“无症状”的幕上硬膜外血肿的期待疗法

作者将CT 所见的血肿量、厚度、中线移位程度及GCS 作为急性硬膜外血肿(EDH)非手术治疗选择的条件,并对符合这些条件的病人治疗的有效性进行了评价,同时探讨了这些病人最佳住院时间。     

急性脑外伤 TRH 兴奋试验改变及对伤情估价和预后判定的意义

本文通过分析66例急性脑外伤病人和34例对照者的血清 TSH、PRL 和 GH 浓度变化及 TRH兴奋试验的改变,探讨 TRH 兴奋试验在急性脑外伤病人病情估计和预后判定方面的意义。发现:TRH 兴奋试验改变与病情和预后的不同有关。13例对 TRH 无反应者中,10例见于特重组,13例全部死亡。随着伤情的加重,预后的变坏,TSH、PRL 和 GH 浓度也越来越高,TSH 和 PRL 对 TRH的反应也越来越差。应用激素计分法判定预后,正确率为82%。作者认为 TRH 兴奋试验可作为估价病情,判定预后的指标。     

CT扫描对急性颅压高患者颅内压估价的临床作用

目的 :通过对 2 10例脑外伤患者的 CT资料进行研究 ,评价其对急性颅压高的临床价值。方法 :应用日立牌 W- 10 0 0 / W- 2 0 0 0型全身 CT机 ,对因脑外伤所致的脑挫伤及颅内血肿进行扫描 ,并随机选择 36例患者在 CT扫描后行腰椎穿刺颅内压测定。结果 :6 5例脑室及脑池无受压 ,中线结构无移位 ,有 145例脑室和脑池轻度和重度受压、变形移位 ,死亡率分别为 48.6 %和 87%。 36例患者颅内压测定显示脑室和脑池受压越重脑压越高。结论 :脑外伤所致脑挫伤及颅内血肿的高颅压程度可用 CT扫描进行评价 ,脑室及脑池的受压程度与颅内压成正比 ,对临床治疗有较大的指导价值。     

硬膜外血肿手术后脑水肿临床多因素分析

目的探讨急性硬膜外血肿患者术后脑水肿发生的机制及其影响因素和术中去骨瓣减压的指征。方法将150例急性硬膜外血肿患者分为水肿组和无水肿组两组,根据患者GCS评分,瞳孔大小,血肿量,CT或MR检查脑中线移位程度,结合手术时间、中线及周围池改变、血肿部位、年龄及是否有原发昏迷等资料进行统计学分析。结果两组在术前GCS评分,瞳孔进行性散大,血肿量增大,脑中线结构移位程度加重,手术拖延等方面均有显著性差异(P＜0．01)而在血肿部位、年龄、是否有原发昏迷等方面未见显著差异(P＞0．05)。结论急性硬膜外血肿术后脑水肿主要是急性脑受压造成的；脑受压程度越重、时间越长,术后脑水肿越严重；早期手术是避免或减轻术后脑水肿的有效措施,对术后发生较大范围的脑水肿病例应及时去骨瓣减压。     

急性半球脑肿胀伴颅内血肿的临床、CT及预后

目的　探讨外伤后急性半球脑肿胀 (HBS)伴颅内血肿的临床特点及治疗方法。　　方法　分析 36例急性半球脑肿胀伴颅内血肿病人的临床表现、CT特点及手术治疗结果。　　结果　急性半球脑肿胀伴颅内血肿多见于交通事故伤 ,临床多表现为外伤后持续昏迷及明显的颅高压。CT表现以中线移位程度与血肿厚度不成比例为其特点。手术治疗的死亡率为 33 3%。　　结论　手术治疗是降低该类病人死亡率的重要措施。预后决定于脑肿胀程度、血肿类型、能否早期的诊断及治疗。     

高血压性脑出血CT分型和治疗方法探讨

本文报告经 CT 检查高血压性脑出血80例。保守治疗36例,手术治疗44例。进行了 CT 分型,测量和计算了血肿量。认为血肿大、中线结构移位显著、血肿穿破脑室、急性脑室扩大和环池—四叠体池消失预后不好,並根据 CT 所见和临床表现提出了治疗适应症。     

