外伤性脑梗死的CT诊断

目的：提高对外伤性脑梗死的认识。方法：分析１８例外伤性脑梗死的临床与ＣＴ表现。结果：外伤性脑梗死成人和儿童均可发生,常继发于严重的颅脑外伤,ＣＴ表现为基底节区或／和脑叶梗死,常伴脑水肿和颅内血肿等颅脑损伤征象,结论：ＣＴ对外伤性脑梗死的诊断有重要价值。     

外伤性脑梗死的诊断与治疗

目的 探讨外伤性脑梗死的发病机制、诊断及治疗.方法 对24例外伤性脑梗死患者的临床资料进行回顾性分析.结果 伤后1年按GOS评价,良好7例,中残3例,重残4例,植物生存2例,死亡8例.结论 外伤性脑梗死多由于动脉闭塞、血管损伤、痉挛等因素所致,CT是诊断的主要依据.其预后与原发伤的损伤程度、梗死部位、梗死灶大小、年龄以及行减压术是否及时有关.     

外伤性脑梗死21例临床分析

目的 探讨外伤性脑梗死的诊断、发病机制与治疗.方法 对21例外伤性脑梗死病人的临床资料进行回顾性分析.结果 21例中均使用ADL(日常生活能力分级)法进行评估,Ⅰ级11例(52.4%),Ⅱ级4例(19%),Ⅲ级3例(14.3%),Ⅳ级3例(14.3%).结论 对外伤性脑梗死病人要密切观察病情变化,及时行CT或MRI检查,争取做到早期诊断,早期治疗,这对病人的康复与预后有重要的意义.     

外伤性脑梗死

我科自1993年11月～2002年11月共收治外伤性脑梗死64例，约占同一时期颅脑损伤患者的3．8％。现探讨其临床表现、发生机制及预后。     

小儿外伤性脑梗死临床诊断及发病机制探讨

目的总结小儿外伤性脑梗死的临床症状、影像学特点,探讨其发病机制。方法回顾性分析15例小儿外伤性脑梗死的临床资料。结果15例均有轻微头外伤史,伤后3 h临床症状不明显,伤后6 h~2 d均出现明显肢体偏瘫,伤后早期（〈6 h）头部CT平扫无脑梗死征象,而MRDWI序列斑点状高信号,伤后6 h~2 d均见基底节区及侧脑室体部后外侧CT低密度、MRIT1低、T2高信号的小梗死灶,脑水肿轻。结论小儿外伤性脑梗死伤后临床症状轻微,病情进展相对迟缓,外侧豆文动脉易于发病,MRI及时检查可尽早确诊。     

重型颅脑外伤性大面积脑梗死24例临床治疗体会

目的探讨重型颅脑外伤性大面积脑梗死的发病机制、临床诊断和治疗。方法回顾性分析24例颅脑外伤性大面积脑梗死患者的临床资料、诊断与治疗。结果 19例患者入院后急诊手术治疗,行血肿清除,去骨瓣减压术。5例血肿量较少患者先行保守治疗,复查CT示大面积脑梗死形成后,行去大骨瓣减压术。药物治疗包括予钙离子拮抗剂,自由基清除剂,保持血容量稳定。伤后6个月,行格拉斯哥预后评分(glasgow outcome scale,GOS)死亡5例,植物生存4例,重残6例,中残7例,良好2例。结论重型颅脑外伤性大面积脑梗死患者病情危重,早期诊断,及时合理的手术治疗,术后抗血管痉挛,改善脑血管微循环有助于改善患者的预后。     

外伤性脑梗塞的临床诊断与治疗

外伤性脑梗塞以往认为是脑外伤后少见并发症。随着CT、MRI普及应用，该病检出率有增多趋势。现总结我院1986年以来由CT检出18例并住院的病例资料，复习相关文献报告如下。     

外伤性脑梗死的临床诊治

目的：阐述外伤性脑梗死发生的原因与诊治方法。方法：对以往经治的外伤性脑梗死２０例作回顾性分析。结果：２０例病人１５例治愈出院,１例转院治疗,死亡４例。结论：及早对外伤性脑梗死病人作出诊断和早期预防及综合性治疗是提高治愈率和生存质量的关键。     

The Usefulness of Brain Magnetic Resonance Imaging with Mild Head Injury and the Negative Findings of Brain Computed Tomography

Objective

To investigate the cases of intracranial abnormal brain MRI findings even in the negative brain CT scan after mild head injury.

