慢性扩展性脑内血肿18例临床分析

目的 总结慢性扩展性脑内血肿的诊断与治疗经验。方法 对18例慢性扩展性脑内血肿的临床资料进行回顾性分析。结果 多数病变术前误诊为脑肿瘤。术后15例痊愈，2例重残，1例死亡。结论 脑内有包膜的占位性病变应考虑慢性扩展性脑内血肿的可能，最后诊断需手术及病理证实。     

外伤性脑内血肿手术治疗探讨

外伤性脑内血肿为颅脑损伤中较重的一种类型，治疗困难，死残率高。我院自1996．11～2000．7对26例外伤性脑内血肿采用手术治疗，取得较满意的结果，现总结如下。     

老年脑挫裂伤与迟发脑内血肿46例临床分析

目的:探讨老年人脑挫裂伤形成脑内血肿的因素和机制。方法;对46例老年脑挫裂伤发展致迟发脑内血肿的临床观察,CT复查。结果:统计同时期老年性脑挫裂伤发生脑内血肿者占同期脑挫裂伤人数的62.2％。结论:老年脑挫裂伤易形成迟发脑内血肿,其发生率伤后24～48h最高,病死率与年龄呈正相关。     

脑内血肿清除术后并发脑梗死18例分析

开颅清除脑血肿后并发脑梗死，常使病情加重，致残率和死亡率增加。2000年1月～2004年12月我科共治疗18例脑内血肿术后并发脑梗死病例，现结合文献进行分析讨论，报告如下。     

神经内窥镜辅助下治疗外伤性脑内血肿

神经内窥镜辅助的神经外科手术是微侵袭神经外科的一部分，随着内窥镜的发展，其工作范围不断扩大犤１犦。本院自２０００年８月至２００２年３月应用神经内窥镜辅助下治疗外伤性脑内血肿３８例取得比较满意的临床效果，现结合有关文献报道如下。资料与方法１．一般资料：本组３８例。男２６例，女１２例；年龄６～６７岁。头颅CT证实均为脑内血肿，部位为：额叶７例，额颞８例，额顶４例，颞叶９例，颞顶５例，顶枕３例，基底节区２例。按多田氏提出的CT血肿量计算公式［T＝L（长轴）×S（短轴）×Slice（层面厚度）×π／６］，本组血…     

脑外伤后进展性脑内血肿28例

目的探讨颅脑外伤后进展性脑内血肿的临床特点,总结其发病机制及诊断治疗方案。方法回顾性分析28例经头颅CT动态观察证实的进展性脑内血肿患者的临床资料。结果按伤后6个月GOS评分作为判断预后标准,非手术组6例恢复均良好（21．4％）,手术组良好14例（50．0％）,中残3例（10．7％）,重残5例（17．9％）。结论颅脑外伤后易出现脑内血肿进展性变化,是多种因素相互持续作用的结果,应进行动态观察和CT复查,根据血肿量和意识变化及时调整治疗方案。     

慢性自发性包膜型脑内血肿

近年来，我科共收治３例慢性自发性包膜型脑内血肿，均经手术和病理证实。现结合文献复习，介绍如下。例１女，２４岁。双额颞疼痛２年，持续性加重３个月入院。查体：神志清楚，能合作，但反应迟钝，血压１１２／７５ｍｍＨｇ，双侧视神经乳头水肿明显，余神经系未见异常...     

高血压性脑内血肿的内镜手术清除

本报道纤维内镜辅助下小骨窗开颅清除13例脑内血肿，术后第2天及第7天复查CT，术后6月根据GOS量表及Barthel评分表进行远期疗效评价，优6例，良2例，中2例，死亡3例，远期疗效评定优良率达62％(8／13)。     

基底节区高血压性脑出血85例临床治疗分析

目的探讨基底节区高血压性脑出廊不同治疗方式的临床疗效。方法85例患者分为开颅手术组、血肿引流组及保守组进行治疗，统计并比较三组间颅内感染、再出血、死亡及临床治愈的差别。结果手术组及引流组患者在颅内感染、再出血、死亡及临床治愈无差别。保守治疗死亡率较前两组患者高。讨论对于有手术指征的基底节区高血压性脑出血患者，应根据患者不同情况选择合适的手术治疗方式。     

