桥脑出血的临床、CT与MRI

本文收集了经ＣＴ或ＭＲＩ证实的桥脑出血１９例，结合其ＣＴ及ＭＲＩ表现，对其临床表现进行分析，并比较ＣＴ及ＭＲＩ对桥脑出血的诊断价值。提出桥脑出血的预后与出血的部位及数量有关。桥脑出血各期ＭＲＩ均有阳性表现，且ＭＲＡ（磁共振血管成像）无创伤，可发现隐匿血管畸形，有助于桥脑出血病因诊断，故桥脑出血的最佳影像诊断方法为ＭＲＩ。     

桥脑出血24例

目的探讨桥脑出血的临床和ＣＴ、ＭＲＩ的改变，出血部位、出血量与预后的关系。方法选择有头部ＣＴ、ＭＲＩ材料的２４例桥脑出血病例，对其出血部位、出血量与预后的关系进行比较分析。结果发现多部位出血，出血量≥５ｍｌ以上症状复杂，死亡１００％；出血部位单一、出血量＜５ｍｌ症状轻，死亡率２５％，两者差异性显著（Ｐ＜０．０５）。结论桥脑出血的部位、出血量是影响预后的主要因素     

“自发性”桥脑出血

本文报告了“自发性“桥脑出血１２例，对其临床表现，神经放射检查及手术治疗诸问题作了较深入分析，出血原因系脑血管畸形，病理证实３例为海绵状血管瘤，２例为ＡＶＭ和２例为畸形血管。我们认为，目前ＭＲＩ检查是术前诊断最主要方法，Ｘ－ＣＴ在急诊检查及术后随诊中起一定作用，而脑血造影对诊断几乎没有帮助。全组术后平均随访２年，结果令人满意，提出，无论哪种类型的血管畸形所造成的桥脑血肿，尤其病灶较大者，手术治疗能     

多系统萎缩的临床与CT及磁共振分析

目的　评价临床表现与ＣＴ、磁共振（ＭＲＩ） 结合对多系统萎缩（ＭＳＡ） 的诊断价值。方法　选择５６ 例多系统萎缩病人，其中橄榄桥脑小脑萎缩（ＯＰＣＡ）３７ 例，Ｓｈｙ－ Ｄｒａｇｅｒ 综合征（ＳＤＳ）１３ 例，纹状体黑质变性（ＳＮＤ）６ 例。全部病人均行头颅ＣＴ、ＭＲＩ检查，并对其临床表现、分型、ＭＲＩ进行比较。结果　临床发现各型早期各有特点，且ＭＲＩ表现也各不相同。结论　临床表现与ＭＲＩ结合可提高ＭＳＡ 中ＯＰＣＡ、ＳＮＤ的诊断率，但在ＳＤＳ病人ＭＤＩ改变不明显。头颅ＣＴ对ＭＳＡ 诊断意义不大。     

脑干海绵状血管瘤影像学

目的：结合临床表现特点，对４８例有组织学结果的脑干海绵状血管瘤的影像学表现进行分析。方法：４８例依发作方式分为两种类型。一类表现为突然发作的颅神经及传导束症状，部分为反复类似发作；另一种为静止性发作。所有病人均进行了ＣＴ及ＭＲＩ检查。并通过手术得到病理证实。结果：所有病例ＣＴ及ＭＲＩ均表现出海绵状血管瘤的特点。在非增强ＣＴ扫描表现为等或稍高密度，在增强ＣＴ扫描，病灶表现为轻至中度强化，水肿及占位效应均不明显。ＭＲＩ扫描表现为高信号或混杂信号，代表不同时相的出血及胶质样变。部分病例可见典型的桑椹样或网络样结构。除１８例病灶位于延髓或中脑外，大多病灶位于桥脑。３例在梯度回波扫描可见多发病灶。有１例组织学可见海绵状血管瘤的血管腔内存在弹性纤维；４例可见引流静脉及供血动脉。结论：桥脑是脑干海绵状血管瘤最常见部位；影像学特别是ＭＲＩ表现与病程及病变构成有关；部分组织病理学具有与其它血管畸形重叠的特点。手术彻底切除病灶对防止复发非常重要。     

桥脑梗塞的临床、CT、MRI分析（附60例报告）

桥脑梗塞的临床、ＣＴ、ＭＲＩ分析（附６０例报告）金莎，马温良脑干梗塞属于少见而又严重的脑梗塞部位，其中以桥脑梗塞多见。我院自１９８９年９月～１９９５年１０月共收治桥脑梗塞６０例。现将其临床、ＣＴ及ＭＲＩ表现报道如下。临床资料一、一般资料：６０例中男４...     

