小儿外伤性硬膜外血肿诊治分析

小儿外伤性硬膜外血肿在临床所占比例不高．并由于其解剖、生理等方面的特点．决定了其临床症状不典型．容易造成漏诊。本院自1998．2004年共收治27例小儿外伤性硬膜外血肿．手术治疗21例．非手术治疗6例．现分析如下。     

小儿外伤性后颅窝硬膜外血肿

本院1995年7月至2003年6月,共收治小儿外伤性后颅窝硬膜外血肿46例,现报告如下.     

小儿急性外伤性颅内血肿的诊疗

小儿急性外伤性颅内血肿除具一般颅内血肿的发生发展规律外,还具有其特殊性。本院自1990年1月至2000年12月,共收治小儿急性外伤性颅内血肿96例。本文根据小儿急性外伤性颅内血肿的临床特点,总结分析如下。1临床资料1.1一般资料:男66例,女30例;2岁以下7例,3～6岁37例,7～15岁51例,平均年龄7.9岁。坠落伤46例,跌伤28例,车祸伤19例,打击伤3例。1.2伤情分类及临床表现:入院时意识状态按格拉斯哥计分(GCS):3～5分5例,6～8分18例,9～12分31例,13～15分42例。伤后有原发昏迷史39例,入院时昏迷且意识阻碍进行加重23例。入院时单侧瞳孔散大伴对侧偏…     

外伤性后颅窝硬膜外血肿的诊治分析

外伤性后颅窝硬膜外血肿（traumalic epidural hematoms of the posterior era-nial fossa）是一类并不多见的硬膜外血肿,占硬膜外血肿的2%～11%。本病在早期缺乏特有的临床表现,但病情常可急剧恶化,并危及生命。本院从2005年3月至2008年3月,     

外伤性后颅窝硬膜外血肿的诊治体会

后颅窝硬膜外血肿(posterior fossa epidural hernatcxna．PFEDH)是颅脑外伤中的一种特殊血肿类型,我科自1994年6月至1999年8月共收治28例,现总结报告如下：     

急性外伤性硬膜外血肿的保守治疗

本文重点介绍外伤性硬膜外血肿保守治疗的初选条件,详细论述了各个观察指标的意义,具有一定的临床实用价值。     

小儿跨横窦硬膜外血肿诊断治疗

我院自1985～1996年间共收治48例小儿跨横窦硬膜外血肿，现报告如下：     

网眼式钻孔清除小儿外伤性硬膜外血肿

本院自1999年1月至2004年9月收治11例网眼式钻孔清除小儿外伤性硬膜外血肿(EDH)的患者,占同期颅脑外伤病人的0.5%.现报告如下.     

外伤性硬膜外血肿穿刺治疗76例分析

硬膜外血肿是基层医院常见的颅脑损伤疾病，约占外伤性颅内血肿的30％左右，其中绝大多数(86．2％)属于急性血肿：急性外伤性硬膜外血肿的传统治疗观念以骨瓣开窗血肿清除为主2000年6月～2004年2月，我院选择性应用特制一次性使用颅内血肿穿刺针穿刺清除治疗外伤性急性硬膜外血肿76例，效果满意，现报告如下。     

Bilateral epidural hematomas

Sixty-four cases of bilateral epidural hematomas were reviewed. The factors of patient age, direction of injuring forces, location of hematomas, presence of associated skull fracture, and time interval between injury and onset of signs and symptoms were analyzed. The results of this analysis show that bilateral epidural hematomas may develop slowly and indicate that they occur with traumatic forces predominantly oriented in the anteroposterior direction, have fewer overlying fractures associated with them than unilateral epidural hematomas, and commonly contain venous blood. The differences between unilateral and bilateral epidural hematomas in direction of injuring forces, frequency of overlying skull fracture, and type of hemorrhage suggests that varying mechanisms may be responsible for production of these hematomas. Serial angiograms and CT scans have shown delayed accumulation of blood in bilateral epidural hematomas. This finding challenges the theory that epidural hematomas develop within minutes following injury.     