Methods

During a 2-year period (January 2009-December 2010), we prospectively evaluated both brain CT and brain MRI of 180 patients with mild head injury. Patients were classified into two groups according to presence or absence of abnormal brain MRI finding even in the negative brain CT scan after mild head injury. Two neurosurgeons and one neuroradiologist validated the images from both brain CT scan and brain MRI double blindly.

Results

Intracranial injury with negative brain CT scan after mild head injury occurred in 18 patients (10.0%). Headache (51.7%) without neurologic signs was the most common symptom. Locations of intracranial lesions showing abnormal brain MRI were as follows; temporal base (n=8), frontal pole (n=5), falx cerebri (n=2), basal ganglia (n=1), tentorium (n=1), and sylvian fissure (n=1). Intracranial injury was common in patients with a loss of consciousness, symptom duration >2 weeks, or in cases of patients with linear skull fracture (p=0.00013), and also more frequent in multiple associated injury than simple one (35.7%>8.6%) (p=0.105).

Conclusion

Our investigation showed that patients with mild head injury even in the negative brain CT scan had a few cases of intracranial injury. These findings indicate that even though the brain CT does not show abnormal findings, they should be thoroughly watched in further study including brain MRI in cases of multiple injuries and when their complaints are sustained.     

放射性脑损伤的诊断

目的探讨放射性脑损伤的诊断、治疗及其与肿瘤复发的鉴别诊断。方法总结分析6例经临床手术病王甲证实的放射性脑损伤的临床表现及影像学特点。结果全组患者均经手术治疗，切除坏死灶，术后临床症状改善，无手术并发症及死亡。结论随着直线加速器、X刀、γ刀、光子刀、组织间近距离放疗等放射技术在临床上作中的广泛应用，放射性脑损伤的发病率也逐渐增高。其与肿瘤复发的鉴别诊断存存一定难度，早期诊断和有效治疗具有十分重要的意义。     

轻型颅脑损伤致脑梗死临床分析

目的探讨轻型颅脑损伤后发生脑梗死的特点、治疗及预后。方法统计2000年至2007年内25例此类患者,对其发生原因、发病特点,治疗及预后进行研究,并结合文献进行临床分析。结果青少年、老年人,全身多发损伤病人及不适当的治疗后轻型颅脑损伤患者易出现脑梗死;治疗应采用综合疗法;预后大多良好。结论对轻型颅脑损伤后脑梗死讨论对预防其发生在临床上有重要意义。     

肿瘤样脑梗塞的诊治

目的探讨肿瘤样脑梗塞的诊断及鉴别诊断。方法回顾性分析6例术前诊断为脑肿瘤，术后经病理证实为脑梗塞病例的临床表现及影像学特点、诊治经过及病程转归。结果6例均经手术治疗，术后病理证实为脑梗塞。术前诊断：4例为胶质瘤，1例为转移瘤，1例为胆脂瘤。5例治愈，1例轻残。结论正确的鉴别有助于脑梗塞患者的明确诊断而免于不必要的手术，对于占位效应明显或合并出血、感染的病人应手术治疗。动态观察可避免误诊。     

Biomarkers for the Clinical Differential Diagnosis in Traumatic Brain Injury—A Systematic Review

Rapid triage and decision‐making in the treatment of traumatic brain injury (TBI) present challenging dilemma in “resource poor” environments such as the battlefield and developing areas of the world. There is an urgent need for additional tools to guide treatment of TBI. The aim of this review is to establish the possible use of diagnostic TBI biomarkers in (1) identifying diffuse and focal brain injury and (2) assess their potential for determining outcome, intracranial pressure (ICP), and responses to therapy. At present, there is insufficient literature to support a role for diagnostic biomarkers in distinguishing focal and diffuse injury or for accurate determination of raised ICP. Presently, neurofilament (NF), S100β, glial fibrillary acidic protein (GFAP), and ubiquitin carboxyl terminal hydrolase‐L1 (UCH‐L1) seemed to have the best potential as diagnostic biomarkers for distinguishing focal and diffuse injury, whereas C‐tau, neuron‐specific enolase (NSE), S100β, GFAP, and spectrin breakdown products (SBDPs) appear to be candidates for ICP reflective biomarkers. With the combinations of different pathophysiology related to each biomarker, a multibiomarker analysis seems to be effective and would likely increase diagnostic accuracy. There is limited research focusing on the differential diagnostic properties of biomarkers in TBI. This fact warrants the need for greater efforts to innovate sensitive and reliable biomarkers. We advocate awareness and inclusion of the differentiation of injury type and ICP elevation in further studies with brain injury biomarkers.     