自发性桥脑出血CT、MRI所见与生命预后

本文对２２例自发性桥脑出血患者的ＣＴ、ＭＲＩ检查结果、临床表现与生命预后的关系进行了分析，发现多部位出血、出血量＞６ｍｌ，表现复杂的死亡率达８０％－９１％；出血部位单一，出血量＜４ｍｌ，表现轻的死亡率为４０％－４６％，两者比较有显著差异（Ｐ＜０．０５）。认为出血部位、出血量是影响桥脑出血患者预后的最主要因素。     

闭锁综合征114例临床分析

目的：探讨闭锁综合征的临床，ＣＴ，ＭＲＩ，病理及生命预后。方法：详细临床查体，ＣＴ，ＭＲＩ及病理解剖确定脑部受损部位及波及范围。结果：证明ＭＲＩ对此征有重要诊断价值。结论：临床有浅感觉障碍或去大脑强直发作，病变波及桥脑被盖者生命预后差，肺内感染是此征的常见并发症及死因。     

CT,MRI和DSA诊断蛛网膜下腔出血价值的评价

本文通过对７９例ＳＡＨ的临床、ＣＴ、ＭＲＩ和ＤＳＡ的对照研究，发现ＣＴ对急性期ＳＡＨ诊断价值较大，可作为筛选措施。ＭＲＩ对亚急性ＳＡＨ及隐匿性血管畸形的诊断优于ＣＴ和ＤＳＡ。ＤＳＡ可直观显示动脉瘤、动静脉畸形和供血动脉、引流静脉，还可作介入治疗。     

病毒性脑炎的头颅MRI表现

目的 研究头颅核磁共振（ＭＲＩ）对病毒性脑炎的早期诊断价值。方法 观察１０例病毒性脑炎患者头颅ＣＴ、ＭＲＩ表现,其中８例增强扫描。５例行快速液体衰减反转回复（ＦＬＡＩＲ）检查。结果 头颅ＭＲＩ较ＣＴ发现更多病灶,其病灶多不增强,ＦＬＡＩＲ技术可以更清发现病灶,其中单纯疱疹病毒性脑炎的ＭＲＩ更有其特征性表现。结论 头颅ＭＲＩ有助于病毒性脑炎的早期诊断同。     

Spontaneous muscular haematomas in hemiplegic patients receiving anticoagulation therapy

INTRODUCTION: Muscular hematomas are frequently reported as a complication of anticoagulation therapy. METHODS: We report six cases of spontaneous muscular hematomas occurring in hemiplegic patients receiving anticoagulation therapy using heparin, low-molecular-weight heparin or fluindione. Anticoagulation therapy was given in prophylactic doses to two patients to prevent deep vein thrombosis and in therapeutic doses to four patients with deep vein thrombosis, pulmonary embolism or cardiac arrhythmia. Two patients experienced episodes of bleeding when heparin and fluindione were temporarily associated. RESULT: Contrary to previous reports, the more frequent site of bleeding was not the ilio-psoas muscle (only 2 patients); hematomas were also observed in hip adductors and gluteus muscles. The most striking finding was the constant location of the hematoma on the hemiplegic side. CONCLUSION: Location on the hemiplegic side can lead to underestimating the frequency of neurologic compression by the hematoma; the diagnosis can nevertheless be established by electromyography. Local signs may not be present, but general signs of hypovolemia and anemia are more frequent. Ultrasound may be the first line investigation but in our experience, the results can be misleading and computed tomography (CT) or MRI are often required to confirm the diagnosis.     

慢性硬脑膜下血肿的血肿成份分析及发病机理研究

作者对65例慢性硬膜下血肿病人的血肿成份进行分析,以探讨该病的发病机理及治疗问题。血肿成份的分析证实活体病人血肿液的血红蛋白及红细胞含量与血肿的CT值是显著性正相关,血肿液的血红蛋白与红细胞含量与病人的病程无显著相关性。对血肿性状的分析提示采用颅骨钻孔引流术可有效地清除血肿。本组观察结果支持该病的发病机理与原发血肿外膜持续出血致血肿扩大有关的理论。     

Prognostic evaluation of brainstem hematomas: the role of CT scan and brainstem auditory evoked potentials

Abstract– 6 cases of brainstem hematoma were studied utilizing CT scan and brainstem auditory evoked potential (BAEP) recordings. CT scan did not contribute to an early discrimination between primary and secondary hematomas. Size of the hematoma and the presence of blood in the CSF did not represent evident signs in differentiating benign from unfavourable brainstem hematomas or hemorrhages. BAEP recordings showed the presence of electrophysiological anomalies at the level of the lesion, demonstrating that bleeding as well as tumor in the brainstem can provoke a focal damage.     

