerebral arterial blood vessels are not fully dilated, timely decompression, blocking the further expansion of the cerebral arterial blood vessels, cerebrovascular elasticity gradually restored, blood supply recovery, good prognosis.
therefore, for acute diffuse brain swelling, decompression is the key to the success or failure of rescue.
, for diffuse brain swelling, the standard double-sided large bone valve decompression surgery treatment is gradually clinically accepted.
.