迟发性脑挫裂伤的CT表现及复诊时间

目的:探讨迟发性脑挫裂伤的CT表现及复诊时间。方法:回顾分析152例经2 次以上CT检查证实的迟发性脑挫裂伤的CT首诊时间、首诊CT 表现、CT首次检出脑挫裂伤的时间及表现。结果:伤后24小时内复查CT共检出迟发性脑挫裂伤88例,占57.9%;首诊CT发现伴蛛网膜下腔出血和广泛脑水肿的31例中,27 例日后形成重型或极重型迟发性脑挫裂伤。结论:头部外伤后,应于伤后24小时内复查头部CT,以尽早明确有无迟发性脑挫裂伤。对临床累计昏迷超过30分钟,首诊CT呈现伴有蛛网膜下腔出血的广泛脑水肿者尤应密切随诊。     

急性脑损伤CT和MRI诊断价值的对比分析

<正>脑损伤是外界暴力作用于头部造成的脑组织器质性损伤,脑损伤包括脑震荡、弥漫轴索损伤、脑挫裂伤和脑干损伤。急性脑损伤往往表现为发病急,病情变化快,病情危重,致残率和病死率高[1,2]。脑损伤根据伤后脑组织与外界相通与否分为开放性或闭合性脑损伤。脑震荡头部CT检查无异常;脑挫裂伤头部CT了解有无骨折、蛛网膜下腔出血、有无颅内血肿。头部MRI了解具体损伤部位、     

双额脑挫裂伤患者的临床观察与护理

双额脑挫裂伤是一种严重的颅脑损伤,多由接触力和惯性力所致的冲击伤和对冲性损伤所致,伤后所致的急性脑血管扩张、脑水肿及弥漫性轴索损伤的程度较重。颅内压增高所致的脑移位很容易造成继发性脑干损伤,常突发形成脑疝。患者在入院时可表现为意识清醒,头颅CT早期表现有不同程度的双前额底的挫裂伤,环池尚清晰可见,此时若未引起足够的重视,病情可随着脑挫裂伤、脑内血肿的扩大、脑水肿的进展迅速恶化.     

脑挫裂伤及其并发症的CT诊断

笔者对35例有多次CT资料及临床资料的病例进行分析,结果显示脑挫裂伤大部分是对冲伤,挫伤早期,局部脑密度增高,密度不均匀是脑挫裂伤的早期征象。本文试图提出了CT诊断脑疝的标准,并就早期脑挫裂伤病灶CT值升高的理论基础进行了讨论。     

脑挫裂伤不同时段CT复查的影像对比分析与临床价值

目的:动态观察脑挫裂伤患者行首次CT检查、伤后24h内、24h左右及2天以上复查CT的影像表现,并进行对比分析,探讨不同时间段CT复查的影像变化与临床价值。材料与方法:收集我院2014年8月至2015年8月外伤后首次行脑CT检查,以及伤后复查发现脑挫裂伤的70例患者,比较两次或多次CT检查挫裂伤病变不同时间段影像的动态变化。结果:70例患者中,伤后首次检查发现脑挫裂伤的患者52例(74.3%),合并蛛血、硬膜下血肿、硬膜外血肿或骨折者30例(42.9%),单纯性脑挫裂伤者22例(31.4%)。其余18例(25.7%)患者未发现明显脑挫裂伤征象,但有蛛网膜下腔出血、硬膜下血肿、硬膜外血肿或骨折。第1次CT检查后2-26h再次复查CT,18例挫裂伤阴性患者均出现挫裂伤征象,6例(33.3%)表现为重度挫裂伤,12例(66.7%)表现为轻-重度挫裂伤;其余52例挫裂伤患者复查,22例(42.3%)患者挫裂伤区域出现出血、水肿明显加重征象,22例(42.3%)表现为轻-中度加重,8例(15.4%)表现稳定。44例患者于第1次CT后48h-8d进行了第3次复查,与第2次比较其中30例(68.2%)病变稳定,6例(13.6%)出现病变加重或明显加重,其余8例(18.2%)出现病变区水肿加重征象。结论:脑挫裂伤患者24h以内及24h左右复查价值重大,多数患者在此时间段病变进展迅速,CT及时复查对采取正确的治疗方案意义重大。     

