慢性硬脑膜下血肿中的癫痫发作

慢性硬脑膜下血肿伴有癫痫发作者较少见,作者对130例手术治疗的慢性硬脑膜下血肿进行了总结,探讨了有关问题.临床资料 130例均行钻孔闭式引流术.术前癫痫发作者9例,均为男性,年龄为30～70岁,均有轻度头外伤史,癫痫发作均在伤后6周后.9例中4例表现为血肿对侧局灶性癫痫,其中2例合并轻瘫;另5例为癫痫大发作,其中4例无神经系统阳     

以精神障碍为首发症状的慢性硬膜下血肿(附九例报告)

以精神障碍为首发症状的慢性硬膜下血肿（附九例报告）四川省绵阳市中心医院脑外科（６２１０００）谭学书刘平王晓莉陈旭马大鹏我院于１９９０年６月～１９９６年６月，共收治慢性硬膜下血肿（ＣＳＤＨ）１０７例，其首发症状为精神障碍者９例，初诊时均误诊，占８．４％...     

以癫痫为首发症状的脑型血吸虫病47例分析(摘要)

９８８年６月至１９９７年１０月，收治了以癫痫为首发症状，临床检查诊断为脑型血吸虫病共４７例，其中手术２９例。本组男３８例，女９例。年龄１３～５０岁。临床症状，均以癫痫为首发症状就诊，首次发作为癫痫大发作者１２例，局限性癫痫发展成全身大发作者１８例，局...     

外伤性癫痫24例临床分析

外伤性癫痫２４例临床分析南京空军机关医院田芝亮我院收治硬脑膜芽透伤所致癫痫１０例，颅骨骨折引起癫痫６例，颅内血肿５例，其他３例。男１８例，女６例，年龄１４～７２岁。大发作８例，部分性发作１３例，由部分发作到大发作３例，全部病例应用药物治疗。外伤性癫痫...     

老年精神分裂症出现慢性硬脑膜下血肿致昏迷1例

慢性硬脑膜下血肿（chronic subdural hematomas,CSDHs）一般在头部外伤3周后出现症状,以颅内压增高为主,头痛表现较为突出,部分患者有进行性痴呆、淡漠、嗜睡等精神症状[1].由于老年人、癫痫、酒精中毒和痴呆患者容易发生头部外伤,故也容易出现硬脑膜下血肿.现将1例表现为意识障碍的CSDHs的老年患者诊治经过报告如下.     

老年人慢性硬膜下血肿临床观察

老年人慢性硬膜下血肿，由于症状各异极易误诊，尤其是外伤史不明确，更易误诊。1986年一1997年我院确诊为慢性硬脑膜下血肿28例，其中老年人16例，青中年12例，现就两组主要临床特点作一对比，探讨老年人慢性硬脑膜下血肿的临床特点，以减少误诊。1临床资料11一般资料老年组16例，年龄m年一85岁，（平均年龄687岁），均为男性；青中年组门倒，年龄对年一54岁（平均年龄322岁），男9例，女3例c病程老年组2一匕个月，青中年组l－9个月c12外伤史老年组外伤史7例（均为轻伤），无外伤史9例；中青年组均有不同程度的外伤史，两组比较差异显著（…     

老年慢性硬脑膜下血肿

慢性硬脑膜下血肿为手术绝对适应症,予后良好。但发生于老年患者,往往因症状不典型而延迟诊断,尤其未追溯到外伤史者易被忽略。为及时准确诊断,将我院十年来收治的五例貌似脑血管病的老年慢性硬脑膜下血肿报告如下,并结合同期收治的14例老年慢性硬脑膜下血肿的临床病案,提几点体会。例一,66岁高血压妇女,头昏头痛一     

外伤性硬脑膜下积液CT动态变化(附12例分析)

