外伤性脑室内出血31例临床分析

目的分析总结外伤性脑室内出血的诊断和治疗特点。方法对过去10年来31例外伤性脑室内出血的的病因学、影像学、诊断和治疗特点进行分析。结果多数为车祸致伤，重型颅脑伤占26例。原发TIVH17例，继发TIVH14例。脑室出血量按Graeb法分类：1～4分(轻度)12例，5～8分(中度)10例．9M2分(重度)9例。28例合并其他颅脑损伤。伤后6个月GOS评分：死亡14例，植物状态1例，重残2例，中残5例，良好9例。结论闭合性颅脑损伤后TTVH的发生率较低，反映了脑损伤的严重程度。     

外伤性脑室出血38例分析

目的总结外伤性脑室内出血的治疗方法。方法回顾38例外伤性脑室内出血的治疗,其中开颅清除颅内血肿的同时行侧脑室切开清除血肿并行侧脑室外引流术14例,开颅清除颅内血肿的同时行侧脑室穿刺外引流术7例,单纯行侧脑室穿刺引流9例,单纯开颅清除颅内血肿4例,保守治疗4例。结果38例病人生存23例,死亡15例,行脑室外引流的患者多获救。结论在积极处理原发性和其他继发性脑损伤的同时,应行脑室外引流术,以提高疗效。     

21例外伤性脑室内出血治疗分析

目的总结探讨外伤性脑室内出血的临床治疗方法。方法采用额角常规钻孔脑室外引流 尿激酶溶血。结果治疗后半年GOS评分,良好10例,中残5例,重残3例,死亡3例。结论尽早脑室外引流解除血肿对脑室壁压迫,改善脑微循环与脑脊液循环是脑室内出血救治成功的关键;尿激酶灌注治疗能快速、安全、有效溶解血肿,排出积血。     

外伤性脑室内出血外科治疗临床分析（附45例）

我院自1990年1月～2002年6月共收治脑室外引流术治疗外伤性脑室内出血病例共45例,本文就外伤性脑室内出血的脑室外引流手术治疗及预后进行分析讨论。1 临床资料 男28例,女17例,男:女=1.6:1,年龄17～75岁,平均38.4岁。减速伤25例,加速伤20例。入院后GCS计分3～5分19例;6～8分16例;9～15分10例。继发性脑干损伤19     

侧脑室联合置管引流治疗脑室内铸型血肿(附116例临床报告)

脑室内血肿按病因可分为自发性和创伤性两大类.自发性脑室内出血占自发性颅内血肿的20％～60％[1],外伤性脑室内出血占同期重型颅脑创伤CT检查者的1.5％ ～7.1％ [2-3],根据病理又可分为单纯性脑室内出血和脑室内铸型血肿.我科于2008年6月至2011年5月采用弹头形大口径多孔引流管侧脑室内联合置管引流治疗脑室内铸型血肿116例,效果满意,报道如下.     

外伤性脑室内出血

外伤性脑室内出血张楷文，陈荷红，张赛，焦德让我院自１９８９年１月至１９９５年３月共收治经ＣＴ确诊的外伤性脑室内出血（ＴＩＶＨ）４５例，死亡１８例（４Ｏ％），占我院同期收治颅脑损伤病人３０１５例的１．４９％，占颅脑损伤死亡２８９例的６．２％。本文就ＴＩ...     

腰大池灌注林格液加脑室外引流治疗脑室出血

目的探讨腰大池恒压灌注林格液加侧脑室外引流治疗脑室内出血的疗效。方法应用腰大池恒压灌注林格液加侧脑室外引流的方法治疗脑室内出血9例。结果死亡1例，存活8例。脑室引流管留置时间分别为：3d4例，5d4例。结论腰大池恒压灌注林格液加侧脑室外引流治疗脑室内出血的方法安全可行，能更快地消除脑室内积血对脑室周围结构的刺激，改善预后。     

双侧脑室引流治疗脑室出血

目的 探讨双侧脑室引流尿激酶灌注在脑室内出血治疗中的相关问题。方法 对28例脑室内出血病人行双侧脑室引流，经引流管注入尿激酶进行纤溶治疗。结果 28例中恢复良好者8例，生活能自理者6例，需人照顾者5例，植物生存者2例，死亡7例。结论 双侧脑室外引流及尿激酶治疗脑室内出血效果良好。     

脑室内灌注尿激酶治疗脑室内出血

目的评价脑室外引流结合脑室内灌注尿激酶治疗脑室内出血的临床疗效。方法28例脑室内出血患者，行脑室外引流术后，连续5d每天一次脑室内注入尿激酶2万单位，夹管2h后开放引流血性脑脊液。定期复查头颅CT，术后一周，脑室内积血基本清除后拔管。结果本组28例患者中，26例患者均引流通畅，24例患者术后4周意识恢复清醒，3例患者持续昏迷，1例患者因术后再出血死亡。结论该方法综合治疗脑室内出血是一种简单、有效，安全，可行的治疗措施。     