儿童原发性脑干损伤导致脑萎缩20例分析

目的探讨儿童原发性脑干损伤与脑萎缩的关系。方法回顾性分析儿童原发性脑干损伤患者伤后2～6个月头颅CT扫描所见脑室、脑池、脑沟变化情况。结果 20例儿童原发性脑干损伤患者伤后2～6个月头颅CT扫描表现脑室、三脑室扩大、脑池增大、脑沟增宽。结论儿童原发性脑干损伤可导致脑萎缩。     

迟发性脑挫裂伤与性别差异

目的探讨迟发性脑挫裂伤患者的临床和影像表现是否存在着性别的差异。方法回顾经2次以上CT检查确诊的迟发性脑挫裂伤164例（男116例，女48例），分别统计其发病年龄、发病率、致伤因素、临床症状、CT首诊时间及表现、CT首次确诊迟发性脑挫裂伤的时间及表现等，对全部资料进行了统计分析。结果上述资料中男女两性的差异均无显著性（P〉0．05）。结论迟发性脑挫裂伤患者的临床和影像表现不存在性别的差异。     

自主呼吸三次停止的重型颅脑伤抢救成功1例

患者男,28岁,被人击倒枕部着地受伤,伤后呼叫不应,立即送某医院抢救,作头颅CT扫描检查,提示脑挫裂伤、脑肿胀、原发性脑干伤。抢救12小时无好转,于1997年5月28日转入我院。检查:病人昏迷,躁动,双瞳孔等大、等圆、大小正常、对光反应存在。右耳流血性脑脊液。血压14/8kPa,脉搏82次/分,呼吸平稳,GCS8分。再作头颅CT扫描,显示左右额叶、右颞叶、右枕叶严重脑挫裂伤伴多发性脑内血8中、脑肿胀、脑干周围池封闭、蛛网膜下腔出血、左枕骨骨折。给予吸氧、脱水利尿、控制血糖、应用止血剂,躁动时给安定10mg静推。病情逐渐好转。29日上午GCS上升到10分。腰穿:脑脊液外观血性,初压170mmHg,用30ml生     

老年与青少年迟发性脑挫裂伤患者的CT表现对照分析

目的 探讨迟发性脑挫裂伤患者的CT表现在老年人与青少年患者间是否存在差异。方法 回顾经2次以上CT检查确诊的迟发性脑挫裂伤25例，62～79岁5例，12～20岁20例；分析其致伤因素、首诊临床表现及CT所见和迟发性脑挫裂伤的CT表现。结果 老年人与青少年迟发性脑挫裂伤患者的致伤因素、临床表现、首诊CT所见及迟发性脑挫裂伤病灶的CT表现无明显的差异。结论 迟发性脑挫裂伤病灶的CT表现在老年与青少年患者间无明显差异。     

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。     

脑外伤患者99Tcm-ECD SPECT显像的影像特征和应用价值

目的　探讨99Tcm 双胱乙酯 (ECD)SPECT局部脑血流显像在各类脑外伤的影像特征和应用价值。方法　正常对照组 10例 ,脑外伤组 2 4例。病员准备、采集条件和图像处理基本同常规脑血流灌注断层显像。所有患者均进行同期CT扫描。结果　 2 4例脑外伤患者中 2 0例SPECT表现为异常 ,病灶累及脑的部位 71个 ,阳性率 83 % ,CT阳性率为 71%。SPECT发现病灶范围和数目均高于CT。各类脑外伤SPECT除表现为局限性放射性稀疏或缺损的共同特点外 ,不同类型脑外伤还具有各自相应的影像特征 ,如脑挫裂伤表现为假性结构紊乱 ;脑血肿清除术后表现为原血肿区缺损 ,酷似脑梗塞改变。结论　各类脑外伤患者SPECT脑灌注显像具有相应的影像特征 ,该显像具有重要临床价值。     

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     

Identification of Ethanol-intoxicated Patients with Minor Head TVauma Requiring Computed Tomography Scans

