儿童硬膜外血肿的治疗

目的 探讨儿童硬膜外血肿的临床特点及其治疗方法。方法 回顾性分析我院2001年1月～2003年12月收治的儿童硬膜外血肿120例。结果 婴幼儿和学龄前儿童受伤原因以坠落伤及摔伤为主，7岁以上儿童以交通伤为主。65.8％(79/120)的患儿合并有颅骨骨折，格拉斯哥昏迷评分(GCS)平均13．6分。急性血肿除立即手术者外，其他于首次发现血肿1d后及3d左右再复查CT。手术者占57.5％(69/120)，术中发现血肿来源于板障出血的占44％(29/66)。结论 儿童硬膜外血肿的原发颅脑损伤相对较轻，颅骨骨折的发生率低于成人，板障出血为血肿形成的首要原因。有必要做多次CT检查，经恰当治疗预后良好。     

Delayed epidural hematoma after mild head injury

BACKGROUND: Traumatic delayed epidural hematoma (DEH) can be defined as insignificant or not seen on the initial CT scan performed after a trauma but seen on the subsequent CT scan as a "massive" epidural bleeding. CASE REPORT: We presented two cases of traumatic DEH after mild head injury. Both patients were conscious and without neurological deficit on the admission. Initial CT scan did not reveal intracranial hematoma. Repeated CT scan, that was performed after neurological deterioration, revealed epidural hematoma in both cases. The patients were operated with a favorable surgical outcome. CONCLUSION: Traumatic DEH could occur in the patients with head injuries who were conscious on the admission with a normal initial CT scan finding. Early detection of DEH and an urgent surgical evacuation were essential for a good outcome.     

Delayed intracerebral hemorrhage as demonstrated by CT scanning

Summary Three patients are presented who developed delayed intracerebral hematomas after head injury. Two patients had essentially negative CT scans on admission and developed intracerbral hematomas within 24 h after injury. They required surgical treatment and had fatal outcomes. The third patient presented with an epidural hematoma on CT scan, developed an intracerebral hematoma 48 h after evacuation of the epidural hematoma, and did well with conservative management.     

Epidural hematoma as a complication of sphenoid sinusitis and epidural abscess: a case report and literature review

Imaging is of paramount importance in early diagnosis of epidural abscess and its intracranial complications. Typical CT imaging features of an epidural abscess include a hypodense lentiform extra-axial collection with rim enhancement. We present a case of epidural abscess that was hyperdense on CT scan due to the presence of associated epidural hematoma. The literature is reviewed regarding this unusual complication of epidural abscess.     

跨窦骨瓣开颅术治疗骑跨静脉窦硬膜外血肿

目的 探讨骑跨静脉窦硬膜外血肿的手术治疗策略及疗效.方法 对43例骑跨静脉窦硬膜外血肿病例的临床资料、手术方式和预后进行回顾性分析.43例患者均采用跨窦骨瓣开颅,骨瓣复位,窦旁(周)硬脑膜悬吊于骨瓣相应位置的骨孔上.结果 43例术后第3、6天头部CT扫描显示血肿无复发、无残留,骨瓣无移位.出院时GOS预后评分:术后死亡1例,重度残疾1例,中度残疾2例,恢复良好39例.结论 跨窦骨瓣开颅术是治疗骑跨静脉窦硬膜外血肿的一种安全而且有效的方法.     

Nonoperative management of acute epidural hematoma diagnosed by CT: the neuroradiologist's role.

PURPOSE: To determine whether certain patients with epidural hematomas would benefit from conservative treatment and to assess the neuroradiologist's role in decision-making. METHODS: We reviewed the CT scan findings, clinical presentation and outcome of 48 consecutive patients with epidural hematoma managed at our institution within the past 5 years. In 18 patients, initial management was nonsurgical, and only one of these went on to require surgery due to clinical deterioration and evidence of enlargement of hematoma on CT. The remainder of these 18 did well without surgery. OBSERVATIONS AND CONCLUSIONS: Clinical indicators of neurologic dysfunction (decrease in Glasgow coma scale score, pupillary dilatation, and hemiparesis) in the presence of even small epidural hematomas usually dictates the need for surgical management. The role of the neuroradiologist is most important when the patient presents in a good clinical state, when identification of both favorable and unfavorable prognostic factors on Ct is essential. The initial diameter of nonsurgically managed epidural hematomas generally must be small (mean, 1.26 cm in our series, all under 1.5 cm), and midline shift should be minimal (mean, 1.8 mm in our series). The identification of lucent areas within the epidural hematoma (suggesting active bleeding), or CT evidence of uncal herniation, can be ominous and the neurosurgeon must be alerted to their presence. Even in the presence of a favorable clinical status, presence of a larger epidural hematoma with significant mass effect or central lucent areas should alert the neuroradiologist and neurosurgeon to the strong possibility of sudden neurologic deterioration, and indicate the probable need for surgical management.     

