小儿外伤性迟发性硬脑膜外血肿

目的 研究小儿外伤性迟发性硬脑膜外血肿的临床特点。并探讨其发生机制。方法 总结分析我科1991年1月-2001年10月收治的小儿外伤性迟发性硬脑膜外血肿23例。结果 本组手术清除血肿21例。血肿自行吸收2例。无死亡。结论 小儿迟发性外伤性硬脑膜外血肿多发生在伤后2-5d，占该类血肿78.3%，跌倒伤是主要的致伤原因，此类血肿可发生于颅内任何部位，但多伴有颅骨线形骨折。小儿外伤性迟发性硬脑膜外血肿及时发现和治疗，预后良好，CT扫描是可靠而简便的诊断方法，而延误诊断往往造成严重后果。     

The chronic expanding intracerebral hematoma

Three normotensive patients presented with seizures and CT showed an intracerebral hematoma. Although these patients had no more seizures and developed no other neurological deficit, repeat CT scans (performed 2 to 3 weeks later) showed hematoma enlargement. Angiogram was performed in 2 cases and showed no evidence of vascular malformation or neoplasm. Six weeks to 6 months later, CT showed that the hematoma had changed from a hyperdense to an isodense appearance and in two cases slight enhancement occurred. During a follow-up interval of 6 to 24 months, no other neurological episodes have occurred. The etiology of the chronic expanding intracerebral hematomas was not delineated in these 3 patients.     

Computed tomography of intracerebral hematomas. II. Radionuclide and transmission CT studies of the perihematoma region.

Transmission CT studies of 40 patients with intracerebral hematomas were used for an analysis of the perihematoma region. Nineteen of these patients had radionuclide studies. In the brain adjacent to an intracerebral hematoma, the patterns of pertechnetate uptake on scintillation scans and contrast enhancement on transmission CT resemble those observed in cerebral infarctions. The healing of the perihematoma region proceeds similarly to that of infarcts. The brain about the hematoma is ischemic tissue which behaves much like cerebral infarction not related to hematomas.     

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.     

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.     

Magnetic resonance of the brain: the optimal screening technique

Magnetic resonance (MR) images and computed tomograms of 25 patients with head trauma were compared. MR proved to be superior in many ways for demonstrating extracerebral as well as intracerebral traumatic lesions. Isodense subdural hematomas, which present a diagnostic dilemma on CT images were clearly seen on MR, regardless of their varying CT densities. In a case of epidural hematoma, the dura mater was shown directly as nearly devoid of signal on MR. Direct coronal images provided excellent visualization of extracerebral collections along the peritentorial space and subtemporal area. In a patient with intracerebral hematoma, CT failed to demonstrate residual parenchymal changes in a 3-month follow-up study, but MR clearly depicted the abnormalities. The superiority of MR over CT was also well illustrated in a patient with post-traumatic osteomyelitis of the calvarium.     

Nontraumatic lobar intracerebral hemorrhage: CT/angiographic correlation

Cerebral angiography in patients with nontraumatic lobar intracerebral hemorrhage may or may not uncover the underlying cause of the disorder. The CT and cerebral angiographic studies of 67 consecutive patients with nontraumatic lobar intracerebral hemorrhage were reviewed to assess the relationship between CT pattern and location of hemorrhage and the frequency of diagnostic angiographic findings. Origins of these hematomas were also determined and correlated with radiographic findings. CT revealed 26 temporal, 18 frontal, 17 parietal, three occipital, and three multiple lobar hematomas. Thirty-three patients had "pure" lobar hematomas, 12 had coexistent intraventricular hemorrhage, 12 had associated subarachnoid hemorrhage, and 10 had both intraventricular and subarachnoid hemorrhage accompanying their lobar hematomas. Angiographic findings were diagnostic in 29 cases (43%). In the presence of accompanying subarachnoid hemorrhage, angiographic findings were diagnostic in 17 (77%) of 22 patients; in its absence, angiography was diagnostic in 12 (27%) of the remaining 45 patients. Diagnostic angiograms were also more frequent in the presence of a frontal or temporal lobar hematoma than with a parietal or occipital lobar hematoma. While CT patterns do influence the frequency of diagnostic angiographic findings, cerebral angiography is recommended in all patients with otherwise unexplained nontraumatic lobar intracerebral hemorrhage.     

