Relapsing juvenile chronic subdural hematoma in adult life.

Two cases of relapsing juvenile chronic subdural hematoma with late relapse in adult life are presented and the literature reviewed. Both patients contracted subdural hematoma early in life; its persistence resulted in characteristic skull deformitites. The patients led an asymptomatic life until a second head trauma caused rebleeding into the old hematoma sac with recurring symptoms and signs. The source of rebleeding is the outer subdural membrane. Radiographic features vary, depending on the location and size of the subdural hematoma. The significance of localized thickening of the cranium is stressed in refining the differential diagnosis.     

慢性硬膜下血肿钻孔引流术后并发症的预防及治疗

探讨慢性硬膜下血肿行钻孔引流（BHID）术后并发症的预防及治疗措施。认为只要合理掌握适应证,严格手术操作规范,重视术后治疗及护理,可以减少并发症的发生。     

轻度脑外伤患者SPECT局部脑血流显像

目的 探讨SPECT脑血流灌注显像在研究轻度脑外伤后临床症状发病机理中的作用。方法对39例无意识丧失、CT检查正常的轻度脑外伤患者进行^99Tc^m-双半胱乙酯(ECD)脑血流灌注断层显像。以双侧小脑平均每像素的均数为参比值，计算各大脑感兴趣区(ROI)放射性计数比值(RAR)。大脑皮质或基底神经节RAR低于70％，颞叶中部低于50％视为异常。结果39例患者中23例(59％)SPECT显示异常，其中3例为弥漫性血流灌注减低，20例为局部血流灌注减低灶，共计74个病灶。伤后3个月内脑血流灌注异常15例，2例为弥漫性血流灌注减低，13例为局灶性血流灌注减低；13例中发现病灶58个。8例受伤3个月后显像异常者，1例为弥漫性血流灌注减低，7例为局灶性血流灌注减低，发现病灶16个。结论 轻度脑外伤后患者主要症状为头痛、头昏、记忆力减退；无意识丧失的脑外伤患者可出现局部脑血流灌注减低，且SPECT检查比CT灵敏。     

99mTc HM-PAO brain perfusion SPECT in brain death

Diagnosis of brain death must be certain to allow discontinuation of artificial ventilation and organ transplantation. Brain death is present when all functions of the brain stem have irreversibly ceased. Clinical and electrophysiological criteria may be misinterpreted due to drug intoxication, hypothermia or technical artefacts. Thus, if clinical assessment is suboptimal, reliable early confirmatory tests may be required for demonstrating absence of intracranial blood flow. We have easily carried out and interpreted^99mTc HM-PAO SPECT in a consecutive series of 40 comatose patients with brain damage, without discontinuing therapy. Brain death was diagnosed in 7 patients, by recognising absence of brain perfusion, as shown by no intracranial radionuclide uptake. In patients in whom perfusion was seen on brain scans, HM-PAO SPECT improved assessment of the extent of injury, which in general was larger than suggested by CT.     

Correction for partial-volume effects on brain perfusion SPECT in healthy men.

The limited spatial resolution of SPECT scanners does not allow an exact measurement of the local radiotracer concentration in brain tissue because partial-volume effects (PVEs) underestimate concentration in small structures of the brain. The aim of this study was to determine which brain structures show greater influence of PVEs in SPECT studies on healthy volunteers and to investigate aging effects on SPECT after the PVE correction. METHODS: Brain perfusion SPECT using (99m)Tc-ethylcysteinate dimer was performed in 52 healthy men, 18-86 y old. The regional cerebral blood flow (rCBF) was noninvasively measured using graphical analysis. SPECT images were corrected for PVEs using gray-matter volume, which was segmented from coregistered MR images and convoluted with spatial resolution of SPECT scanners. Absolute rCBF data were measured using a 3-dimensional (3D) stereotactic template for regions of interest on anatomically standardized SPECT. We examined correlation of advancing age with rCBF before and after the PVE correction. To validate the correction method for PVEs, a Hoffman 3D brain phantom experiment was also performed. RESULTS: The PVE correction remarkably reduced the coefficient of variation for SPECT counts in the whole phantom. The PVE correction made the rCBF distribution more homogeneous throughout the brain with less intersubject variation than the original distribution. There were significant negative correlations between age and adjusted rCBF in the bilateral perisylvian and medial frontal areas. These correlations remained significant after the PVE correction. Instead of a positive correlation in the medial temporal structures between age and adjusted rCBF before the PVE correction, the sensorimotor and parietal areas mainly showed positive correlations after the correction. CONCLUSION: SPECT data reflect both brain volume loss and functional changes. Use of the PVE correction in brain perfusion SPECT provides a more accurate determination of rCBF even in healthy volunteers.     