椎管内血肿的影像学表现

目的探讨椎管内血肿的CT及MRI表现特点,提高椎管内血肿CT及MRI表现的认识。方法回顾分析18例经手术及临床治疗随访复查证实的椎管内血肿的CT及MRI表现。18例患者均常规CT、MR平扫,其中2例MR增强扫描。使用GE公司Lightspeed16CT扫描仪,及Phillip1．5TAcheive超导MR扫描仪,2例MR增强扫描采用钆喷酸葡甲胺（Gd—DTPA）对比剂经静脉团注,注射剂0．1mmol/kg。结果颈胸段3例,胸段5例,胸腰段6例,腰段4例;位于脊髓背侧方14例,脊髓两侧2例、腹侧2例。硬膜外血肿11例,硬膜下血肿6例,硬膜外血肿并蛛网膜下腔内积血1例。CT表现为高密度或等密度,MRI分别呈长T1长T2信号、长T-短Tz信号、等T1短T2信号及短T1长T2信号,其中2例MR增强扫描,1例边缘强化,1例未见强化。结论椎管内血肿的CT、MRI表现具有一定的特征性,对其定性定位诊断及鉴别诊断有着重要的价值。     

Computed tomography of spinal epidural hematoma

Three cases of spinal epidural hematoma are presented. Computed tomography (CT) was the first diagnostic method used in two patients and demonstrated a surgically confirmed spinal epidural hematoma in both patients. In a third patient who presented with a complete block on myelography, CT was helpful in assessment of the extent of the lesion and suggested a vertebral hemangioma as the cause of the hematoma. CT is a very useful tool in the diagnosis of spinal epidural hematomas.     

外伤性颅内血肿332例分析

本文分析了从1980～1987年我院收治的外伤性颅内血肿332例。其中111例人院时已发生脑疝。本组总死亡率为16.9％。不同类型的血肿死亡率:特急型57.1％,急性型9.3％,亚急型无死亡。硬膜外血肿3.8％,硬膜下血肿39.1％,脑内血肿7.5％,多发性血肿27.9％,脑室内血肿50％。作者认为CT检查对脑室内血肿、小脑内血肿和基底节区血肿的诊断有重要意义,并强调了动态的CT观察的必要性,特别对迟发性血肿和多发性血肿尤为重要。此外,为了降低死亡率,应加强对并发症的防治和对脑损伤的治疗。     

CT myelography of spontaneous spinal epidural hematoma

A case of so-called spontaneous epidural hematoma is presented. A new constellation of myelographic and CT myelographic signs are described that may assist in localizing a mass within the spinal epidural space.     

脑内等密度占位性病变的CT诊断途径分析(附116例报告)

目的：分析总结脑内等密度占位性病变的CT征象及诊断途径，加强对此类疾病的认识，提高诊断准确率。方法：回顾分析经病理或治疗随访证实的116例脑内等密度占位性病变的CT征象特点，其中109例行CT增强检查。结果：116例中，确诊主要途径为：仅通过CT平扫确诊10例，结合CT平扫及增强确诊59例，结合病史确诊16例，结合临床查体确诊9例。结合其他影像或实验室检查确诊15例。脑瘤87例，其中胶质瘤34例、转移瘤31例、脑膜瘤10例、垂体瘸5例、其他7例，亚急性硬膜外或硬膜下血肿15例，脑脓肿7例，脑血管畸形4例，脑囊虫病3例。结论：通过仔细分析CT平片和全面结合病史、临床查体、其他检查，提示脑内占位性病变，并尽可能做出神经功能定位，再辅以CT增强，必要时随访，对于正确诊断脑内等密度占位性病变，减少漏诊，避免误诊，非常重要。     

Peripheral contrast enhancement in chronic epidural hematomas.

Three cases of chronic epidural hematomas with contrast enhanced margins on computed tomography (CT) are presented. The CT findings in epidural hematoma are discussed, and two possible mechanisms for the enhancing margin of the chronic epidural hematoma are suggested.     

Scintigraphic appearance of bifrontal epidural hematoma: case report.

A bifrontal and parasagittal epidural hematoma was detected on the brain scan. The scintigraphic appearance of this rare lesion is described.     

Delayed epidural hematoma after evacuation of a subdural hematoma

CT easily diagnoses epidural hematomas. The appearance of an epidural hematoma may be delayed by compression from a contralateral lesion. The possibility of a delayed epidural hematoma should be kept in mind in the presence of additional findings such as a skull fracture contralateral to the original lesion or decompression of the epidural hematoma into either the subgaleal or the subarachnoid space. We present a case in which an epidural hematoma declared itself after the evacuation of a contralateral subdural hematoma.     

Extravasation of constrast-enhanced blood in an epidural hematoma

Summary A case is reported in which there was a large extravasation of contrast medium into an epidural hematoma during contrast-enhanced CT.     