外伤性丘脑基底节区血肿的临床预后分析

目的探讨外伤性丘脑基底节区血肿的相关危险因素,为早期诊断及治疗提供依据。方法收集杭州师范大学医学院附属余杭医院自2000至2009年收治的外伤性丘脑基底节区血肿患者57例,根据预后分为两组,预后不良组和预后良好组,多因素回归分析相关因素对预后的影响。结果单因素分析显示血肿大小、入院GCS评分、合并其他颅内出血、瞳孔变化、PLT对外伤性丘脑基底节区血肿的预后的影响具有统计学意义（P〈0.05）。多因素logistic回归分析显示血肿大小、入院GCS评分、瞳孔变化是外伤性丘脑基底节区血肿的预后的独立危险因素。结论对于血肿量大、入院GCS评分较低、瞳孔有变化者常提示预后不良,因此要及时观察病情变化,早期救治,对提高外伤性丘脑基底节区血肿的预后有着积极的作用。     

Clinical analysis of the patients with hemodialysis associated with intracerebral hematoma

We treated 64 hemodialysis patients with cerebral hemorrhage over an 18-year period between 1986 and 2003. Clinical features, prognostic factors, and therapeutic strategy were reviewed in these cases. Thirty of the cases were in the 13-year period between 1986 and 1998, and 34 cases, in the 5-year period between 1999 and 2003. In recent years, the incidence of cerebral hemorrhage has risen with the increase in the number of hemodialysis patients. There were 21 patients with at least a 10-year history of hemodialysis. The underlying cause of renal failure was diabetic nephropathy in 25 patients and glomerulonephritis in 24 patients. The most frequent sites of bleeding were the basal ganglia and thalamus, the cerebellum being involved in only one patient. Many patients had severe bleeding with hematomas greater than 61 ml. Outcome assessment by the Glasgow Outcome Scale showed 24 patients with good recovery, 8 with moderate disability, 4 with severe disability, and 28 who died. Good recovery was seen more often in patients in their 50s and 60s, whereas death occurred more often in patients aged 70 and older. Although there is now less morbidity than previously, the prognosis is not uniformly favorable in all cases. Factors associated with a poorer prognosis included mixed hemorrhage, hematomas greater than 61 ml, and age 70 and older. Hematoma size and age were particularly important prognostic factors. Improved management and prognosis in these patients requires acute intensive treatment similar to that for hypertensive cerebral hemorrhage.     

Delayed traumatic intracerebral hematoma.

Although delayed traumatic intracerebral hematomas (DTICHs) have been frequently reported since 1970, the time interval from trauma to hemorrhage and diagnosis has not been well defined. Eight patients with DITCH were found among 1,320 head-injured patients admitted to the neurosurgical service through the emergency department from March 1989 to March 1990. The mean time interval between initial and follow-up CT scan was 22 h. The mean time interval between initial trauma and diagnosis of DITCH was 24 h. One patient was diagnosed incidentally by magnetic resonance imaging. Three patients underwent operation and five patients were managed conservatively. Three patients died, resulting in a case mortality rate of 37.5%. The time interval for DTICHs' development and pitfalls in its diagnosis were discussed.     

外伤性颅内血肿手术后并发迟发性血肿分析

目的分析外伤性颅内血肿手术后并发迟发性颅内血肿,探讨其与诸多因素的关系。方法回顾性调查1994年1月至2002年12月期,间本院收住的764例外伤性颅内血肿手术病人熏术后并发迟发性颅内血肿共98例,对其年龄、受伤机制、血肿厚度与中线移位的关系、血肿量、血肿部位、脑挫裂伤、手术时机以及术后骨窗的压力与发生迟发性血肿的关系,进行研究分析。结果诸多因素与并发迟发性血肿之间的存在相关关系。结论迟发性颅内血肿是颅脑外伤手术后较常见和严重的并发症,对其的发生应有足够的预见性,早期诊治是降低其死亡率和致残率的关键。     