分析１２例少量外伤性硬脑膜下积液发展为慢性硬脑膜下血肿患者的临床过程及ＣＴ变化特点。发现：（１）致伤方式多为减速性损伤。（２）早期ＣＴ示少量硬脑膜下积液。（３）伤后出现进行性颅内压增高表现，可有复视、肢体活动障碍。（４）伤后２月左右复查ＣＴ，发现原积液部位有硬脑膜下血肿。（５）钻孔穿刺治疗效果好。并就其发生机理进行了探讨     

外伤性硬脑膜下积液CT动态变化

分析１２例少量外伤性硬脑膜下积液发展为慢性硬脑膜下血肿患者的临床过程及ＣＴ变化特点。发现：（１）致伤方式多为减速性损伤。（２）早期ＣＴ示少量硬脑膜下积液。（３）伤后出现进行性颅内压增高表现，可有复视、肢体活动障碍。（４）伤后２月左右复查ＣＴ，发现原 液部位有硬脑膜下血肿，（５）钻孔穿刺治疗效果好。并注其性机理进行了探讨。     

硬脑膜下血肿术后癫痫持续状态

硬脑膜下血肿术后癫痫持续状态高刘民，李守缄，冉孝龙，刘学礼，王纪青癫痫持续状态（ｓｔａｔｕｓｅｐｉｌｅｐｔｉｃｕｓ，ＥＳ）是临床上一种具有较高死亡率的急症，需立即处理。对于亚急性或慢性硬脑膜下血肿术后并发ＥＳ，情况更加严重，处理更加困难。我科于１９８...     

颅脑损伤术后迟发性颅内血肿的形成机制

目的 探讨颅脑损伤术后非手术区迟发性颅内血肿的临床特征及形成机制。方法 回顾性分析29例颅脑损伤术后经CT扫描或再次开颅探查证实为飞黄腾达这发性血肿的发生部位，发生时间，及其与脑挫裂伤，颅骨骨折等原发伤的关系。结果 血肿发生部位与手术部位关系；邻近型8例，远隔型12例，对侧型9例；发生在脑内9例，硬膜外12例，硬膜下7例。脑室内1例；12例术后硬膜外血肿中有9例可见颅骨骨折；9例术后脑内血肿中有7例可见脑挫裂伤。结论 颅脑损伤术后迟发性颅内血肿中，硬膜外，硬膜下与脑内血肿形成机制不尽相同，颅骨骨折，脑挫裂伤，脑膜或皮质血管破裂，桥静脉断裂等局部损伤影响不同类型血肿的形成，脑血管麻痹，低氧血症等是非手术区迟发性血肿形成的病理基础。     

高血压丘脑出血的手术治疗

目的探讨高血压丘脑出血患者手术治疗的效果。方法高血压丘脑出血的患者58例,10例丘脑小血肿(10~30 m)l且有单侧或双侧脑室铸型者行脑室外引流及尿激酶纤溶治疗、17例丘脑出血未破入脑室且出血量31~40 ml者立体定向血肿穿刺碎吸术治疗,15例丘脑出血破入脑室且血肿量较大(>40 ml)者行血肿穿刺联合脑室外引流治疗及16例血肿量大且基本位于中心部位并破入脑室者经纵裂入路显微镜下丘脑血肿清除术治疗。结果术后6个月存活49例,死亡9例。存活者术后6个月按日常生活能力分级评估预后:1级15例,2级19例,3级10例,4级5例。结论高血压丘脑出血患者应根据出血量、有无破入脑室及其病情制定手术方案,经纵裂入路显微镜下丘脑血肿清除术对出血位于中线丘脑且出血量较大者有其可行性。     

显微神经外科手术后并发远隔部位颅内血肿临床分析

目的探讨显微神经外科手术后并发远隔部位颅内血肿的形成原因,以提高对这一并发症的认识和预防。方法复习我科近10年来显微神经外科手术后并发远隔部位颅内血肿的9例病例资料,并进行分析归纳,总结其原因。结果病例远隔部位颅内血肿发生在术后5￣21h,7例病人血肿位于额颞部,硬膜外血肿6例,有7例血肿量超过30mL,均再次手术清除。治疗后1例痊愈,3例死亡,其余遗留一定的功能障碍。结论远隔部位颅内血肿多发生在术后24h内,死亡率致残率高,大部分病例血肿位于额颞顶部,与颅内压急剧下降、手术体位及静脉回流受阻等有关。术中术后采取相应的措施、术后严密监护、早期诊断是防治术后远隔部位颅内血肿的关键。     