血浆S-100B蛋白测定在外伤性颅内血肿诊疗中的临床意义

目的 探讨血浆S-100B蛋白在不同类型外伤性颅内血肿的诊断、分型、指导治疗中的临床价值.方法 颅内血肿116例,根据头颅CT分为硬膜外血肿(52例)、硬膜下血肿(32例)、脑内血肿(32例)三组,伤后早期(6小时内)抽取血浆测定S-100B蛋白含量,伤后每24小时送检1次,动态测定(3～7天).三组两两比较.结果 脑...     

Acute subdural hematomas: atypical CT findings

Seventy-one patients with acute subdural hematomas were examined by CT within 72 hr of a documented head injury. Lesions often did not have the classical appearance of a homogeneous, high-density extracerebral collection of blood in a crescentic configuration. Specifically, 28 patients (39%) had mixed-density subdural hematomas (MDSDH) with various degrees of low-density blood within the subdural space. In 10 of these 28 patients, the hematoma had a relatively localized mass effect with a convex inner margin, occasionally mimicking the appearance of an epidural hematoma. The MDSDH group differed from the typical homogeneous high-density subdural hematomas in that they were larger (average maximal thickness was 18.1 mm versus 8.0 mm), had more midline shift, and had a higher mortality rate (50% versus 26%). Four patients with MDSDH demonstrated an unusual pattern of ventricular compression with trapping of cerebrospinal fluid in the body of the ipsilateral ventricle and compression of the body of the contralateral ventricle. This pattern has to our knowledge not been previously described. Possible causes of the low-density regions within the hematomas include unclotted blood in an early stage of hematoma development, serum extruded during the early phase of clot retraction, or cerebrospinal fluid within the subdural space due to an arachnoid tear.     

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 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.     

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。     

Adrenal gland hematomas in trauma patients

PURPOSE: To evaluate the frequency of detection of trauma-induced adrenal gland hematoma in current practice by using computed tomography (CT) and to correlate presence of adrenal hematoma with quantitative clinical indicators of injury severity. MATERIALS AND METHODS: The radiology information system and the trauma registry were searched for cases of adrenal hematoma detected at trauma CT during a 54-month period. CT images depicting adrenal masses with the published characteristics of adrenal hematoma were reviewed by readers who were unblinded to the initial interpretations. Injury severity score (ISS), associated injury, and patient outcome data were gleaned from the trauma registry. The control group comprised patients entered in the trauma registry during the study period who did not have a diagnosis of adrenal hematoma. RESULTS: Fifty-four adrenal hematomas were detected in 51 patients: 42 with right-gland, 12 with left-gland, and three with bilateral lesions. The hematomas were round or ovoid and had a mean maximum diameter of 2.8 cm +/- 0.7 (SD) and a mean attenuation of 52 HU +/- 12. Periadrenal stranding was seen with 48 (89%) hematomas. At follow-up CT, 32 of 35 hematomas had resolved or decreased in size and attenuation. One patient with adrenal hematoma had no other intraabdominal injuries. Compared with the 6,757 control patients, the 51 patients with adrenal hematoma had a higher mortality rate (10% vs 4%; P <.001, chi(2) test) and a higher mean ISS (25.2 vs 9.7; P <.01, t test). Adrenal hematoma was found in 24 (0.4%) of 5,665 trauma patients with an ISS of 0-19, as compared with six (5.0%) of 122 patients with an ISS of 40 or higher. CONCLUSION: Adrenal hematoma was detected in 51 (1.9%) of 2,692 trauma patients who underwent CT, or 0.8% of all patients (n = 6,808) entered in the trauma registry. Compared with the other trauma patients, the patients with adrenal hematomas had severe injuries associated with higher mortality.     

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.     

彩色超声对重型颅脑损伤术中急性脑膨出的诊断及治疗价值

目的 探讨彩色超声对重型颅脑损伤术中急性脑膨出的诊断及治疗价值.方法 回顾性分析2013-12至2018-12武警北京总队医院和武警四川总队医院收治的32例重型颅脑损伤术中发生急性脑膨出患者的临床资料,术中采取超声检查的方法,诊断脑膨出的病因及进一步指导手术治疗方案.观察记录术中超声诊断脑膨出的病因类别、部位特点(包括...     

Chronic encapsulated intracerebral hematoma

Radiological-morphologic features of chronic intracerebral hematomas are observed by computed tomography (CT) and magnetic resonance (MR), and in angiographic examination are particularly characterized by the absence of pathologic vascularization. The patient, aged 61, with confirmed diagnosis of encapsulated intracerebral hematoma, treated at the Clinic of Neurology and Clinic of Neurosurgery of the Military Medical Academy was presented. The patient was released after recovery, and was consequently followed up in an outpatient department by a neurosurgeon. Six-month follow-up demonstrated the regression of the clinical signs of the disease, as well as the alterations in CT and MR images in the same sense.     

