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43岁男性,诊断为占位性左侧枕叶出血,血肿破入整个脑室系统。入院时处于深昏迷状态,有脑疝的临床体征,Glasgow昏迷量表评分4分。由于患者年龄较轻且无高血压史,因此高度怀疑存在血管畸形。鉴于患者存在生命危险,医生建议将开颅和血肿清除术作为首选治疗方案,但被其家属以非医疗原因拒绝。为挽救患者的生命,决定行立体定向抽吸术,并得到患者家属认可。在操作过程中和操作后5d内应用了大剂量尿激酶(50 000IU)治疗。1个月后,该患者转归良好,Glasgow转归量表评分为5分。
43 year old male, diagnosed with occupying left occipital lobe hemorrhage, penetrating the entire ventricular system. The patient was in a deep coma at admission, with clinical signs of hernia, and the Glasgow Coma Scale scored 4 points. Because patients are younger and have no history of hypertension, they are highly suspected of having vascular malformations. Given the patient’s life-threatening condition, doctors recommend craniotomy and hematoma removal as the preferred treatment but are rejected by their families for non-medical reasons. In order to save the life of the patient, we decided to perform stereotactic aspiration and got approval from the patients’ families. High-dose urokinase (50 000 IU) was administered during and 5 days after operation. After 1 month, the patient turned well and the Glasgow outcome scale score was 5 points.