急性外伤性颅内血肿清除术后继发血肿再手术的原因分析

目的探讨急性外伤性颅内血肿清除术后再次手术的原因、预防及处理措施。方法2001年11月至2006年11月我科共对561例颅脑损伤病人急诊行开颅血肿清除术，术后31例发生迟发性血肿行再次手术治疗。结果本组31例再次手术后恢复良好7例，中残7例，重残8例，植物生存3例，死亡6例。结论急性外伤性颅内血肿清除术后继发血肿包括：①原血肿手术部位再出血；②多发性血肿的非手术部位血肿形成。临床应采取相应的有效预防措施，并强调严密观察病情变化、及时复查CT，以便及时发现并再次手术清除继发性血肿、缓解颅内压。     

Spontanes Liquorunterdrucksyndrom Klinische, neuroradiologische, nuklearmedizinische und Liquor-Befunde

We report 11 patients with orthostatic headache due to spontaneous intracranial hypotension. Nausea (3 patients) and abducens palsy (2 patients) were the main additional symptoms. Ten patients had CSF pleocytosis (6 to 43 white cells/microliter) and/or increased protein (581 to 1668 mg/l). CT and/or MRI documented bifrontal accentuated subdural hygromas and hematomas in 5 patients. MRI also documented diffuse meningeal gadolinium enhancement in all 4 patients examined, and descent of the brain in one. Cisternography was done in 9 patients and revealed a decreased or absent activity over the convexities and early detection of the tracer in the bladder in all, and a CSF leak at the cervicothoracal junction in 2 patients. Most patients improved with bed rest, increased fluid intake (oral or intravenous), steroids, and/or epidural blood patch. Subdural hematomas increased in 2 patients and have to be drained. Spontaneous intracranial hypotension is due to a CSF leak followed by decreased CSF volume and hydrostatic CSF pressure changes. The locations of the leaks are mainly cervical or at the cervicothoracal junction. MRI always documents diffuse meningeal gadolinium enhancement. Treatment of choice is an epidural blood patch. Surgical treatment may be needed in patients with subdural hematomas or meningeal diverticula. Prognosis is typically good, but subdural hematomas may occasionally lead to an increased intracranial pressure.     

自发性脑干血肿的诊断和治疗

报告11例自发性脑干血肿,平均年龄33岁,临床缺少典型表现,好发桥脑。MR和CT是本病主要诊断方法,两者有相辅作用:急性期(出血1周内)CT诊断价值较大,亚急性和慢性期则MR优于CT,MR不仅可显示血肿的位置、大小和形态,而且可显示畸形血管,指导手术入路的选择。手术的10例中,9例康复,1例术时未发现畸形血管术后1年再出现,再手术仍未发现亦无改善,终死于肺炎。5例术时和/或病理发现畸形血管。8例随访,平均3年,生活自理2例,复工6例。1例未手术者2年中出血2次致病残。作者认为自发性脑干血肿应手术治疗,手术是安全的。     

Surgery for Bilateral Large Intracranial Traumatic Hematomas: Evacuation in a Single Session

Objective

Management guidelines for single intracranial hematomas have been established, but the optimal management of multiple hematomas has little known. We present bilateral traumatic supratentorial hematomas that each has enough volume to be evacuated and discuss how to operate effectively it in a single anesthesia.

Methods

In total, 203 patients underwent evacuation and/or decompressive craniectomies for acute intracranial hematomas over 5 years. Among them, only eight cases (3.9%) underwent operations for bilateral intracranial hematomas in a single session. Injury mechanism, initial Glasgow Coma Scale score, types of intracranial lesions, surgical methods, and Glasgow outcome scale were evaluated.