血清D-二聚体水平与急性脑出血疾病严重程度及早期预后的关系

目的探讨血清中D-二聚体水平与急性脑出血疾病严重程度及早期预后的关系。方法收集2015年1月～2016年8月于中国医科大学附属盛京医院神经外科住院治疗的128例急性脑出血患者临床资料,患者入院24 h内均行脑CT检查明确脑出血诊断,根据1周内随访患者是否死亡将入组患者分为生存对照组与死亡病例组。分析血清D-二聚体水平与血肿量、中线移位距离、入院格拉斯哥评分(GCS评分)相关性及血清D-二聚体水平对急性脑出血患者早期预后的影响。结果 128例急性脑出血患者中,死亡病例组24例,生存对照组104例。死亡病例组患者血清D-二聚体含量、出血量、脑CT中线移位距离、手术率均显著高于对照组(均P0.001);Spearman相关性分析显示血清D-二聚体含量与患者脑出血血肿量(r=0.426)及中线移位距离(r=0.454)呈正相关性;与入院GCS评分(r=-0.486)呈负相关性(均P0.05)。血清D-二聚体水平预测急性脑出血患者1周不良预后的ROC曲线下面积为0.908(P0.05),其临界值为450.50μg/L时,灵敏度为0.960,特异度为0.827。Logistic回归分析显示,血清D-二聚体含量及中线移位距离是急性脑出血患者1周内死亡的独立危险因素(均P0.05)。结论急性脑出血患者血清中D-二聚体含量显著增加,且与血肿量、中线移位距离、入院GCS评分呈显著相关性,D-二聚体可作为急性脑出血疾病严重程度判断指标之一,D-二聚体含量增高是急性脑出血患者1周内死亡的独立危险因素。     

脑弥漫性轴索损伤

报告48例脑弥漫性轴索损伤(DAI),占同期重型脑外伤的11.9%;病例选择是根据外伤机理,有原发昏迷,无定侧体征;详细分析了 CT 扫描的特征。讨论了 DAI 的分类及诊断条件,本组死亡率为64%,是重型脑外伤死亡的主要原因。对于 DAI 伴有脑挫伤、脑实质血肿并有中线移位者,手术去除血肿及去骨减压,可挽救部分病人生命,其治疗后果取决于 DAI 的严重程度。     

急性脑外伤血清EDLS浓度的变化及其意义探讨

检测57例急性脑外伤患者24小时内血清EDLS含量的变化,并对其中29例行TRH刺激试验。结果显示:脑伤各组血清EDLS水平显著高于对照组;GCS≤8组和死亡组EDLS水平又分别显著高于GCS>8组和生存组。TRH刺激后GCS>8组和生存组EDLS水平升高,30分钟达高峰,而GCS≤8组和死亡组EDLS水平逐渐下降。提示脑外伤后下丘脑的分泌及其分泌的调节有明显改变。测定血清EDLS水平有助于脑伤程度判断及预后估计。     

外伤性急性硬膜下血肿的预后因素探讨

目的探讨影响外伤性急性硬膜下血肿(ASDH)预后的因素。方法术后3个月,113例外伤性急性硬膜下血肿病人分为预后良好组(F组)和预后不良组(non-F组),对其术前资料进行回顾性分析比较。结果F组的年龄低于non—F组(P<0.05),GCS评分低于后者(P<0.01);瞳孔光反射阳性率和中脑周围池开放率高于后者(P<0.05).而伴随的脑挫伤、脑内血肿,蛛网膜下腔出血的发生率(P<0.05)及中线移位程度(P<0.01)低于后者。结论年龄、GCS评分、瞳孔对光反射和中脑周围池形态、中线移位程度及伴随颅内损伤的复杂、严重程度与ASDH病人预后有关,而瞳孔变化和CT影像学所提示的征象是反映ASDH病人预后的最为重要的因素。     

Supratentorial epidural hematoma of traumatic etiology in infants

Introduction and background Traumatic epidural hematoma (EDH) represents a rare head injury complication in infants. Its diagnosis can be quite challenging because its clinical presentation is usually subtle and nonspecific. In our current communication, we present our data regarding the presentation of infants with EDH, their management, and their long-term outcome. Materials and methods In a retrospective study, the hospital and outpatient clinic charts and imaging studies (head CT and skull X-rays) of 31 infants with pure, supratentorial EDH of traumatic origin were meticulously reviewed. Children Coma Scale score and Trauma Infant Neurologic Score (TINS) were also reviewed. The most common presenting symptom was irritability, which occurred in 18/31 (58.1%) of our patients. Pallor (in 30/31 patients) and cephalhematoma (in 21/31 patients) were the most commonly occurring clinical signs upon admission; both signs represent signs of significant clinical importance. Surgical evacuation via a craniotomy was required in 24/31 of our patients, while 7/31 patients were managed conservatively. The mortality rate in our series was 6.5% (2/31 patients), and our long-term morbidity rate was 3.2% (1/31 patients). Conclusions EDH in infants represents a life-threatening complication of head injury, which requires early identification and prompt surgical or conservative management depending on the patient’s clinical condition, size of EDH, and presence of midline structure shift on head CT scan. Mortality and long-term morbidity are low with early diagnosis and prompt treatment.     