Cerebral blood flow imaging with technetium-99m-HMPAO SPECT in a patient with chronic subdural hematoma: relationship with neuropsychological test.

We report the relationship between cerebral blood flow (CBF) and neuropsychologic tests in a patient with a chronic subdural hematoma suffering from severe dementia and left hemiparesis. Regional CBF was quantified using 99mTc-HMPAO SPECT and 133Xe-CBF. CBF-SPECT could detect the hematoma which was isodense by CT scan and the neuropsychological test improved remarkably with the increase in CBF after surgery. We conclude that if there is a strong clinical suspicion of subdural hematoma and CT scan is not diagnostic then CBF-SPECT may be valuable in localizing the hematoma and monitoring the effect of operation.     

Automated three-dimensional quantification of myocardial perfusion and brain SPECT.

To allow automated and objective reading of nuclear medicine tomography, we have developed a set of tools for clinical analysis of myocardial perfusion tomography (PERFIT) and Brain SPECT/PET (BRASS). We exploit algorithms for image registration and use three-dimensional (3D) "normal models" for individual patient comparisons to composite datasets on a "voxel-by-voxel basis" in order to automatically determine the statistically significant abnormalities. A multistage, 3D iterative inter-subject registration of patient images to normal templates is applied, including automated masking of the external activity before final fit. In separate projects, the software has been applied to the analysis of myocardial perfusion SPECT, as well as brain SPECT and PET data. Automatic reading was consistent with visual analysis; it can be applied to the whole spectrum of clinical images, and aid physicians in the daily interpretation of tomographic nuclear medicine images.     

慢性硬膜下血肿86例手术治疗分析

目的总结手术治疗慢性硬膜下血肿的经验。方法回顾性分析我科2004年1月—2012年9月86例慢性硬膜下血肿患者采用手术治疗的临床资料,其中83例,采用进一步改进的钻单孔引流法;3例采用内镜微创治疗。结果 86例患者术后3 d内症状有不同程度好转,随访3个月,血肿消失,无复发。结论针对不同类型的慢性硬膜下血肿,分别采用改进后的钻单孔引流法和内镜微创手术,疗效满意。     

罕见双侧慢性硬膜下血肿机化1例

男，53岁。间断头疼、眩晕1月余，服用止痛药可短暂缓解，入院前2厨上述症状进行性加重。既往无明确外伤史（自述）。发病以来，精神差，神志清，颅神经检查无异常。CT定位像示：额颞部颅内板下土豆形高密度影（见图1），大小约13cm×5cm；横轴位片示：双侧额颞顶颅内板下梭形高密度灶，边界较清，中央见等密度区及斑片状骨化灶，     

微创软通道对慢性硬膜下血肿的治疗

目的探讨慢性硬膜下血肿的简便、安全、有效的临床治疗方法。方法选择慢性硬膜下血肿的病人,随机分为传统外科手术组(对照组)和微创治疗组,对照组采用传统的外科手术治疗,微创治疗组采用简易脑立体定向微创软通道技术。结果两组治疗效果、复发率异差无统计学意义(P>0.05),两组的平均住院时间比较差异有统计学意义(P<0.05),外科手术治疗组平均住院时间高于微创治疗组。结论慢性硬膜下血肿实施定向微创软通道手术,较对照组,可减轻患者手术痛苦、扩大手术实施的人群范围,减少患者平均住院天数,治疗效果与传统外科手术治疗,无显著差异。