隐性骨折，紧急溶栓：静脉注射阿替普酶治疗跌倒后伴有隐匿性股骨近端骨折的急性缺血性卒中
Hidden Fracture, Urgent Thrombolysis: Intravenous Alteplase for Acute Ischemic Stroke With an Occult Proximal Femoral Fracture After a Fall.
摘要(中文译文)
一名89岁女性，患有慢性心房颤动，向右侧跌倒后被发现存在右侧肢体无力和意识障碍。初始评估包括创伤重点超声评估（FAST）、头部计算机断层扫描（CT）、颈椎CT以及胸腹部CT，结果显示无颅内出血、颈椎硬膜外血肿、主动脉夹层或胸腹部出血。脑磁共振成像（MRI）显示左侧大脑中动脉供血区急性缺血性病灶，伴弥散加权成像-液体衰减反转恢复序列（DWI-FLAIR）不匹配。因急性缺血性卒中给予静脉注射组织型纤溶酶原激活剂（IV tPA）。启动IV tPA后，回顾性审阅初始胸腹部CT发现瘫痪侧右侧股骨近端隐匿性骨折。尽管未发生颅内出血，患者出现右下肢肿胀和进行性贫血，需要输注红细胞。本病例表明，跌倒后就诊的急性缺血性卒中患者中，股骨近端骨折可能被漏诊，尤其是当疼痛定位和自主肢体活动受损时。在溶栓前对骨盆、髋部和股骨近端进行系统评估，并在治疗后仔细监测颅外出血，十分重要。
Abstract
An 89-year-old woman with chronic atrial fibrillation fell to the right side and was found to have right-sided weakness and impaired consciousness. Initial evaluation, including Focused Assessment with Sonography for Trauma (FAST), head computed tomography (CT), cervical CT, and thoracoabdominal CT, showed no intracranial hemorrhage, cervical epidural hematoma, aortic dissection, or thoracoabdominal bleeding. Brain magnetic resonance imaging (MRI) showed acute ischemic lesions in the left middle cerebral artery territory with a diffusion-weighted imaging-fluid-attenuated inversion recovery (DWI-FLAIR) mismatch. Intravenous tissue plasminogen activator (IV tPA) was administered for acute ischemic stroke. After IV tPA initiation, retrospective review of the initial thoracoabdominal CT revealed an occult right proximal femoral fracture on the paretic side. Although no intracranial hemorrhage occurred, the patient developed right lower limb swelling and progressive anemia requiring red blood cell transfusion. This case illustrates that proximal femoral fractures may be overlooked in patients with acute ischemic stroke presenting after a fall, particularly when pain localization and voluntary limb movement are impaired. Systematic evaluation of the pelvis, hip, and proximal femur before thrombolysis, followed by careful monitoring for extracranial bleeding after treatment, is important.
如何引用
AMA
Tatsuya Tanaka, Takashi Furukawa, Taku Goto, Hiroko Nakashiro, Yukinori Takase, Akira Matsuno. Hidden Fracture, Urgent Thrombolysis: Intravenous Alteplase for Acute Ischemic Stroke With an Occult Proximal Femoral Fracture After a Fall.. Cureus. 2026; doi:10.7759/cureus.110783.
APA
Tatsuya Tanaka, Takashi Furukawa, Taku Goto, Hiroko Nakashiro, Yukinori Takase, Akira Matsuno (2026). Hidden Fracture, Urgent Thrombolysis: Intravenous Alteplase for Acute Ischemic Stroke With an Occult Proximal Femoral Fracture After a Fall.. Cureus. https://doi.org/10.7759/cureus.110783
GB/T 7714
Tatsuya Tanaka, Takashi Furukawa, Taku Goto, Hiroko Nakashiro, Yukinori Takase, Akira Matsuno. Hidden Fracture, Urgent Thrombolysis: Intravenous Alteplase for Acute Ischemic Stroke With an Occult Proximal Femoral Fracture After a Fall.[J]. Cureus, 2026 doi:10.7759/cureus.110783.
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