Spontaneous Epidural Hematoma from Skull Base Metastasis of Hepatocellular Carcinoma

We report a case of an acute spontaneous epidural hematoma (EDH) due to skull base metastasis in a 46-year-old male patient with hepatocellular carcinoma (HCC). The patient presented with the acute onset of severe headache followed by unconsciousness, and computed tomography showed a large EDH in the right temporal and parietal lobes with midline shift. Emergency evacuation of the EDH was performed, and the hemorrhage was determined to be secondary to skull base metastasis of HCC.     

Double extradural hematoma: an analysis of 46 cases

AIMS: The authors analyze epidemiology, location, clinical profile and outcome of double extradural hematoma (EDH) or EDH at more than one site. DESIGN: A retrospective clinical study. MATERIALS AND METHODS: 46 cases of double EDH were studied. All the cases were evaluated for their mode of injury, clinical presentation, level of sensorium at the time of injury, CT scan finding and outcome after surgery, and were compared with single EDH cases. RESULTS: Out of 1025 cases 46 cases had 'double' EDH. There was bilateral EDH in 39 cases; multiple EDH in 3 cases and ipsilateral double EDH was present in 4 cases. The most common site was frontal (70%). The majority of the patients (80.3%) were in altered sensorium from the time of injury, similar situation was seen in 52.2% of cases with single EDH. The number of patients having a low GCS score was higher when first examined in the double EDH group and the mortality rate was 34.8% as compared to 9% in the single EDH group. CONCLUSION: Majority of the double EDH cases presented with a low GCS and there was a relatively quick neurological deterioration in these cases.     

Spontaneous Intracranial Epidural Hematoma Originating from Dural Metastasis of Hepatocellular Carcinoma

Spontaneous intracranial epidural hematoma (EDH) due to dural metastasis of hepatocellular carcinoma is very rare. A 53-year-old male patient with hepatocellular carcinoma, who was admitted to the department of oncology, was referred to department of neurosurgery because of sudden mental deterioration to semicoma with papillary anisocoria and decerebrate rigidity after transarterial chemoembolization for hepatoma. Brain computed tomography (CT) revealed large amount of acute EDH with severe midline shifting. An emergent craniotomy and evacuation of EDH was performed. Active bleeding from middle cranial fossa floor was identified. There showed osteolytic change on the middle fossa floor with friable mass-like lesion spreading on the overlying dura suggesting metastasis. Pathological examination revealed anaplastic cells with sinusoidal arrangement which probably led to spontaneous hemorrhage and formation of EDH. As a rare cause of spontaneous EDH, dural metastasis from malignancy should be considered.     

脑中线区外伤性出血的治疗与预后

目的 探讨创伤性脑中线区出血的诊断、治疗和预后。方法 选择经CT证实脑中线区域有出血灶的重型颅脑损伤住院患12例。测算血肿体积和血肿距中线距离。急性期后隔日腰椎穿刺测CSF压力，计算平均CSF压力。采用Glasgow预后评定方法评估患预后。结果 预后不良4例(死亡1例、重残1例、中残2例)，恢复良好8例。平均腰椎穿刺CSF压力以及血肿体积在恢复良好和预后不良患组间无明显统计学差异，但预后不良组的血肿距中线距离则明显短于恢复良好组。结论 创伤性脑中线区域出血符合脑弥漫性轴索损伤(diffuse axonal injury，DAI)的病理改变，血肿距中线距离与患预后密切相关。     

中重度颅脑损伤后CT影像特点、颅内压与预后的关系

目的研究中、重度颅脑损伤病人颅内压、CT影像特点及预后之间的关系.方法对28例中、重度颅脑损伤病人行颅内压监测和头部CT扫描,记录颅内压值和CT影像特点(基底池受压、中线移位、脑室受压情况),并进行Rotterdam CT评分,对这些因素进行统计学分析.结果经统计学分析:各CT影像特点与颅内压水平存在相关性,Rotterdam CT评分与颅内压水平的相关性最强.伤后24 h颅内压水平与病人预后相关性最强,而中线移位和脑室受压情况与预后无明显相关性.结论在评估中、重度颅脑损伤病人颅内压及预后方面,Rotterdam CT评分优于单个CT影像特征；颅内压与病人预后存在负相关,对中重、度颅脑损伤行颅内压监测,并进行相关治疗有利于改善预后.     