Objective: To determine whether clinical parameters and neurologic scores can be used to guide the decision to obtain computed tomography (CT) head scans for ethanol-intoxicated patients with presumed-minor head injuries.
Methods: In a prospective cohort analysis, 107 consecutive adult patients who presented to a county emergency department (ED) with serum ethanol levels >80 mg/dL and minor head trauma were studied. Commonly used clinical variables were determined for each patient. Each patient also underwent an abbreviated neurologic scoring examination and a Glasgow coma scale (GCS) score evaluation at the time of presentation and one hour later, after which a cranial CT scan was done. For purposes of analysis, patients with and patients without intracerebral injuries visible on CT scans of the head were compared.
Results: Nine of 107 patients (8.4%; 95% confidence interval [CI] = 3.9–15.4%) had CT scans that were positive for intracerebral injury. Two patients (1.9%; 95% CI = 0.2–6.6%) needed craniotomy. Five patients had hemotympanum and two patients had bilateral periorbital ecchy-mosis, but CT scans were negative for intracerebral injury in these patients. There was no statistically significant difference between the patients with and without CT scan abnormalities, based on the clinical variables, the GCS scores, or the abbreviated neurologic scoring examinations at presentation or at one hour.
Conclusion: The prevalence of intracerebral injury in CT scans of ethanol-intoxicated patients with minor head injuries was 8.4%. Commonly used clinical parameters and neurologic scores at presentation and one hour later were unable to predict which patients would have intracerebral injuries as evidenced by CT scans. Our low (1.9%) neurosurgical intervention rate supports the need to develop a selective approach to CT scanning in this population.     

脑弥漫性轴索损伤CT与临床的表现(附14例报告)

目的结合临床分析脑弥漫性轴索损伤(DAI)的CT诊断及价值。方法对41例DAI的CT表现及临床特点进行回顾性分析,其中男30例,女11例,年龄范围从15～67岁,平均年龄为30.5岁。据临床症状,把病人分轻、中、重3组。结果轻度组10例,CT表现以单侧脑肿胀、单纯脑实质点状出血或蛛网膜下腔出血为主;中度组15例,CT表现以弥漫性脑肿胀和大脑深部灰质点状出血为主;重度组16例,CT表现以重度弥漫性脑肿胀合并灰白质交界处点状出血及硬膜外、下出血为主。结论CT表现能反应DAI临床表现的轻重,对DAI的诊断及预后有较高的价值。     

多层螺旋CT尿路造影在医源性输尿管损伤诊断中的应用体会

目的探讨多层螺旋CT尿路造影(MSCTU)在医源性输尿管损伤的诊断价值。方法选取该院2009年3月至2012年3月收治的6例输尿管医源性损伤的病例,进行16排螺旋CT增强扫描,同时进行三维输尿管重建,将诊断结果与外科手术病理证实结果进行对照分析。结果 6例医源性输尿管损伤的病例进行MSCTU检查,均显影清晰,对比剂自受损的输尿管下段溢至宫颈阴道内,其中右侧输尿管2例,左侧输尿管4例;4例单处损伤,2例为多处损伤。损伤部位经外科手术病理证实均吻合,诊断符合率达到100%。结论 16排螺旋CT扫描速度快,图像后处理功能强大,图像分辨率高且质量好,可以清晰地观察到受损输尿管的部位及对比剂的流向,对医源性输尿管损伤定位、定性具有较高的临床应用价值。     

导致脑外伤后再灌注损伤的临床因素分析

目的 分析导致脑外伤后再灌注损伤的临床因素.方法 回顾总结2002年2月至2010年8月因脑外伤入院治疗过程中并发脑再灌注损伤87例患者的临床资料.结果 复查头颅CT显示87例均存在脑梗死,其中大面积脑梗死13例,格拉斯哥昏迷评分法(GOS)Ⅰ级6例,Ⅱ级3例,Ⅲ级3例,Ⅳ级1例,Ⅴ级0例;小面积梗死74例,GOSⅠ级2例,Ⅱ级0例,Ⅲ级11例,Ⅳ级34例,Ⅴ级27例.大面积脑梗死组患者GOSⅠ级和Ⅱ级比率明显高于小面积脑梗死组患者,差异有显著统计学意义(P<0.01);小面积脑梗死患者GOSⅤ级比率优于大面积脑梗死组患者,差异有统计学意义(P<0.05);小面积脑梗死患者GOSⅣ级比率明显大于大面积脑梗死组患者,差异有统计学意义(P<0.01);而两组患者GOSⅢ级比率,差异无统计学意义(P＞0.05).结论 脑外伤治疗过程中并发脑再灌注损伤可以导致患者病情加重,患者的伤残率及死亡率明显增高.     

