血肿清除术后并发迟发性颅内血肿的临床分析

目的 :探讨外伤性颅内血肿清除术后并发迟发性颅内血肿 (DPIH)的原因、发病机制及防治措施。方法 :790例急性外伤性颅内血肿清除术后 ,4 5例出现术后迟发性颅内血肿 ,将DPIH与未出现术后血肿 (WRIH)者在某些临床特征方面进行比较。结果 :两组比较 ,在术前出现脑疝征象、血肿的类型、凝血功能异常、手术方式、术中低血压及治疗结果等方面均存在显著性差异。结论 :DPIH的发生与颅脑损伤的程度、类型、治疗方式及全身因素密切相关 ,其预后很差。血肿清除术后症状不能改善或病情恶化时应行动态CT检查 ,可尽早发现DPIH。一些预防措施可有助于减少DPIH的发生     

Pneumocephalus leading to the diagnosis of cerebrospinal fluid leak and esophageal perforation after cervical spine surgery

Pneumocephalus is a collection of air within in the intracranial cavity, most commonly seen following traumatic injury or cranial surgeries. Esophageal injury and cerebrospinal fluid (CSF) leak are rare complications that may occur following anterior cervical discectomy and fusion (ACDF). We present a novel case of pneumocephalus arising from unrestricted leakage of CSF via coincident esophageal injury and durotomy in a patient who underwent an ACDF after trauma. A 21-year-old man presented to an outside hospital with C5/C6 subluxation, complete spinal cord injury, and quadriplegia from a motor vehicle accident. He underwent an ACDF, during which a CSF leak was observed. He was then transferred to our institution for rehabilitation and tracheostomy placement 1 week after the ACDF surgery. Following the tracheostomy, the patient developed intractable fevers and nonspecific symptoms. A CT scan demonstrated frontal pneumocephalus without mass effect. Air was found in the retropharyngeal space. There were no accumulations of CSF in the neck. Extravasation of contrast around instrumentation at C5/C6 on a cine esophagogram demonstrated an esophageal perforation at that level. Pneumocephalus may form when large volumes of CSF escape from the intracranial space and air is drawn into the space by the negative pressure. In this unusual case, the esophageal perforation promoted the formation of the pneumocephalus. Treatment included closure of both defects, disrupting the suspected communication between the intracranial space and the esophagus.     

Rapid spontaneous resolution of acute subdural hematoma

Acute subdural hematomas are usually neurosurgical emergencies, although a conservative therapy is indicated in selected cases. In some of these patients a progressive resolution is appreciated. However, rapid spontaneous resolution of an acute suddural hematoma is seldom reported. A patient with antecedent of chronic alcoholism and spontaneous resolution of acute subdural hematoma in less than 18 hours after the head injury is described. The possible mechanisms of this rapid resolution are discussed. A tear in the arachnoid with spilling of CSF into the subdural space and the effect of intracranial antihypertensive measures together with cerebral atrophy, are factors that possibly contribute to dilution and redistribution of blood with hematoma disappearing in CT scan.     

Vertex epidural hematoma with bilateral abducent nerve palsy: case report and literature review

Epidural hematomas which are located at the vertex are rarely seen and form a small percentage of total epidural hematomas. Tearing in the superior sagittal sinus is the usual cause of an epidural hematoma located in the vertex. The clinical features of this entity are non-specific; hence, localization of the lesion is difficult. We report an adult who was hit by a motorcycle and was initially discharged from the hospital as a case of concussional head injury. He returned back with raised intracranial pressure symptoms, so a CT scan was done but was misinterpreted, and he reported one week later with bilateral abducent nerve palsy. Magnetic resonance imaging confirmed vertex EDH for which he was operated.These hematomas are seen rarely and can be interpreted as an artifact. Its recognition is important because it has an excellent prognosis. We concluded that all head injury patients should get high axial cuts on the CT scan, and any degree of suspicion should prompt a neurosurgeon to investigate further with coronal CT scan or MRI.     

The Usefulness of Brain Magnetic Resonance Imaging with Mild Head Injury and the Negative Findings of Brain Computed Tomography

Objective

To investigate the cases of intracranial abnormal brain MRI findings even in the negative brain CT scan after mild head injury.

Methods

During a 2-year period (January 2009-December 2010), we prospectively evaluated both brain CT and brain MRI of 180 patients with mild head injury. Patients were classified into two groups according to presence or absence of abnormal brain MRI finding even in the negative brain CT scan after mild head injury. Two neurosurgeons and one neuroradiologist validated the images from both brain CT scan and brain MRI double blindly.

