迟发性外伤性颅内血肿临床分析

探讨迟发性外伤性颅内血肿的发病机制，临床特点及处理方法。对高危患者密切观察病情变化，及时复查CT，清除血肿，可明显提高抢救成功率。     

外伤性迟发性颅内血肿

外伤性迟发性颅内血肿，系指头伤后经过一段时间才发生的颅内血肿。自ＣＴ问世后对其发病机理有了新的认识。我科自１９８６年至１９９１年６月共收治外伤性迟发性颅内血肿３１例，占同期颅脑伤住院患者的２．０％，颅内血肿的５．９％。现结合文献对本组资料进行讨论。临...     

外伤性迟发性颅内血肿

外伤性迟发性颅内血肿是指外伤后经过一定时间才发生的颅内血肿。血肿可位于脑实质（DTICH）、硬膜外（DTEDH）、硬膜下（DTSDH）和脑室内（DTIVH）。CT时代对颅脑损伤引起本病的病理变化过程有了新的认识。本病在临床上并非罕见，表现形式多样，易延误诊治，其发生机理尚未完全清楚，部份原因可能与某些治疗措施有关，连引起临床上的重视。     

迟发性外伤性颅内血肿42例临床分析

回顾分析42例迟发性外伤性颅内血肿临床资料,其中开颅清除血肿36例,非手术治疗6例。随访半年,恢复良好28例,中残6例,重残3例,死亡5例。迟发性外伤性颅内血肿不仅可发生于术前,也可发生于术中及术后。尽早发现和及时处理是防止迟发性颅内血肿发生的关键。     

迟发性外伤性颅内血肿30例分析

迟发性外伤性颅内血肿(町ICH)多处于额颞部减速对冲伤,及时复食c．r、早期诊断足救治成功的关键。、     

外伤性迟发性颅内血肿

外伤性迟发性颅内血肿是指头颅外伤后首次CT检查未见血肿，经过一段时间后CT检查方发现血肿，或清除血肿一段时间后又在不同部位发现血肿者犤１犦。本院自１９９３年６月～２０００年５月，经CT扫描或手术证实外伤性迟发性颅内血肿３２例，现报道如下。１临床资料１．１一般资料本组３２例中，男性２３例，女性９例；年龄１２～７０岁，平均４１．２岁。本组病例中车祸伤２０例，后仰跌倒伤３例，高处坠落伤８例，其他损伤１例。伤后出现头痛、呕吐、意识障碍加重；手术后意识障碍好转后又恶化，减压窗膨张力高等，临床表现为CT扫描复查…     

迟发性外伤性颅内血肿18例

我院2002年10月-2005年5月共收治颅脑外伤376例，迟发性外伤性颅内血肿（DTICH）18例，占同期颅脑外伤的4．8％。现报告如下。     

迟发性外伤性颅内血肿的CT诊断

本文报导3例迟发性外伤性颅内血肿的病历,提出病人如有明确的颅脑外伤史,经过治疗颅内压增高症状无改善或进行性恶化,应及时复查CT,以免漏诊。     

迟发性外伤性颞叶脑内血肿的早期诊治

目的总结迟发性外伤性颞叶脑内血肿的早期诊治经验,以提高疗效.方法对本组首次CT检查无血肿者,严密观察,及时CT复查,对血肿量≥25ml伴脑干周围池受压变窄者,积极手术治疗,其余行保守治疗.结果本组16例中,手术治疗9例,保守治疗7例.恢复良好11例,中残2例,重残2例,死亡1例,总死亡率6.25%.结论迟发性外伤性颞叶脑内血肿的救治关键在于早诊早治,早期手术者多预后良好.     

迟发性外伤性脑内血肿33例临床分析

探讨迟发性外伤性脑内血肿(DTICH)的发病机制及防治措施,强调手术方式的选择和手术时机的掌握,是降低死亡率及致残率的关键.     

发生迟发性脑内血肿的脑挫裂伤的临床特征

回顾分析了42例脑挫裂伤患者发生性脑内血肿的临床资料,此类脑挫裂伤有原发性昏迷,CT表现为中线移位,Ⅲ脑室及周围池受压,合并颅内血肿或广泛性脑挫裂伤等特点。对于此类病人应在72小时内重点监护。     