Clinically suspected coagulopathy in blunt head trauma

Patients with moderate to severe head injury and abnormal coagulation studies have a significantly higher risk of brain injury. The objective of this study was to determine the association of clinical suspicion of coagulopathy and intracranial injury (ICI) among patients sustaining blunt head trauma, including minor injuries. As part of the NEXUS II blunt head injury study, enrolled patients were prospectively evaluated for ICI and suspicion of coagulopathy. We examined the relationship between suspicion of coagulopathy and the presence of any clinically significant or "therapeutically inconsequential" ICI based on head computed tomography (CT) scan results. The NEXUS II study enrolled 13,728 patients, including 493 with suspicion of coagulopathy. Significant ICI was present in 46 (9.3%; 95% confidence interval [CI] 6.9-12.2) patients with suspected coagulopathy, and in 460 of 9863 (4.7%; 95% CI 4.3-5.1) patients without such suspicion. "Therapeutically inconsequential" findings were found on head CT scan in 74 patients, and 7 of these had suspected coagulopathy. Interventions including intubation, intracranial pressure monitoring, or craniotomy were performed in 5 of these 7 (71%; 95% CI 29-96) individuals, compared with only 3 of 67 (4%; 95% CI 1-12) patients without suspicion of coagulopathy. Initial clinical suspicion of coagulopathy, independent of laboratory confirmation, is associated with a greater prevalence of significant ICI injury after blunt head trauma; it also substantially increases the risk of morbidity despite the presence of an apparent "therapeutically inconsequential" injury. CT scanning of the head should be performed initially based on clinical suspicion of coagulopathy.     

CT or not CT--that is the question. Whether 'tis better to evaluate clinically and x ray than to undertake a CT head scan!

Objective: To evaluate the usage of computed tomography (CT) head scanning in children at the Royal Aberdeen Children''s Hospital after the publication of the National Institute of Clinical Excellence (NICE) guidelines on the management of head injury. Methods: The Accident and Emergency case records of all children presenting with a head injury over a three month period were reviewed and the number of attendances, radiographs, and CT head scans undertaken were noted. Also noted was the number of additional CT head scans that would have been performed if the NICE guidelines had been rigidly followed. Results: Five hundred and thirty seven children were included in the study: 67% were boys. Two hundred and ten (39%) had skull radiographs: six demonstrated skull fractures and eight (1.5%) underwent CT head scan, with one positive report of a skull fracture. There were no reports of intracranial abnormalities. Ninety nine (18.4%) were admitted. Strictly applying all the NICE criteria for CT scanning would have resulted in an additional 54 patients being scanned. Conclusion: Rigid adherence to the NICE guidelines in all children with head injuries would have resulted in an almost eightfold increase in CT head scans performed. None of these children had clinical signs of intracranial injury and would have been exposed to a large amount of ionising radiation. The use of guidelines in practice must always be considered in conjunction with clinical judgement.     

LISFRANC FRACTURE-DISLOCATION IN A FEMALE SOCCER ATHLETE

Individuals with midfoot injuries may present to physical therapists in a variety of clinical settings. The ability of the physical therapy practitioner to optimally manage the care of such an individual may be dependent on understanding the diagnostic imaging that is indicated or has been been completed. Among the potentially most debilitating midfoot injuries are Lisfranc fracture-dislocations. This case outlines the use of conventional radiology, standard computerized tomography (CT), and three-dimensional CT for differential diagnosis of Lisfranc and associated midfoot injury in a 26 year-old female recreational athlete. Her subsequent surgical and post-surgical management is briefly discussed.Physical therapists evaluating patients with suspected midfoot injuries should be cognizant of the tendency for Lisfranc injuries to escape initial detection, possibly precipitating misdiagnosis or delay to diagnosis. Nonweight-bearing radiography may be insensitive to demonstrating the anatomical disruption of significant midfoot injuries. Weight-bearing radiographic views along with selective use of MRI and CT aid in proper identification of injury to the tarsometatarsal joints and optimal management of patients with these injuries.