Results

The most common injury mechanism was a fall (four cases). The types of intracranial lesions were epidural hematoma (EDH)/intracerebral hematoma (ICH) in five, EDH/EDH in one, EDH/subdural hematoma (SDH) in one, and ICH/SDH in one. All cases except one had an EDH. The EDH was addressed first in all cases. Then, the evacuation of the ICH was performed through a small craniotomy or burr hole. All patients except one survived.

Conclusion

Bilateral intracranial hematomas that should be removed in a single-session operation are rare. Epidural hematomas almost always occur in these cases and should be removed first to prevent the hematoma from growing during the surgery. Then, the other hematoma, contralateral to the EDH, can be evacuated with a small craniotomy.     

颅脑损伤术后并发迟发性颅内血肿分析（附22例报告）

本文报告了２２例颅脑损伤开颅术后并发２５个迟发性颅内血肿。发生在幕上２２个，幕下３个。脑实质内１１个，硬膜下４个，硬膜外１０个。并对其发生机理进行探讨，认为脑血管舒缩机制障碍、手术前后颅内压急骤变化、以及凝血机制障碍是术后发生迟发性颅内血肿的重要因素。对其诊断和治疗提出建议。     

表现为侧裂区血肿的颅内动脉瘤的诊断和治疗

目的探讨颅内动脉瘤破裂导致侧裂区血肿的诊断和处理原则。方法本组男7例,女5例,年龄18～63岁,平均49岁。12例侧裂区血肿均经脑血管造影（DSA）或CT脑血管造影（CTA）检查确诊,其中大脑中动脉瘤9例,后交通动脉瘤2例,后交通动脉瘤合并大脑中动脉瘤1例。本研究对其临床表现、影像学特点及处理原则分别进行了分析。结果12例患者中有10例经开颅动脉瘤夹闭及血肿清除术,1例行经股动脉穿刺血管内弹簧圈栓塞治疗,1例经DSA检查明确动脉瘤后术前准备时再出血,抢救无效死亡。术后1例患者出现脑梗死,经对症治疗好转,3例遗留神经功能障碍,其余病人恢复良好。结论表现为侧裂区的自发性脑内血肿,很有可能是动脉瘤破裂出血所致,需尽早行DSA或CTA检查明确诊断,治疗以手术为首选,术中夹闭动脉瘤并将血肿清除。     

Expanding traumatic intracerebral contusion/hematoma

BACKGROUND AND AIMS: Delayed traumatic hematomas and expansion of already detected hematomas are not uncommon. Only few studies are available on risk factors of expanding hematomas. A prospective study was aimed to find out risk factors associated with such traumatic lesions. MATERIALS AND METHODS: Present study is based on 262 cases of intracerebral hematomas / contusions out of which 43 (16.4%) hematomas expanded in size. computerized tomography (CT) scan was done in all the patients at the time of admission and within 24 hours of injury. Repeat CT scan was done within 24 hours, 4 days and 7 days. Midline shift if any, prothrombin time, activated partial thromboplastin time, bleeding time, clotting time and platelet counts, Glasgow coma scale at admission and discharge and Glasgow outcome score at 6 months follow up were recorded. RESULTS: Twenty six percent, 11.3 and 0% patients developed expanding hematoma in Glasgow Coma scale (GCS) of 8 and below, 9-12 and 13-15 respectively. The chances of expanding hematomas were higher in patients with other associated hematomas (17.4%) as compared to isolated hematoma (4.8%) (Fisher's exact results P =0.216). All the cases of expanding hematoma had some degree of midline shift and considerably higher proportion had presence of coagulopathy. The results of logistic regression analysis showed GCS, midline shift and coagulopathy as significant predictors for the expanding hematoma. Thirty nine patients (90.7%) of the total expanding hematomas developed within 24 hours of injury. CONCLUSIONS: Enlargement of intracerebral hematomas is quite common and majority of them expand early after the injury. These lesions were common in patients with poor GCS, associated hematomas, associated coagulopathy and midline shift.