骨瓣成形术清除迟发性骑跨横窦巨大硬膜外血肿

目的探讨骨瓣成形术清除迟发性骑跨横窦巨大硬膜外血肿的临床效果。方法对11例迟发性骑跨横窦巨大硬膜外血肿,采用枕部倒"U"切口骨瓣成形清除血肿的手术方法。结果术前幕上血肿约40~120 ml,幕下血肿约10~15 ml左右。骑跨横窦巨大硬膜外血肿均被清除彻底,且止血可靠,骨瓣复位稳定。结论与传统手术方式相比,骨瓣成形术清除骑跨横窦的硬膜外血肿具有进颅迅速、直视止血、不留颅骨缺损等优点。     

Visualization of an actively bleeding cortical vessel into the subdural space by CT angiography

Spontaneous subdural hematomas of arterial origin are rare with only a few published case reports in the literature. In the CT era, vessel imaging of extra-axial hematomas is not commonly performed. In this case report we present a patient with a large, spontaneous acute subdural hematoma that demonstrated active contrast extravasation from a small cortical vessel on CT angiography. During surgical evacuation the vessel was confirmed to be a small cortical artery that was bulging through the arachnoid membrane and bleeding into the subdural space. The historical, radiographic, and clinical aspects of this unusual cause of subdural hematoma are discussed.     

The prognostic value of the CT scan in conservatively treated patients with intracerebral hematoma

Prognostic factors for survival and neurological recovery were assessed in 42 patients with nontraumatic intracerebral hematoma (ICH) diagnosed by CT scan. None underwent surgical evacuation of hematoma. CT scans were used to determine location and volume of ICH and presence or absence of intraventricular hemorrhage (IVH). Only 11 patients (26%) died and 17 patients (40.5%) recovered fully. Mortality was associated with: 1) loss of consciousness as a presenting symptom (63.5% mortality rate versus 13% when there was no loss of consciousness at the onset; p less than 0.01). 2) extension of the bleeding into the ventricular system (45% mortality rate versus 9% when hemorrhages were confined to brain parenchyma; p less than 0.01). 3) location of hematoma in the posterior fossa (mortality rate of 43% versus 23% for intrahemispheric hematomas). Mortality was unaffected by age of patients and size of ICH. Full neurological and functional recovery occurred mainly when estimated volume of hematomas was less than 15 cc and with lobar hematomas regardless of size. In survivors there is CT evidence of complete resolution of ICH. Our data indicates a favourable outcome in a relatively large percentage of patients with ICH treated conservatively and therefore questions the need for surgical evacuation of hematoma.     

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.     

Chronic epidural hematoma of the vertex

Epidural hematomas of the cranial vertex can be rarely found in patients victims of head trauma. The diagnosis of the vertex hematoma may be delayed by the odd location of the bleeding site and the absence of a clear localization symptomatology. The current method of choice for investigation of head trauma patients, the computed tomography (CT) scans, may also give misleading diagnostic clues. Epidural hematomas of the vertex can be also encountered in a chronic form, and re-bleeding is possibly the underlying mechanism for the long term permanence of the hematoma. We report a case of a patient with a chronic epidural hematoma of the cranial vertex with a long interval between the trauma and the symptoms onset. We review the current literature focusing on the diagnostic pitfalls and forms of treatment of the chronic epidural hematoma of the vertex.     

自发性低颅压综合征伴双侧硬膜下血肿二例

目的探讨自发性低颅压综合征的临床表现及影像学特征,以及其并发症慢性硬膜下血肿的处理。方法收集河北医科大学第二医院就诊的2例自发性低颅压综合征伴慢性硬膜下血肿的临床资料。分析该病的主要临床表现及影像学特征,及其慢性硬膜下血肿的处理。结果自发性低颅压综合征伴慢性硬膜下血肿,若有血肿进展或意识改变应及时外科治疗。结论自发性低颅压综合征伴慢性硬膜下血肿应密切观察患者病情,随访CT/MRI,了解有无血肿的进展,以便及早给予相应的治疗。