儿童外伤性脑梗死的诊断与治疗

目的分析不同类型的外伤性脑梗死患儿的治疗方案,结合文献探讨其发病机制,以提高其治愈率,降低致残率。 方法回顾性分析解放军陆军第八十一集团军医院自2015年1月至2019年12月收治的42例外伤性脑梗死患儿的临床资料。采用头颅CT扫描和MRI诊断儿童外伤性脑梗死,根据不同病情将儿童外伤性脑梗死进行诊断分型,选择不同的治疗方案。腔隙性脑梗死患儿给予钙拮抗剂和神经营养药物治疗,并辅以高压氧、运动康复治疗;局灶型脑梗死、混合型脑梗死患儿除应用钙拮抗剂和神经营养药外,还应用小剂量脱水剂和小剂量激素,并随病情演变随时调整治疗方案;大面积脑梗死的患儿,急诊行去骨瓣减压术,术后给予降颅压、预防并发症等综合治疗。观察患儿的治疗结果及恢复情况。 结果42例外伤性脑梗死患儿中,恢复良好35例（83.3%）,中残4例（9.5%）,重残2例（4.8%）,死亡1例（2.4%）,无植物生存。腔隙性脑梗死的恢复良好率为100%,局灶型脑梗死的恢复良好率为62.5%,混合型脑梗死的恢复良好率为60%,大面积脑梗死的恢复良好率为50%。 结论针对不同类型的脑梗死患儿采用不同的治疗方案,对提高儿童外伤性脑梗死的治疗效果、改善预后意义重大。     

Head injury and risk of Parkinson disease: A systematic review and meta‐analysis

Head trauma has been implicated in the etiopathogenesis of Parkinson's disease (PD). We performed a meta‐analysis to investigate the association between head trauma and the risk of developing PD. We included observational studies if they (1) clearly defined PD, (2) defined head trauma leading to concussion, and (3) presented odds ratios (ORs) and 95% confidence intervals (CIs) or provided data to compute these statistics. Random effect model was used to estimate the pooled, adjusted OR. Heterogeneity between studies was evaluated with the Q test and the I² statistic. We conducted a sensitivity analysis to assess the influence of each study and repeated the analysis by excluding the studies with the largest weights. We used funnel plot to assess the presence of publication bias. After reviewing more than 636 article titles, 34 articles were selected for full review. In total, 22 studies (19 case–control studies, 2 nested case–control studies, and 1 cohort study) were included in the meta‐analysis. The pooled OR for the association of PD and head trauma was 1.57 (95% CI, 1.35–1.83). The results of our meta‐analysis indicate that a history of head trauma that results in concussion is associated with a higher risk of developing PD. © 2013 Movement Disorder Society     

重型颅脑损伤合并寰枢椎半脱位的诊断与治疗

目的探讨重型颅脑损伤合并寰枢椎半脱位的诊断和治疗方法。方法重型颅脑损伤137例患者中合并寰枢椎半脱位者17例。每例患者均行颅脑和寰枢椎CT扫描，必要时加做寰枢椎CT三维重建或MRI检查。在积极治疗颅脑损伤同时，均予以颈同固定制动、颌枕吊带或颅环弓牵引治疗。结果17例重型颅脑损伤合并寰枢椎半脱位患者经治疗后12例神志转清，5例植物生存。2例有脊髓损伤者完全恢复。无1例因寰枢椎半脱位而导致呼吸骤停或猝死，CT复查寰枢椎结构恢复正常。结论对重型颅脑损伤患者在颅脑伤诊治的同时，应常规行寰枢椎CT检查，以明确诊断，早期治疗，能有效预防并发症，改善预后。     

重型颅脑外伤后大面积脑梗死的原因及防治

目的探讨重型颅脑外伤后大面积脑梗死的原因及防治措施。方法对收治的36例重型颅脑外伤后大面积脑梗死病例进行回顾性分析。结果按格拉斯哥预后评分(Glasgow outcome scale,GOS)标准:恢复良好6例(16.7%),中残9例(25.0%),重残6例(16.7%),植物生存3例(8.3%),死亡12例(33.3%)。结论对重型颅脑外伤后大面积脑梗死患者及早明确诊断,进行积极有效的综合治疗是改善大面积脑梗死患者预后的关键。