颅脑损伤患者CT与MRI的比较

目的:探讨MRI在颅脑损伤中的诊断作用。方法:对近2年诊断有争议的28例颅脑损伤患者CT和MRI检查结果行回顾性分析。首次CT扫描均在伤后6 h内进行,对CT诊断有争议的颅脑损伤患者行MRI检查。结果:硬膜下血肿、硬膜外血肿的诊断,CT与MRI结果相符;蛛网膜下腔出血、颅骨骨折的诊断,CT较敏感;脑叶挫裂伤、脑深部挫裂伤的诊断,MRI明显优于CT。结论:MRI能明显提高脑叶挫裂伤和脑深部挫裂伤诊断敏感性,减少漏诊和误诊。     

重症创伤性颅脑损伤后血清垂体前叶激素的变化及相关因素

目的 分析重症创伤性颅脑损伤后血清垂体前叶激素的变化及相关因素.方法 回顾性分析2018年6月至2020年6月晋城市人民医院收治的重症创伤性颅脑损伤患者109例的临床资料,在颅脑损伤后1～3d采取静脉血检测血清垂体前叶激素水平,按照是否出现血清垂体前叶激素分泌异常分为正常组(n=60)与异常组(n=49),对影响血清垂...     

脑弥漫性轴索损伤的MRI诊断

目的:探讨MRI对脑弥漫性轴索损伤的诊断价值。材料与方法:搜集经临床证实的41例DAI患得,进行回顾性分析。结果:34例DAI早期MRI表现为弥漫性脑肿胀,脑室及脑沟、裂、池受压变小或闭塞;脑实质出血33例,呈斑点状,直径小于2.0cm;蛛网膜下腔及脑室出血17例;硬膜下血肿13例;硬膜外血肿7例;颅骨骨折8例。结论:MRI对DAI具有较高诊断价值,可弥补CT的局限性。     

迟发性颅内对冲伤26例CT分析

目的 :提高对迟发性颅内对冲伤的认识。方法 :迟发性颅内对冲部位新病变和 (或 )病变增大者 2 6例 ,分析其CT表现。结果 :首次CT检查发现 :脑挫裂伤 10例、蛛网膜下腔出血 (SAH) 13例、硬膜下血肿 (SDH) 7例、硬膜外血肿 (EDH) 4例 :复查发现 :脑内血肿 18例 (其中 8例为原挫裂     

CT与MRI在弥漫性颅脑轴索损伤诊断中的应用价值评价

目的比较计算机断层扫描(CT)与磁共振成像(MRI)在弥漫性颅脑轴索损伤(DAI)临床诊断中的价值。方法采用回顾性研究方法,选取2016年2月至2019年4月苏州大学附属第二医院收治的50例脑外伤患者,均在入院后进行MRI以及CT影像学检查,比较两种影像学检查技术的DAI的病灶检出数量,同时对不同类型、是否出血以及不同位置病灶检出率进行比较分析。结果MRI确定的病灶总数为156个,平均(3.12±2.43)个;CT确定的病灶总数为103个,平均(2.06±1.47)个;MRI检查病灶均数明显多于CT,差异具有统计学意义(P<0.05)。MRI检查方式下弥散性脑肿胀以及蛛网膜下腔出血的检出率(66.0%、48.0%)明显高于CT(34.0%、20.0%),差异具有统计学意义(P<0.05);MRI检查方式下非出血病灶的检出率(66.0%)明显高于CT(30.0%)(P<0.05);MRI检查方式下皮质下脑白质、基底节、胼胝体的病灶检出率(64.0%、40.0%、56.0%)明显高于CT(36.0%、18.0%、28.0%),差异具有统计学意义(P<0.05)。结论在弥漫性颅脑轴索损伤临床诊断中,MRI相比CT具有明显的优势,在弥散性脑肿胀、蛛网膜下腔出血等类型以及皮质下、基底节以及胼胝体等位置的病灶检查中敏感性更高,所以在临床诊断中需要根据患者实际情况确定是否需要MRI检查,确保临床诊断的准确性。     