脑室腹腔分流术治疗外伤性脑积水26例体会

目的探讨脑室腹腔分流术治疗外伤性脑积水的适应证及并发症的防治。方法对26例外伤性脑积水脑室腹腔分流术后的病人进行临床总结，并结合文献复习。结果脑室腹腔分流术治疗外伤性脑积水26例，无直接手术死亡者，81％的病人获得较好的疗效。分流装置的阻塞及术后感染是最常见的并发症。结论脑室腹腔分流术是治疗外伤性脑积水的首选方法。     

Early and late outcome in head injury patients with radiological evidence of brain damage

This study examined the early and late outcome in head injury patients with focal or multifocal (unilateral or bilateral) brain contusions revealed by computerized tomography (CT) scanning. The outcome was also evaluated in patients hospitalized due to brain concussion. Three months after the injury (the early outcome) 43% of the 86 cases with multifocal contusions on the CT scan were dead. As evaluated by the Glasgow Outcome Scale, all the 57 patients with a focal brain contusion, as well as the 117 cases with brain concussion, made a good recovery or were moderately disabled. The late outcome (1 to 5 years after injury) was evaluated in 78 cases with brain contusion and in 85 cases with brain concussion, and revealed that complaints and impaired adaptive functioning were frequent in both the contusion and concussion group. The occurrence of headache, dizziness and sleep problems did not significantly differ among the various head injury groups. However, focal or multifocal brain contusions on the CT scan increased the frequency of impaired memory, impaired concentration, speech problems, weakness in arms or legs and seizures with loss of consciousness. Cognitive deficits and speech problems were particularly common in patients with a focal contusion in the temporal lobe. The late adaptive and social functioning were most markedly impaired in cases with multifocal bilateral contusions.     

Long-term outcome in aqueductal stenosis

In this study, 78 patients with aqueductal stenosis were submitted to detailed neurodevelopmental assessment with a follow-up of 5–25 years. Sixty-eight percent of patients were categorized as normal; they either attended normal school courses or had regular jobs. Among these, 34% had some motor abnormalities (ataxia, mild hemiparesis, visual disturbances). Twenty-four percent (19 cases) were moderately disabled (trainable retardation) and 8% (6 cases) were severely handicapped. Epilepsy was observed in 13% of the cases. Incidence of recurrent and generalized seizures paralleled neurodevelopmental outcome (5% in normal, 16% in moderately disabled and 50% in severely disabled patients). Endocrine dysfunctions were evident in 28% of the cases and were characterized by precocious or delayed puberty, amenorrhea and somatic underdevelopment. No patient with ventricular enlargement and a cortical mantle width below 20 mm showed a good outcome. Large ventricles were compatible with normal mental development when compensated with a corresponding cranial vault enlargement. In patients with normal mental status and motor abnormalities, longterm CT scan findings revealed the presence of focal brain abnormalities (poroencephaly, brain atrophy, calcifications, extracerebral collections).Presented at the Consensus Conference: Hydrocephalus '92, Assisi, Italy, 26–30 Aprill 1992     

特重型颅脑损伤患者术中急性脑膨出的预防方法探讨

目的 探讨特重型颅脑损伤患者手术中发生急性脑膨出的防治措施。方法 采用扩大额颞顶开颅去骨瓣减压术治疗19例特重型颅脑损伤．术中均采取顺序硬脑膜切开法分次切开硬脑膜。对此19例病例临床资料进行了回顾性分析。结果 所有病例术中均未出现难以控制的脑膨出。术后复查头颅CT显示，血肿基本清除12例，血肿仍大片存在4例，其它部位继发血肿3例；环池、基底池、第三脑室复现12例,无明显变化7例。出院时行GOS预后评定：良好1例，中残1例，重残2例，植物生存4例．死亡11例（死亡率57．9％）。结论 特重型颅脑损伤患者颅内压高，术中减压过快容易出现急性脑膨出，采用“尽早减压、逐步减压”和顺序硬脑膜切开法能明显降低术中急性脑膨出发生率，降低残死率。     

颅脑转移瘤的CT和MRI研究

134例颅脑转移瘤,CT增强薄层扫描88例,其中延迟扫描58例;薄层MRI 44例。114例(85％)有幕上转移,38例(28％)有幕下转移。73例(54％)多发,64例(46％)单发。增强MRI显示清晰和尚清晰者为42例(95％),增强后1～3min CT延迟扫描显示清晰和尚清晰者为55例(95％),延迟3min以上显示清晰和尚清晰为95％。可见,增强CT延迟扫描和大剂量增强CT对颅脑转移瘤的检出效果与增强MRI是相仿的。     