Spontaneous intracerebral hematomas from vascular causes

Summary The aim of the present study was to assess the diagnostic accuracy of CT in determining the underlying causes of brain hematomas with a state-of-the art CT. For this purpose, CT and angiographic data of 149 subjects with spontaneous intracerebral hematomas (ICH) were statistically compared in a blind, retrospective study, taking angiography, supported when possible by surgical findings, as providing the correct diagnoses. 5 groups were distinguished on the basis of CT data: 103 patients with isolated deep ICH had normal angiograms; 9 patients with isolated superficial ICH and 8 with deep ICH and intraventricular hemorrhage (IVH) had arteriovenous malformations (AVMs). 4 with this combination showed no angiographic abnormalities, one had an aneurysm. 14 subjects with ICH and subarachnoid hemorrhage (SAH) had a middle cerebral or carotid artery aneurysm; and 10 with ICH, SAH and IVH had also an aneurysm, in 7 on the anterior communicating artery. Sensitivity, specificity, positive and negative predictive values were respectively: for AVMs 100, 96, 77 and 100%; and for aneurysms 96, 100, 100 and 99%. Kendall coefficient was 0.95, indicating close correlation between the two modalities. This study confirms that CT can accurately predict the likelihood, nature and location of vascular ICHs. It indicates whether angiography is necessary or not, and if so, what vascular tree ought to be explored.     

Traumatic and alternating delayed intracranial hematomas

Summary Repeat computed tomography has enabled us to confirm the concept of delayed hematomas. With this in mind we report two cases of alternating, post-traumatic intracranial hematomas; confirming also the role of tamponade after surgical removal of an intracranial hematoma.     

Sequential MR studies of intracerebral hematomas in monkeys

It is well recognized that the MR appearance of intracranial bleeding changes with the age of lesion. It is also well known that hemoglobin in stagnating blood undergoes oxidation to methemoglobin, a substance that lowers the relaxation times of surrounding water protons. To study these phenomena in a controlled way, about 3 ml of blood was injected into the right frontal lobe of two rhesus monkeys, and they were scanned sequentially for up to 2 months in a Picker NMR scanner (Bo = 0.25-0.5 T). The image intensity of the blood changed during the first week, consistent with the lowering of T1 and T2. On the inversion-recovery scans the initial appearance of the blood was less bright than was the contralateral white matter, reversing after 3-5 days. The opposite was true on spin-echo images. T1 and T2 values were calculated for all images. In parallel experiments, several milliliters of freshly drawn blood was placed in test tubes and relaxation times were measured in a bench-top analyzer at 0.25 T over a period of 10 days. The relaxation times dropped markedly, at a rate that depended on sterility, temperature, etc., closely approaching the expected result for complete conversion of hemoglobin to methemoglobin. Ten blood samples with different methemoglobin concentrations were prepared by adding varying doses of sodium nitrite. The change in 1/T1 was found to be roughly proportional to the methemoglobin concentration for values up to 40%, and the initial slope was consistent with published data.     

小儿外伤性迟发性硬脑膜外血肿

目的 研究小儿外伤性迟发性硬脑膜外血肿的临床特点。并探讨其发生机制。方法 总结分析我科1991年1月-2001年10月收治的小儿外伤性迟发性硬脑膜外血肿23例。结果 本组手术清除血肿21例。血肿自行吸收2例。无死亡。结论 小儿迟发性外伤性硬脑膜外血肿多发生在伤后2-5d，占该类血肿78.3%，跌倒伤是主要的致伤原因，此类血肿可发生于颅内任何部位，但多伴有颅骨线形骨折。小儿外伤性迟发性硬脑膜外血肿及时发现和治疗，预后良好，CT扫描是可靠而简便的诊断方法，而延误诊断往往造成严重后果。     

Pre-enhancement ring density in resolving intracerebral hematomas.

Pathologic material is presented demonstrating a pre-enhancement ring density in later stages of hematoma resolution on CT. This pre-enhancement ring density is due to aggregates of hemosiderinladen macrophages.     

外伤性基底节血肿11例临床分析

同顾总结11例外伤性基底节区血肿(TBGH)的临床资料,分析探讨其发病机制和临床特点.TBGH多由交通事故引发,大多为对冲伤,常伴发肢体功能障碍,临床上需与高血压脑出血鉴别.     

Indications for surgical treatment of hypertensive intracerebral supratentorial hematomas

The retrospective analysis comprised 26 operatively and 28 conservatively treated patients with hypertensive intracerebral supratentorial hematomas (HISH). According to indications for surgical treatment the patients were divided into three groups. The first group included patients with milder disorders of consciousness, slight neurological deficit and intracerebral hematomas less than 50 ccm. The second group included patients with more severe disorders of consciousness, marked neurological deficit and intracerebral hematomas larger than 50 ccm. The third group included patients with severe disorders of consciousness at the level of coma and decortication or decerebration phenomena. The results of surgical treatment are significantly better compared to conservative treatment (42,3%:14,3%).