Results

Intracranial injury with negative brain CT scan after mild head injury occurred in 18 patients (10.0%). Headache (51.7%) without neurologic signs was the most common symptom. Locations of intracranial lesions showing abnormal brain MRI were as follows; temporal base (n=8), frontal pole (n=5), falx cerebri (n=2), basal ganglia (n=1), tentorium (n=1), and sylvian fissure (n=1). Intracranial injury was common in patients with a loss of consciousness, symptom duration >2 weeks, or in cases of patients with linear skull fracture (p=0.00013), and also more frequent in multiple associated injury than simple one (35.7%>8.6%) (p=0.105).

Conclusion

Our investigation showed that patients with mild head injury even in the negative brain CT scan had a few cases of intracranial injury. These findings indicate that even though the brain CT does not show abnormal findings, they should be thoroughly watched in further study including brain MRI in cases of multiple injuries and when their complaints are sustained.     

新型国产16层移动CT在颅脑创伤中的临床应用

目的探讨新型国产16层移动CT在颅脑创伤中的应用价值。 方法收集吉林大学第一医院神经创伤外科自2018年10月16日至11月16日选取的100例志愿者的新型16层移动CT的头部影像资料,包括普通头部体检者50例,神经创伤外科普通病房患者25例和重症监护室患者25例。所有患者在神经创伤外科重症监护病房的铅防护CT室内进行16层移动CT头部扫描,同时在放射线科行普通CT头部检查。对比分析新型16层移动CT头部成像质量和性能,并对重症监护室患者行16层移动CT头部检查耗时与转运去放射线科普通CT头部检查耗时进行比较。 结果50例体检者头部16层移动CT扫描显示脑组织形态、结构和密度清楚,成像质量清晰;50例颅脑创伤患者头部16层移动CT扫描显示脑挫裂伤、颅内血肿、脑梗死、颅骨骨折等病灶显示清晰,满足颅脑创伤疾病的诊断要求。重症监护室患者16层移动CT检查耗时[（7.2±0.4）min]显著少于转运去放射线科普通CT检查耗时[（22.3±1.9）min]。 结论新型国产16排移动CT成像清晰,适合于颅脑创伤患者的临床应用,并且耗时短,尤其适合神经重症监护室的颅脑创伤患者。     

外伤性进展性颅内血肿的诊断和治疗

目的探讨外伤性进展性颅内血肿的临床特点,总结其发病机制及诊断、治疗方法。 方法选取自2011年1月至2015年12月中国人民解放军第二五一医院神经外科收治的97例外伤性进展性颅内血肿的临床资料进行分析。 结果本组97例占同期外伤性颅内血肿的15.3%,手术63例,死亡7例;保守治疗34例,死亡1例,总死亡率8.2%。 结论外伤性进展性颅内血肿临床意义重大,绝不能仅仅依赖首次CT结果即制定一成不变的治疗方案,而应进行动态观察和CT监测,根据患者血肿量的变化及时调整治疗方案。     

Posttraumatic retroclival acute subdural hematoma: report of two cases and review of literature

Traumatic retroclival hematomas are uncommon lesions usually associated with significant trauma. Majority of the reported hematomas are epidural; and in the pediatric population. Retroclival acute subdural hematomas (RSDH) are very rare, with only two previous cases reported in English literature. An 18-year-old man presented with headache and no deficits following an accident. Computer tomography (CT) scan and magnetic resonance imaging (MRI) showed an acute RSDH extending into the spinal subdural space. He developed bilateral sixth nerve palsies, with symptoms of raised intracranial pressure within the next 24 hours. He underwent evacuation of hematoma with a good outcome. Another 19-year-old man presented with neck pain following a fall from a moving bus. He had no neurological deficits. CT scan showed a RSDH extending across the craniovertebral junction. He was managed conservatively with good outcome.     

颅内肿瘤切除术后继发血肿分析及处理

目的 总结颅内肿瘤术后继发血肿的病例,探讨防治对策.方法 回顾性分析手术切除颅内肿瘤后继发血肿的临床资料.结果 702例颅内肿瘤病人术后19例(2.71%)继发颅内血肿;均发生于术后48 h内,16例发生于24 h内;12例病例出现脑疝或脑疝前期症状,7例为术后CT检查发现;继发血肿病例术中失血量平均为1102.63 ml;5例曾行脑室外引流;再次手术血肿清除后痊愈12例,部分神经功能障碍4例,植物生存1例,死亡2例.结论 术前、术中对患者危险因素的充分评估以及术后的密切监测是减少继发血肿的前提,治疗的关键在于早期发现、早期行血肿清除.     