Computed tomography of spontaneous acute cervical epidural hematoma

Cervical spinal epidural hematoma is a rare cause of acute neurologic syndromes including paralysis of various types. Although devastating, it can be successfully treated surgically if recognized early. We report two cases of spontaneous cervical epidural hematoma diagnosed by computed tomography, the first with a plain scan and the second with a scan after intrathecal injection of metrizamide. In both patients the diagnosis was not clinically suspected. Surgery resulted in a dramatic improvement of the neurologic deficit in both cases.     

主动脉壁内血肿的影像学诊断及鉴别诊断

目的：探讨主动脉壁内血肿的影像学诊断和鉴别诊断。方法：回顾性分析16例经临床及CT和MRI诊断的主动脉壁内血肿及5例可疑壁内血肿患者的病例资料。12例因胸痛或腹痛入院、经CT或MRI扫描时发现,4例为外伤或内科疾病行胸部或腹部检查时意外发现;另外搜集18例主动脉夹层及11例主动脉瘤患者的影像学资料。结果：16例主动脉壁内血肿,表现为主动脉壁环形增厚7例,新月形增厚5例,环形和新月形增厚同时存在或不规则增厚4例,腔内无内膜片及真假两腔形成,增厚的血管壁内无对比剂进入。5例可疑主动脉壁内血肿表现为管壁轻度环形增厚。18例主动脉夹层均可见真假两腔及内膜片,其中14例其真假腔在横轴面图像上表现为＂D＂字形或反＂D＂字形,真假两腔内均有对比剂进入;11例主动脉瘤表现为血管瘤样扩张或梭形扩张,无真假两腔和内膜片,其中8例可见附壁血栓。结论：CT平扫及增强扫描结合图像后处理技术及MRI多方位成像能够诊断较为典型的主动脉壁内血肿,并与主动脉其它常见疾病相鉴别。     

Active bleeding in hematoma of the abdominal rectus muscle shown by Tc-99m red blood cell scintigraphy: compared with CT

A patient with cirrhosis of the liver complicated with left rectus muscle hematoma following paracentesis underwent consecutive noncontrast CT images and a novel Tc-99m red blood cell (RBC) bleeding scan. Six liters of clear yellow fluid were withdrawn. Progressive enlargement of a left rectus muscle hematoma was diagnosed by 3 consecutive CT scans and confirmed by a Tc-99m RBC bleeding scan. Although consecutive CT scans showed progressive enlargement of the hematoma, the radionuclide study showed an active bleeding site.     

非外伤性脊髓硬膜外血肿的MR诊断

目的　探讨非外伤性脊髓硬膜外血肿的MR表现特点及其鉴别诊断。方法　 14例非外伤性脊髓硬膜外血肿 ,男 9例 ,女5例 ,年龄 4～ 63岁 ,平均 41.3岁。所有病例均无明显的外伤史。常规行T1W矢状位 ,T2 W矢状位及横切位扫描 ,1例行MR增强扫描。结果　 14例非外伤性脊髓硬膜外血肿中 11例位于椎管背侧 ,3例位于椎管腹侧 ,呈新月状或长条带状 ,分别累及 3～ 12个脊髓节段 ,平均 5 .2个脊髓节段。血肿位于颈胸段 4例 ,位于胸段 3例 ,位于胸腰段 5例 ,位于腰段 2例。 10例血肿T1W及T2 W均呈较均质性高信号强度 ,3例血肿T1W及T2 W呈不均质性高信号强度 ,1例于T1W呈中等信号强度 ,T2 W呈较低信号强度。 14例中 1例于血肿内可见低信号的血管流空影 ,术后证实为动静脉畸形。血肿于T1W及T2 W与脊髓之间有一低信号带相隔 ,尤以T2 W显示最佳。 2例受压脊髓于T2 W呈高信号。 1例行MR增强扫描 ,血肿壁轻度强化。结论　MR是诊断非外伤性脊髓硬膜外血肿的最佳检查方法 ,不仅可以清楚地显示血肿的部位及范围 ,而且可以清楚地显示血肿新旧程度及脊髓受损的情况     

Influence of "optical illusion" on detectability in diagnosis for head CT images: participation of optical illusion of light perception in medical image reading and diagnosis

Even if the visual impression of the photographic density of the brain in head CT images is shown as physically the same, it is known that optical illusions of lightness perception (assimilation, contrast, picture frame effect, etc.) occur and that practical density can be observed psychologically differently, according to differences in the color of the skull and background, and differences in cases (differences in picture pattern). Therefore, in this study, in order to clarify the influence of optical illusion on detectability in diagnosis, the author attempted to compare detectability in four sample cases, consisting of acute cerebral infarction (1), acute epidural hematoma (1), and chronic subdural hematoma (2), using visual subjective evaluation. In the case of acute cerebral infarction, there was no significant difference in detectability between the original image and the virtual images. Further, it clarified that the original head CT image (acute epidural hematoma) with the high-density hematoma recognized at the marginal limited part of the brain was inferior to virtual images in detectability, while it clarified that the original head CT image (chronic subdural hematoma) with the low-density hematoma was superior to virtual images in detectability, because of visual psychological emphasis on the difference of the film contrast between the hematoma and white skull.