CT对迟发性颅脑损伤的诊断价值

目的：探讨CT对迟发性颅脑损伤的诊断价值，使病人得到及时诊断和治疗。方法：搜集颅脑损伤后首次CT检查阴性复查为阴性和首次CT检查阳性复查原病变扩大或出现新病变90例，前8例，后82例。结果：颅脑损伤的迟发性CT表现为脑挫裂伤、脑内血肿形成、脑肿胀、硬膜外及硬膜下血肿、蛛网膜下腔出血、弥漫性轴索损伤及外伤性脑梗塞等。结论：颅脑外伤病人经治疗后未见好转，有加重趋势或突然恶化，应考虑到迟发性病变的可能，CT复查是必要的。     

152例急性颅内损伤的CT分析

目的研究急性颅内损伤的CT表现及急性外伤性颅内血肿的变化。方法分析 15 2例急性颅内损伤的CT影像。结果本组颅内血肿 10 0例 ,外伤后 5 -72h内复查CT发现血肿明显增大者 2 5例 ,外伤 72h— 7dCT示血肿明显增大者 3例。脑挫裂伤 76例 (包括脑内血肿 30例 ) ,其中对冲伤 17例。CT显示蛛网膜下腔出血 6 1例 ,其中脑沟内高密度影 49例。本组合并颅骨骨折75例。结论外伤性颅内血肿于外伤后 7d内有逐渐增大可能 ,硬膜下血肿及脑挫裂伤部分为对冲伤所致。脑沟内高密度是蛛网膜下腔出血最常见的CT征象。大脑中线旁脑沟内高密度 ,是鉴别该处蛛网膜下腔出血与硬膜下血肿的重要CT征象。硬膜外血肿常合并相邻部位的颅骨骨折     

Diagnostic imaging of acute thoracic injury.

In recent years, the advent of multidetector CT (MDCT) has begun to change the imaging approach to patients sustaining blunt or penetrating thoracic injury. The ability to directly detect some injuries that are often occult on chest radiography, such as pericardial hemorrhage, major thoracic vascular injury, small pneumothorax, and diaphragm tears, as well as the ability to better define the extent of other injuries, such as lung contusion and laceration, account for this transition. This article reviews current concepts of diagnostic imaging in acute chest trauma from both blunt force and penetrating mechanisms, emphasizing the spectrum of diagnostic imaging findings for various injuries, primarily based on multidetector MDCT.     

外伤性基底节出血的CT与MRI诊断

目的分析21例外伤性基底节出血的CT与MRI表现,探讨其诊断价值。方法收集我院21例外伤性基底节出血的临床、CT和MRI资料,所有病例在伤后马上作CT平扫,在1～3d内作MRI平扫,其中12例加做弥散功能成像（DWI）检查。并对所有病例的CT与MRI表现作回顾性总结。结果发现单纯基底节出血8例;复合性基底节出血13例,合并硬膜下血肿6例,硬膜外血肿3例,蛛网膜下腔出血2例,其他部位脑挫裂伤6例,颅骨骨折4例。21例26个基底节出血灶,其中有11例14个出血灶在苍白球部位,首次CT检查与苍白球钙化无法区别,经MRI检查证实为出血。MRI检查多发现脑挫裂伤灶5个,脑白质剪切伤灶4个。结论CT与MRI结合检查,能够全面、及时、准确地诊断外伤性基底节出血及其合并症,对临床治疗和预后评估有重要价值。     

A Tangential Gunshot Wound to the Head: Case Report and Review of the Literature

Background: Patients with tangential gunshot wounds (TGSWs) commonly present with a good Glasgow Coma Scale score and without a history of loss of consciousness. Typically, the bullet does not breach the skull, however, there is a considerable force directed into the brain, and these patients are best treated as sustaining a moderate-to-severe blunt head injury. These patients require observation and repeat imaging. Physicians should be aware of this entity as these patients can deteriorate in a delayed fashion. Objectives: The authors present a case of a TGSW to the head in a neurologically intact patient. The initial post-injury computed tomography (CT) scan showed a very small subdural hematoma (SDH) with no overlying fracture of the skull. A delayed CT scan performed 4 h after arrival to the Emergency Department and 6 h after injury demonstrated an increase in size of the SDH, new traumatic subarachnoid hemorrhage, and bilateral cerebral contusions. Clinically, the patient showed worsening of her neurological examination. She underwent aggressive non-surgical treatment for increased intracranial pressure with almost complete recovery. Conclusion: Although patients with TGSWs are typically in good condition upon presentation, these injuries are not always trivial, and these patients should have, at minimum, a non-contrast brain CT scan to evaluate underlying damage to the brain and skull. In addition, a delayed CT scan and close observation on a neurosurgical service are indicated.     