B型超声波在颅脑损伤术中及术后的应用研究

目的 应用B超在颅脑损伤术中探查多发性血肿并导向手术,对术后危重病人进行床旁监测。方法 应用超声显像仪,对术中急性脑膨出,疑有多发性颅内血肿者实时术中B超扫查,开颅后在血肿清除部位彻底止血,将探头用无菌乳胶膜包裹,进行多角度多层面扫查。术后则经骨缺损区或颅骨钻孔处进行水平、冠状、矢状或滑行扫查。结果 术中扫查54例,不同部位的颅内血肿或积血42例,同侧脑内血肿6例,脑挫裂伤脑水肿6例。B超引导下手术清除血肿42例,术后50例进行了CT检查,损伤部位和范围与B超及手术发现基本一致。术后检查118例。其中114例经CT扫描检查,总体符合率为74.56％,与CT参照对比P>0.05。结论 术中B超扫查对多发性颅内血肿能准确定位,对明确术中急性脑膨出的原因具有重要意义,术后经骨缺损对迟发性血肿能准确检出,对脑挫伤,脑水肿的扫查无意义。     

急性外伤性颅内血肿清除术后继发血肿再手术的原因分析

目的探讨急性外伤性颅内血肿清除术后再次手术的原因、预防及处理措施。方法2001年11月至2006年11月我科共对561例颅脑损伤病人急诊行开颅血肿清除术，术后31例发生迟发性血肿行再次手术治疗。结果本组31例再次手术后恢复良好7例，中残7例，重残8例，植物生存3例，死亡6例。结论急性外伤性颅内血肿清除术后继发血肿包括：①原血肿手术部位再出血；②多发性血肿的非手术部位血肿形成。临床应采取相应的有效预防措施，并强调严密观察病情变化、及时复查CT，以便及时发现并再次手术清除继发性血肿、缓解颅内压。     

Relevance of emergency head CT scan for fall in the elderly person

ObjectivesFall of the elderly person is a public health problem. The objectives of our study were to evaluate the relevance of systematically performing in emergency a computed tomography (CT) scan for fall in the elderly person, to identify specific criteria predicting the appearance of lesions.Material and methodsWe performed a retrospective analysis of 500 consecutive patients aged 65 and over, who underwent an emergency head CT scan for fall from their height. Outcome at the end of the acute care, clinico-biological data and delays between trauma an d CT were collected, and crossed with a detection of head lesion on the CT scan.ResultsOf 500 patients, 38 (7.6%) had traumatic lesions depicted on the CT scan and 267 (53.4%) were hospitalized after the CT scan. Three (0.6%) had been operated for urgent head surgery. Nine of the 38 (23.6%) patients with traumatic lesion returned home. Presence of a lesion depicted on the CT scan was not correlated with the orientation of the patient (P < 0.0001). Post-traumatic injury was significantly associated with male sex (RR = 2.19, P = 0.0217), consciousness impairment (RR = 1.56, P < 0.0001), focal neurological deficit (RR = 6.36, P = 0.0362) and past history of post-traumatic brain injury (RR = 7.17, P = 0.0027). Anticoagulant therapy was not associated with increased risk of traumatic lesions (P = 0.3315). ROC analysis determined that a 5-hours time-interval between head trauma and CT allowed optimal detection of lesions.ConclusionThe systematic indication of an emergency head CT scan for fall in elderly patients presents a low diagnostic and therapeutic yield and is not relevant. Male sex, consciousness impairment, focal neurological deficit, past history of post-traumatic brain injury and time-interval between head trauma and CT are statistically related to the presence of lesions and should therefore be taken into account.     

The use of handheld near-infrared device (Infrascanner) for detecting intracranial haemorrhages in children with minor head injury

Objective

A handheld device using near-infrared technology (Infrascanner) has shown good accuracy for detection of traumatic intracranial haemorrhages in adults. This study aims to determine the feasibility of use of Infrascanner in children with minor head injury (MHI) in the Emergency Department (ED). Secondary aim was to assess its potential usefulness to reduce CT scan rate.