Encapsulated chronic intracerebral hematoma caused by venous angioma of the basal ganglia: a case report

A case is reported of venous angioma at the right basal ganglia simulating the encapsulated chronic intracerebral hematoma. A 29-year-old man was admitted to our hospital on July 14, 1988 with a two-month history of headache. Neurological examination revealed left homonymous lower quadrantic anopsia. CT scans showed a mosaic high density lesion at the right basal ganglia with extensive adjacent edema. MRI revealed that the high density lesion on CT scans was the combination of a reticulated core of mixed signal intensity with a surrounding rim of decreased signal intensity. The lesion was accompanied with extensive edema. Followed up CT scans showed the transformation of the lesion and ring-shaped enhancement. A right frontotemporal craniotomy was performed on August 9, 1988. After thorough dissection of the sylvian fissure and small corticotomy to the insula, a tough capsule was seen. There was blood in various stages of organization in the capsule. A histological examination gave a diagnosis of venous angioma in the membrane similar to the outer membrane of chronic subdural hematomas. Postoperatively, the patient showed slight left motor weakness, but it gradually improved and he was discharged on foot, on October 19, 1988. There have been a lot of reports about angiographically occult intracranial vascular malformation (AOIVM). But AOIVM at the basal ganglia is rare, and to our knowledge, only 8 cases have been reported. In our case, the presence of adjacent extensive edema, and ring-shaped enhancement on CT scans confused the preoperative diagnosis. Those findings might have been caused by encapsulation. By using CT scans and MRI, a complete and accurate diagnosis was impossible.(ABSTRACT TRUNCATED AT 250 WORDS)     

Congenital astrocytoma presenting with intracerebral hematoma. Case report.

A massive left intracerebral hematoma was surgically evacuated from a 2-week-old infant. Pathological examination showed that the hemorrhage had developed within a fibrillary astrocytoma. Neonatal intracerebral hemorrhage should raise the question of congenital tumor because such a hemorrhage in this age group is rarely the result of trauma, bleeding diathesis, or vascular malformation.     

Nonsurgical management of spontaneous intracerebral hematoma

This report describes our experience with the use of osmotic diuretics, governed by continuous monitoring of intracranial pressure (ICP), as the primary treatment for 12 consecutive patients suffering from an acute, supratentorial intracerebral hematoma. In all cases the hematoma, as shown by computed tomographic scan, had a long axis of greater than 4.0 cm. ICP and cerebral perfusion pressure were successfully maintained within the assigned limits in all patients, and in none was surgical evacuation required. There was one death during the 6-month follow-up period. With appropriate weighting to differences in admission status, statistical comparison of the patient outcome in the present series with that reported by McKissock et al. suggests that ICP monitoring can improve the outcome of conservatively (and perhaps surgically) treated patients.     

外伤性迟发性颅内血肿临床特点及首次CT的影像学特征分析

目的分析外伤性迟发性颅内血肿临床特点及首次CT影像学特征,早期诊断外伤性迟发性颅内血肿,提高疗效。方法回顾性分析我院2005年至2009年经CT证实的外伤性迟发性颅内血肿患者的临床资料,总结临床特点和首次CT影像学特征。结果迟发性血肿多发生在伤后3d内,额颞部好发,老年人容易发生,进行性的意识水平下降或出现新的神经系统体征往往意味着迟发性血肿;首次CT发现头皮血肿、颅骨骨折、气颅、脑挫伤、蛛网膜下腔出血、外侧裂血肿等预警征象时,要警惕迟发性血肿的发生。结论如果首次CT扫描有头皮血肿、颅骨骨折、脑挫伤、蛛网膜下腔出血、外侧裂血肿者,或颅内血肿成功清除后,但临床症状和特征未改善甚至加重者,进行性的意识水平下降者,伤后应将头部CT动态扫描作为常规检查,做到早期诊断、及时治疗。