Transorbital penetrating brain injury by branchlet: a rare case

Penetrating injury of the brain and skull is uncommon, representing about 0.4% of head injuries. With advances in radiological techniques such as high-resolution and reconstruction computed tomography (CT), assessment of injuries is more accurate and easier. In this article, we report the case of a 46-year-old man presenting with head injury after a branchlet had penetrated through the right orbit into the brain. CT scan of the brain revealed diffuse subarachnoid hemorrhage, intraventricular hemorrhage, and mild obstructive hydrocephalus. CT scan of the brain with reconstruction revealed that the branchlet tip penetrated through the medial aspect of the right orbit to the parasellar region. CT scan of the brain with contrast showed gradual tapering of the right proximal internal carotid artery with total occlusion after the carotid bulb. Advance radiological examinations, such as three-dimensional CT, are required to obtain the correct emergent diagnosis and treatment of such injuries.     

Tension pneumocephalus as a complication of hyperbaric oxygen therapy in a patient with chronic traumatic brain injury

ABSTRACT: Although hyperbaric oxygen therapy has not been accepted as a standard therapy for traumatic brain injuries, it has been used, along with rehabilitative exercises, for traumatic brain injuries, and the standard protocol has a low risk of complications. We report a case of chronic traumatic brain injury that progressed to tension pneumocephalus after hyperbaric oxygen therapy. The patient was a 25-yr-old man who presented with left occipital bone fracture and subarachnoid and subdural hemorrhage after being hit by a car. He underwent craniectomy to remove the hematoma and cerebrospinal fluid diversion with a ventriculoperitoneal shunt for the treatment of hydrocephalus. Fifteen months after the trauma, the patient received hyperbaric oxygen therapy to promote functional recovery. Tension pneumocephalus developed after the first session of hyperbaric oxygen therapy, and immediate burr hole drainage followed by ligation of the ventriculoperitoneal shunt was performed. The patient's consciousness recovered gradually, and he was discharged home. We suggest that patients with unrepaired skull base fracture and cerebrospinal fluid diversion should be carefully evaluated before receiving hyperbaric oxygen therapy.     

Cerebral injuries and intracranial hemorrhages as a result of trauma

Cerebral injuries refer to an actual injury to the brain matter. Injuries seen are concussion, contusion, or diffuse axonal injury. Bleeding into any of the meningeal spaces, brain, or ventricles is known as intracranial hemorrhage. Seldom do cerebral injuries appear as distinct entities but rather as a combination of injuries. The neurologic dysfunction is the sum total of the injury. The significance of the initial injury lies in the development of secondary events, such as edema, hemorrhage, and swelling. These events may lead to further deterioration and neurologic dysfunction. Treatment is directed at preservation of brain homeostasis and prevention of secondary injury. Controlled hyperventilation is the mainstay in the treatment of increased ICP. Other therapies include barbiturate coma and the use of corticosteroids to reduce ICP. Nursing interventions focus on methods to promote cerebral perfusion and support other body systems affected by immobility and altered level of consciousness. Planning nursing care and activities to the patient's ICP and CPP responses is indicated.     

CT对蛛网膜下腔出血的诊断价值

目的:探讨CT对蛛网膜下腔出血的诊断价值。材料与方法:分析经腰椎穿刺证实的自发性蛛网膜下腔出血45例以及外伤性蛛网下腔出血105例的CT征象。结果:自发性蛛网膜下腔出血的CT表现为脑池铸型高密度影,脑沟、脑内线状或雾带状高密度影。外伤性蛛网膜下腔出血常伴有灶性或普遍性脑挫裂伤,颅骨骨折等。结论:CT扫描在自发性蛛网膜下腔出血和外伤性蛛网膜下腔出血的定位、定性诊断中具有十分重要的价值。     