Subarachnoid haemorrhage of unknown cause: Clinical, neuroradiological and evolutive aspects

The clinical and radiological data of 52 patients with subarachnoid haemorrhage (SAH) and a negative panangiography were analysed with an average follow-up period of 3.8 years. Of these 52 patients, only one (1.9%) was subsequently found to have an aneurysm. Second angiography proved to be inconclusive in all 24 cases where it was performed. Of the 51 'true' non-aneurysmal SAH, 80% were in a good clinical grade on admission and 12% developed cerebral ischaemia. The mortality rate following SAH was 4%. There was one rebleeding. At follow-up examination, 87% of the patients had made a good recovery and 6% were left disabled due to SAH. Four patients with an aneurysmal pattern of SAH required a permanent shunt. All of the 22 patients with a perimesencephalic SAH were in a good neurological condition upon admission; one of them developed an angiography-induced transient cerebral ischaemia and another one suffered from a fatal rebleeding. None of the 21 survivors was disabled at follow-up examination. The clinical course of patients with SAH of unknown cause, especially those with a perimesencephalic pattern of haemorrhage, is good. Repeated angiography in this latter group is not useful. In the aneurysmal pattern SAH group, repeat angiography is advised only if there is strong computed tomographic (CT) scan suspicion of an aneurysm.     

囊性、囊实性颅咽管瘤的立体定向囊内放疗

目的研究CT、MRI引导立体定向囊内放射治疗囊性和囊实性颅咽管瘤的疗效。方法对100例囊性和囊实性颅咽管瘤的囊性部分行CT、MRI引导立体定向囊腔内置入Ommaya,吸除囊液、注入胶体磷酸铬,对囊实性颅咽管瘤的实质部分行伽玛刀治疗。结果全部病例经手术排出囊液后临床症状迅速改善,经囊腔内放疗后6～84个月随访90例病人,CT及MRI扫描显示42例瘤腔持续消失,临床症状消失,恢复正常工作和学习;18例肿瘤显著缩小,症状持续改善;20例肿瘤无明显改变;复发10例,其中再手术6例;死亡7例。结论CT、MRI引导立体定向放射治疗囊性颅咽管瘤安全、有效。     

SEQUENTIAL CT STUDIES OF 24 CHILDREN WITH INFANTILE SPASMS ON ACTH THERAPY

Sequential CT studies were performed in 24 patients with infantile spasms, before, during and after ACTH therapy, in order to analyze the relationship between the dose of ACTH and changes in CT scan findings. In six cases CT scans did not return to their original state after ACTH therapy. Two illustrative cases are reported. There was a good correlation between the total dose of ACTH and the percentage decrease of brain parenchyma. It is concluded that 'cerebral atrophy' on CT scans may represent an accumulative effect of ACTH and that ACTH should be given with the utmost discretion, and in as low a dose as possible.     

Late paraphrenia — a follow-up study

We report a 3.7 year follow-up study carried out on 42 patients with an original diagnosis of late paraphrenia who had had a CT scan and simple tests of cognition in addition to an assessment by means of the Geriatric Mental State Schedule. Mortality was found to be no different than in a control group. Patients showed improvement in target symptoms but exhibited a good deal of residual morbidity, particularly of motor and cognitive function. Cognitive performance, which was previously mildly impaired, showed some futher deterioration, usually falling short of clear-cut dementia. Ventricular size on the CT scan was not a predictor of outcome. The article highlights the organic substrate of late paraphrenia but suggests that the cerebral changes are relatively subtle and slowly progressive.     

大脑中动脉高密度征的动态螺旋CT表现及其对超急性期脑梗死的诊断及预后判断价值

目的探讨大脑中动脉高密度征(hyperdense middle cerebral artery sign,HMCAS)在大脑中动脉(Middle cerebral artery,MCA)供血区超急性期梗死的诊断价值及动态CT表现的临床意义。方法对46例MCA供血区超急性期脑梗死(发病6h内)MCA的CT征象及临床表现进行分析,并定期复查CT观察其动态变化。结果MCA供血区超急性期脑梗死46例中表现为HMCAS者32例(69.6%),临床均为完全前循环梗死,25例死亡(78.1%),其中HMCAS进展且合并MCA点状征(MCA dot sign)的14例中12例(85.7%)死亡,其余均遗留严重神经功能缺损;而无HMCAS的14例中8例为部分前循环梗死,6例为完全前循环梗死,仅2例(14.3%)死亡。有HMCAS的患者死亡的发生率明显大于无HMCAS的患者(P<0.01)。经随访,3例患者HMCAS消失,病人病情好转且均转化为出血性脑梗死。结论HMCAS的动态CT变化有助于大脑中动脉供血区超急性期脑梗死的诊断及预后判断。