Outcome prediction in severe head injury: analyses of clinical prognostic factors.

Retrospective analysis of 272 patients with severe head injury was performed. Patient age, Glasgow Coma Scale (GCS) score, pupillary abnormalities, impaired oculocephalic response, presence of subarachnoid haemorrhage, and multiplicity of parenchymal lesions on computerised tomography (CT) were examined. The CT findings were divided into 2 groups, diffuse brain injury (DBI) and mass lesion, according to the classification of the Traumatic Coma Data Bank. The DBI, basically, has no high or mixed density lesion more than 25 ml on CT, and was classified into 4 subgroups: DBI I includes injuries where there is no visible pathology; DBI II includes all injuries in which the cisterns are present with a midline shift of less than 5 mm; DBI III includes injuries with swelling where the cisterns are compressed or absent and the midline shift is less than 5 mm; DBI IV includes injuries with a midline shift of more than 5 mm. The mass lesions were categorised into 3 subgroups: epidural haematoma; acute subdural haematoma; and intracerebral haematoma. Outcomes were determined at 6 months following trauma using the Glasgow Outcome Scale. All DBI I patients recovered well. In the DBI II group, age, GCS score and detection of multiple parenchymal lesions on CT were significantly correlated with outcome. For the DBI III and IV groups, the only significant prognostic factor was the GCS score. In patients with a mass lesion, the GCS score was the only significant prognostic factor in the epidural haematoma group, but the GCS score and the presence of subarachnoid haemorrhage were predictive factors in the acute subdural haematoma group. Outcomes were unfavourable in the majority of patients with intracerebral haematoma. GCS score could predict outcome in all groups. The confidence of the outcome prediction ranged from 75.8 to 92.1%, depending on logistic regression analysis.     

Is Routine Repeated Head CT Necessary for All Pediatric Traumatic Brain Injury?

Objective

Repeated computed tomography (CT) follow up for traumatic brain injury (TBI) patients is often performed. But there is debate the indication for repeated CT scans, especially in pediatric patients. Purpose of our study is to find risk factors of progression on repeated CT and delayed surgical intervention based on the repeated head CT.

Methods

Between March, 2007 and December, 2013, 269 pediatric patients (age 0-18 years) had admitted to our hospital for head trauma. Patients were classified into 8 subgroups according to mechanisms of injury. Types, amount of hemorrhage and amount changes on repeated CT were analyzed as well as initial Glasgow Coma Scale (GCS) scores.

Results

Within our cohort of 269 patients, 174 patients received repeat CT. There were progression in the amount of hemorrhage in 48 (27.6%) patients. Among various hemorrhage types, epidural hemorrhage (EDH) more than 10 cc measured in initial CT was found to be at risk of delayed surgical intervention significantly after routine repeated CT with or without neurological deterioration than other types of hemorrhage. Based on initial GCS, severe head trauma group (GCS 3-8) was at risk of delayed surgical intervention after routine repeated CT without change of clinical neurologic status.

Conclusion

We suggest that the patients with EDH more than 10 cc or GCS below 9 should receive repeated head CT even though absence of significant clinical deterioration.     

Actual asymptomatic epidural hematomas in childhood Report of three cases

It is well known that the mortality of epidural hematoma (EDH) cases is directly related to the patient's level of consciousness at the time of surgery. The authors report three actually asymptomatic patients with mild head injury, in whom the diagnosis of EDH was possible because of quite broad indications for computed tomographic (CT) scanning, which allowed diagnosis and treatment in an early phase. These cases illustrate the possibility of an EDH in a totally asymptomatic patient.     

重型颅脑损伤患者血清高敏C-反应蛋白、D-二聚体的变化及其意义

目的探讨重型颅脑损伤（STBI）患者血清高敏C-反应蛋白（hs—CRP）、D-二聚体（D—D）的动态变化及其意义。方法选择2011年12月至2012年12月收治的STBI患者80例,根据入院时GCS评分分为GCS6、7、8分三组,检测患者伤后1、3、7、14天hs-CRP、D—D浓度;选取同期健康志愿者20例作为对照组。结果STBI组伤后1、3、7、14d血清hs—CRP、D—D浓度均高于对照组（P〈0．01）;血清hs-CRP、D—D浓度与GCS评分、GOS评分呈显著负相关（P〈0．01）;血清hs—CRP、D—D浓度随颅脑CT中线移位程度的增加而显著升高（P〈0．05）。结论STBI患者血清hs—CRP、D—D浓度的动态变化能反映患者的伤情;早期检测血清hs—CRP、D—D可作为评估STBI预后的重要参数。