急性外伤性颅内血肿清除术后再发血肿的CT表现

目的探讨外伤性颅内血肿清除术后再发血肿（即迟发血肿）的临床CT表现及相关因素。方法以43例外伤性颅内血肿清除术后再发血肿的患者为观察组，选择同时期外伤性颅内血肿清除术后无再发血肿的病例50例为对照组。分析迟发血肿的CT表现，并将两组病例术前CT片中除颅内血肿外的其它外伤性CT表现进行对比分析。结果再发血肿有：硬膜外血肿17例、硬膜下血肿6例、脑内血肿13例、混合性血肿7例；观察组术前其它外伤性CT表现有：多发性脑挫伤33例、广泛蛛网膜下腔出血23例、基底池受压或闭塞32例、多发颅骨折21例、中线结构移位〉1cm19例；与对照组比较上述前3种CT表现病例数差异有显著性意义（P〈0.05）；上述术前5种其它外伤性CT征象在观察组每一病例中至少有两种以上征象合并存在，与对照组比较差异有显著性意义（P〈0.05）。结论CT检查是发现和评价外伤性颅内血肿清除术后再发血肿的重要方法，对术后可能发生再发血肿有重要的提示作用。     

汶川地震颅脑损伤CT诊断及其价值

目的：分析四川汶川地震颅脑损伤患者CT表现及其价值。方法：对地震发生后近2个月内陆续送至四川大学华西医院治疗,因地震致有颅脑损伤史的140名伤员进行颅脑CT分析总结。结果：在本组伤员中,头皮损伤97例（69％）;颅骨骨折68例（49％）;脑挫裂伤66例（47％）;硬膜外和（或）硬膜下积血、积液44例（31％）;蛛网膜下腔出血36例（26％）;脑水肿、软化灶29例（21％）;其他43例（31％）。结论：CT扫描能准确、快速、有效地对地震颅脑损伤患者进行判断,可为临床治疗方案起指导作用。     

常规超声及超声造影在脑外伤中的应用

目的 探讨常规超声及超声造影在脑外伤中的应用价值.方法 ①10只健康犬,麻醉满意后开颅.暴露硬脑膜后以不同外力制造加速性脑损伤模型.对不同病灶行常规超声及灰阶超声造影检查,实验结束后犬脑行病理学检查.②选取13例脑外伤患者行术中超声检查.应用常规超声检测病灶,确定外伤灶的位置、深度、大小、内部回声等.对血肿清除术中出现的急性脑膨出再行超声检查,以检测是否有迟发性血肿出现.选取8例脑外伤患者行术中超声造影检查.结果 ①10只实验犬中共有脑外伤灶12处,选取10处行超声造影检查,证实脑挫裂伤1处,脑挫伤伴出血1处,脑内血肿7处,脑内血肿破人脑室2处,脑内血肿包绕血管1处.②13例患者中,术前CT检查发现病变15处,术中超声发现病变18处.其中,术中超声发现对侧硬膜外血肿4例,1例经CT证实为对侧硬膜外血肿;3例超声诊断为硬膜外血肿后,在超声引导下将血肿清除.脑内血肿造影后边界清晰,出血区表现为无或低增强,而脑挫裂伤挫伤区内有造影剂进入;与二维超声比较,病变区范围变大.结论 常规超声可清晰显示脑外伤灶,并对其进行精确定位.对于术中急性脑膨出,超声可发现颅内迟发性血肿并进行定位,不同类型脑外伤灶其超声造影表现不同.     

Diagnostic capabilities of magnetic resonance imaging and computed tomography in acute cervical spinal column injury

The present study was conducted to evaluate the imaging capabilities of magnetic resonance imaging (MRI) in evaluating acute cervical spinal column injury and compare these results to that of computed tomographic (CT) imaging. Forty-nine patients undergoing MRI at a Level I and regional spinal cord trauma center to evaluate cervical spinal column injury were studied. Seventy-one injuries were identified by MRI. These injuries were classified as osseous (fracture/dislocation) (n = 21), disc herniation (n = 29), and spinal cord injury (edema/contusion/transection) (n = 21). Diagnostic imaging results in 33 of the 49 patients undergoing both MRI and CT were compared. CT demonstrated 22 fracture/dislocations compared to 10 on MRI. MRI demonstrated 19 disc protrusions compared to 7 on CT. Additionally, MR imaged 13 cord injuries as compared to 0 by CT. MR imaging proved superior in demonstrating spinal cord pathology and intervertebral disc herniation. CT was superior to MRI in demonstrating osseous injury. CT and MRI may be useful together in determining presence and extent of spinal column injury.