Methods

Prospective pilot study conducted in two paediatric EDs, including children at high or intermediate risk for clinically important traumatic brain injury (ciTBI) according to the adapted PECARN rule in use. Completion of Infrascanner measurements and time to completion were recorded. Decision on CT scan and CT scan reporting were performed independently and blinded to Infrascanner results.

Results

Completion of the Infrascanner measurement was successfully achieved in 103 (94 %) of 110 patients enrolled, after a mean of 4.4?±?2.9 min. A CT scan was performed in 18 (17.5 %) children. Only one had an intracranial haemorrhage that was correctly identified by the Infrascanner. The exploratory analysis showed a specificity of 93 % (95 % CI, 86.5–96.6) and a negative predictive value of 100 % (95 % CI, 81.6–100) for ciTBI. The use of Infrascanner would have led to avoid ten CT scan, reducing the CT scan rate by 58.8 %.

Conclusions

Infrascanner seems an easy-to-use tool for children presenting to the ED following a MHI, given the high completion rate and short time to completion. Our preliminary results suggest that Infrascanner is worthy of further investigation as a potential tool to decrease the CT scan rate in children with MHI.     

Intracranial hemorrhage in infancy due to vitamin K deficiency: report of a case with multiple intracerebral hematomas with ring-like high density figures

It is well known that vitamin K deficiency is an important cause of the spontaneous intracranial hemorrhage in infancy. A 60-day-old male infant with spontaneous intracerebral hematomas due to vitamin K deficiency was presented. He was breast-fed. He had been medicated oral antibiotic agent for diarrhea and fever. Three days later he developed petechien, vomiting and twitching, and became drowsy. The blood studies showed anemia, and advance of ESR. He was administered of vitamin K immediately. CT scan was showed four intracerebral hematomas with niveau, which were surrounded by high-density rings. The ring-like figures were unique for this case. The reason may be next, we think. Under the states in which blood can separate easily with advance of ESR, blood clot would adhere to the wall of the hematomas. So these hematomas showed ring-like figures and had niveau in them. CT scan of this case was also interesting because there was little deviation in spite of the big hematomas. The reason of this may be that the brain of infancy is incomplete in myelination and contains much water, and that the possibility of bleeding due to vitamin K occurs slowly. We examined 84 cases of intracranial hemorrhage due to vitamin K deficiency from literatures, and they were all identified for the hemorrhage sites by CT scan. Subarachnoidal hemorrhage was in 72 cases (85.7%), subdural hemorrhage was in 41 cases (48.8%), intracerebral hematomas was in 36 cases (42.9%) and intraventricular hemorrhage was in 9 cases (10.7%). In 52 cases the CT findings were described.(ABSTRACT TRUNCATED AT 250 WORDS)     

Management of minor head injury: the value of early computed tomography and serum protein S-100 measurements

Computed tomography (CT) scan was performed within 6 h in 91 patients with minor head injury (MHI). Eight patients (9%) demonstrated intracranial lesions on CT scan (6 brain contusions, 1 brain edema and 1 extradural hematoma). No patient required craniotomy. In patients with normal CT scan, no complications to the head injury were observed. Patients with intracranial lesions were hospitalized significantly longer (mean 9.4 days) than patients without (mean 1.6 days). In a subgroup of 50 patients with normal CT scan, serum S-100 protein was measured on admission. Elevated S-100 levels were seen in 10 of 50 patients (0.5-2.4 mug/L, mean 1.1). These patients were hospitalized significantly longer (mean 3.4 days) compared to patients with normal CT scan and normal S-100 levels (mean 1.1 days). MHI patients with GCS 14-15 without neurological deficits can safely be discharged when CT scan is normal. Serum protein S-100 measurements appear to provide information about diffuse brain injury after MHI.     

