脑弥漫性轴索损伤的CT表现及GCS评分与预后的评价

目的:探讨CT对弥漫性轴索损伤(DAI)的诊断价值。方法:回顾性分析72例经临床证实为DAI患者的临床及CT资料,分析病灶累及部位与临床预后、GCS评分的关系。结果:60例DAI早期CT均表现为弥漫性脑肿胀,脑室及脑沟池受压变小或闭塞;脑白质内单发或多发小出血灶53例,呈斑点状,直径多<20 mm,主要位于胼胝体、皮髓质交界处、基底节区、脑干及小脑;蛛网膜和/或脑室出血47例,合并硬膜外血肿24例,颅底骨折28例。37例累及中线部位。本组中治愈40例,好转5例,植物状态1例,死亡14例。GCS评分13分15分4例,9分12分16例,≤8分40例。结论:病灶累及脑中线部位,预后差且GCS评分较低。DAI的CT征象有其特点,对临床早期诊断和治疗及评价预后有重要价值。

Relationship between CT Diagnostic Value of Diffuse Axonal Injury and Its GCS

Objective To evaluate the value of CT in the diagnosis of diffuse encephalic axonal injury(DAI).Methods The CT imagine data and its correlated clinicfeatures of 60 patients with clinically-proved DAI were retrospectively analyzed.The clinic features,the relationships between location and clinic prognosis,GCS marking were also evaluated.Results At the early stage of the disease,diffuse encephalic swelling,compressed or occlued ventricles,sulci and cisterna were seen on CT in all 53 cases .Speckled hemorrhage(<20 mm) in cerebral parenchyma,mainly located at mesolobus,corttico-medullary conjunction,basal nodal region,brain stem and cerebellum.Hemorrhage in subarachnoid cavity and/or ventricle was seen in 47 cases.Epidural hematoma was complicated in 24 cases,subdural hematoma in and skull fracture in 28 cases.The lesions involved the medial part of brain in 37cases.40cases had been cured,5cases straightened up,1cases showed a state of plant,14cases died.There were 4 cases got 13~15 GCS points,16cases got 9~12 points,and 40 cases got lower than 8points.Conclusion The lesions involving the medial part of brain had worse prognosis and got lower GCS than lesions that no involving the medial part of brain.CT manifestation of DAI have some features and can provide useful information for early diagnosis and for the evaluation of the treament and prognossis.