Epidural hematomas of the posterior fossa

BACKGROUND: Posterior fossa epidural hematomas represent 7-14% of all traumatic intracranial epidural hematomas. They are most frequently encountered posttraumatic mass lesions in the posterior fossa. The aim of this study was to identify clinical features that could lead to the early diagnosis of posterior fossa epidural hematoma. METHODS: Between 1980 and 2002, 28 patients with epidural hematoma of the posterior fossa were operated on at the Institute for Neurosurgery, Belgrade. Clinical course, neuroradiological investigations, and the results of surgical treatment of the patients with posterior fossa epidural hematomas were analyzed retrospectively. RESULTS: Almost two thirds of patients were younger than 16 years of age. In 20 cases injury was caused by a fall, in 6 cases by a traffic accident, and in 2 by the assault. Clinical course was subacute or chronic in two thirds of the patients. On the admission Glasgow Coma Scale was 7 or less in 9 injured, 8-14 in 14 injured, and 15 in 5 injured patients. Linear fracture of the occipital bone was radiographically evident in 19 patients, but was intraoperatively encountered in all the patients except for a 4-year old child. In 25 patients the diagnosis was established by computer assisted tomography (CAT) and in 3 by vertebral angiography. All the patients were operated on via suboccipital craniotomy. Four injured patients who were preoperatively comatose were with lethal outcome. Postoperatively, 24 patients were with sufficient neurologic recovery. CONCLUSION: Posterior fossa epidural hematoma should be suspected in cases of occipital injury, consciousness disturbances, and occipital bone fracture. In such cases urgent CAT-scan is recommended. Early recognition, early diagnosis, and prompt treatment are crucial for good neurological recovery after surgery.     

Organized intracerebral hematoma with acute hemorrhage: CT patterns and pathologic correlations

Five cases of pathologically proven organized intracerebral hematoma with recent hemorrhage are reported. The hemorrhages were spontaneous, were located in deep structures of the brain, and presented without a clinical history of hypertension or trauma. No underlying causes of the hematomas were identified histologically. Various computed tomographic (CT) patterns of recurrent hemorrhage in an organized hematoma were observed. A hyperdense, well demarcated mass with minimal contrast enhancement but no surrounding edema was observed when rehemorrhage was confined within a late-organizing hematoma. A "target" sign of a ring-enhancing mass was observed when the new hemorrhage developed within an early-organizing hematoma. When a new hemorrhage occurred outside a solid-enhancing organized hematoma, the CT appearance suggested a possible tumoral hemorrhage. Close clinical and CT follow-up is desirable for initial management of a suspicious rehemorrhaging organized hematoma situated in the deep-seated or superficial sensitive structures if the symptomatology has stabilized or improved. Tissue diagnosis and surgical evacuation are indicated when the clinical course fluctuates or progresses and CT demonstrates an interval increase of lesion.     

迟发性颅内血肿的CT检查

目的:分析迟发性颅内血肿的临床表现、CT复查指征及预后。对象与方法:36例颅脑外伤后临床症状进行性加重的迟发性颅内血肿患者均经CT复查,并与第1次CT检查所见比较。结果:经CT复查发现36例颅内血肿,其中,脑内血肿16例(19个病灶),硬膜下血肿7例(伴蛛网膜下腔出血1例),硬膜外血肿9例,以及混合性血肿4例。结论:当颅脑外伤病人临床症状进行性加重时,择期进行CT复查可以发现第1次CT检查未发现的颅内血肿。     

„Verschwinden“ des Epiduralhämatoms im Verlauf

Spontaneous rapid resolution, redistribution or drainage (disappearance) of an acute epidural hematoma within 24 h has occasionally been reported, mostly in younger traumatized persons. The mechanism could be drainage of the hematoma through an overlying skull fracture into the subgaleal and subcutaneous space caused by increasing brain swelling and intracranial pressure. This was the case in an 85-year-old cyclist who suffered severe craniocerebral trauma in a traffic accident. The epidural hematoma detected by emergency computed tomography (CT) was no longer visible in the control CT 8 h later (and the autopsy). All that was found was a massive intracerebral bleeding and accompanying brain edema.