Expanding traumatic intracerebral contusion/hematoma

BACKGROUND AND AIMS: Delayed traumatic hematomas and expansion of already detected hematomas are not uncommon. Only few studies are available on risk factors of expanding hematomas. A prospective study was aimed to find out risk factors associated with such traumatic lesions. MATERIALS AND METHODS: Present study is based on 262 cases of intracerebral hematomas / contusions out of which 43 (16.4%) hematomas expanded in size. computerized tomography (CT) scan was done in all the patients at the time of admission and within 24 hours of injury. Repeat CT scan was done within 24 hours, 4 days and 7 days. Midline shift if any, prothrombin time, activated partial thromboplastin time, bleeding time, clotting time and platelet counts, Glasgow coma scale at admission and discharge and Glasgow outcome score at 6 months follow up were recorded. RESULTS: Twenty six percent, 11.3 and 0% patients developed expanding hematoma in Glasgow Coma scale (GCS) of 8 and below, 9-12 and 13-15 respectively. The chances of expanding hematomas were higher in patients with other associated hematomas (17.4%) as compared to isolated hematoma (4.8%) (Fisher's exact results P =0.216). All the cases of expanding hematoma had some degree of midline shift and considerably higher proportion had presence of coagulopathy. The results of logistic regression analysis showed GCS, midline shift and coagulopathy as significant predictors for the expanding hematoma. Thirty nine patients (90.7%) of the total expanding hematomas developed within 24 hours of injury. CONCLUSIONS: Enlargement of intracerebral hematomas is quite common and majority of them expand early after the injury. These lesions were common in patients with poor GCS, associated hematomas, associated coagulopathy and midline shift.     

脑外伤后进展性出血性脑损伤的诊治体会

目的研究脑外伤后进展性出血性脑损伤的临床特点,总结其发病机制,探讨及时诊断、治疗的方法。 方法回顾性分析解放军第二五一医院神经外科自2015年1月至2017年6月收治的167例脑外伤后进展性出血性脑损伤患者的临床资料。本组患者入院时按GCS评分：3~5分11例,6~8分36例,9~12分83例,13~15分37例。临床表现均有不同程度的颅高压症状,观察治疗过程中,76例患者出现意识障碍或意识障碍加深,94例患者肢体肌力减退,81例患者频繁呕吐,43例患者躁动,5例患者脑疝。 结果手术治疗94例,保守治疗73例。所有患者依据GOS评分判断：恢复良好114例,中残32例,重残13例,死亡8例（4.8%）。 结论动态CT观察是早期发现进展性出血性脑损伤的有效方法。对外伤性颅内血肿的患者绝不能仅仅依赖首次CT结果即制定一成不变的治疗方案,应进行专科监测和动态CT观察,根据患者血肿量的变化及时调整治疗方案。     

CT动态观察对外伤性迟发性颅内病变的诊断价值

目的 探讨CT扫描动态观察对颅脑损伤迟发性病变的诊断价值.方法 对265例头部外伤患者进行2次及2次以上的CT扫描动态观察.结果 迟发性病变67例,占25.28%,其中迟发性颅内血肿46例(脑内血肿32例,硬膜外血肿11例,硬膜下血肿3例),占17.36%;外伤性脑梗死6例,占2.26%;外伤性硬膜下积液15例,占5.66%.结论 对头部外伤患者进行CT扫描动态观察,能及时发现颅内迟发性病变;动态复查的时间应在48h以内,以12～24h最佳.     

A false traumatic giant aneurysm of the supraclinoid carotid artery. A case report and review of the literature

Abstract

A patient presented with left hemiparesis and facial palsy developed 20 days after a traffic accident A computerized tomography (CT) scan revealed right suprasellar mass lesion. A repeated CT scan revealed a growing mass. Carotid angiogram demonstrated a giant aneurysm of the supraclinoid internal carotid artery (ICA) with no distal filling. Formation of the aneurysm was thought to be due to an overstretching or torsion of the artery or tearing of the ICA by nearby prominent bony structure since no basal skull fracture was detected in the plain skull film or CT scans. The aneurysm was treated by intracranial trapping of the ICA. We present this patient’s findings and review previously reported cases in the literature. [Neurol Res 1996; 18: 135–139]     

B超在地震灾害颅脑损伤中的应用

目的 探讨地震灾害中B超在颅脑损伤术中及术后的应用价值.方法 对于地震灾害中颅脑损伤患者术中急性脑膨出,怀疑有多发性颅内血肿者,应用B型超声仪实时扫查,术后经骨缺损或颅骨钻孔处进行水平、冠状、或滑行扫查.结果 在地震灾害中共进行了58例开颅手术,24例术中进行了B超扫查,不同部位的颅内血肿或积血18例,同侧脑内血肿2例,B超引导下手术清除血肿14例.58例手术患者口术后28例同时进行CT和B超检查,检查结果基本一致.结论 术中B超扫查可以定位多发性颅内血肿,对明确术中急性脑膨出的原因具有重要意义;术后经骨缺损扫查能准确检出迟发性血肿,能快速及时准确的指导医生进行手术,提高救治成功率.