Craniofacial trauma and double epidural hematomas from horse training

INTRODUCTIONA case of complex poly-trauma requiring multi-service management of rare, diagnoses is reviewed.PRESENTATION OF CASEA healthy 20 year old female suffered double epidural hematoma, base of, skull fracture, traumatic cranial nerve X palsy, benign positional paroxysmal vertigo and supraorbital, neuralgia following equestrian injury.DISCUSSIONEpidemiology, differential diagnosis, and principles of management for each condition, are reviewed.CONCLUSIONCoordinated trauma care is well suited to address the complex poly trauma following, equestrian injury.     

Preoperative neurological status in predicting surgical outcome of spinal epidural hematomas

The postoperative progress of 3 patients with spinal epidural hemorrhage, but without spinal fracture or dislocation, is presented.From the literature, 158 cases were collected of spontaneous spinal epidural hematoma treated surgically. Postoperative return of motor function was noted in 95.3%, 87%, and 45.3% of the patients with incomplete sensorimotor, incomplete sensory but complete motor, and complete sensorimotor lesions, respectively. Complete sensorimotor recovery occurred in 41.9%, 26.1%, and 11.3% of these 3 groups of patients, respectively.Recovery following surgical treatment depends on the severity of neurological deficits before treatment. However, the absence of motor or sensorimotor functions preoperatively does not necessarily indicate a poor prognosis.     

Traumatic bilateral epidural hematomas presenting at different times in a patient with large ventricles

In a patient with large ventricles, a huge epidural hematoma of venous origin developed after removal of a contralateral traumatic epidural clot which was produced by the tearing of the middle meningeal artery. The possible pathophysiologic characteristics of such hematomas are discussed.     

小儿外伤性脑梗死34例临床分析

目的探讨小儿外伤性脑梗死的发病机制、临床特点、诊断及治疗。方法回顾总结收治的均行非手术治疗34例小儿外伤性脑梗死的临床资料。结果32例随访6-12个月,治愈31例,治愈率96.88%,1例肢体肌力Ⅲ级。结论小儿外伤性脑梗死以婴幼儿多见,有明确外伤史,临床上有不同程度迟发性偏瘫者,应考虑为本病;CT、MRI检查可明确诊断,经积极的综合治疗,预后良好。     

Lumbar epidural hematoma following epidural anesthesia

A 68-year-old woman who developed a lumbar epidural hematoma following epidural anesthesia is described. The patient had severe lumbar spondylosis and osteoporosis that had not been recognized before her initial gynecological operation. Despite the delayed laminectomy, the patient experienced a complete neurological recovery.     

Clinical characteristics of traumatic extradural hematoma: a comparison between children and adults

In this study of 43 children who had surgery for traumatic extradural hematoma (EDH) at Frenchay Hospital, England, between 1975 and 1987, the authors attempt to outline the various clinical characteristic of EDH which are different in children (age range 1–15 years) and adults (age range 16–84 years). The results confirm that children with traumatic EDH are less likely to have injury be caused by an RTA, are less likely to remain unconscious from the time of injury to the time of the operation, and are less likely to require immediate surgery (less than 6 hours after injury). In addition, the CT scan is less likely to show in associated intradural inuury, and the outcome is significantly better.     

Nonoperative management of acute epidural hematomas: a "no-brainer"

BACKGROUND: Acute epidural hematomas are generally considered to require urgent operation for clot evacuation and bleeding control. It has become increasingly apparent, however, that many epidural hematomas will resolve with nonoperative management. The purpose of the current study was to review our experience with nonoperative management of acute epidural hematomas. METHODS: Patients admitted to our busy urban level I trauma center with an epidural hematoma were identified using our trauma registry. Patients were excluded if they suffered other significant intracranial injury mandating operative intervention. Patient records were reviewed and relevant data collected. Patients who required subsequent craniotomy were compared to those who did not in order to identify risk factors for failure of nonoperative treatment. RESULTS: Between January 1995 and June 2004, 84 patients were identified. The mean age was 27 +/- 1.6 years and 68 (81%) were male. Mean Glasgow Coma Scale in the emergency department was 13.7 +/- 0.3. The most common mechanism of injury was a fall. Fifty-four (64%) patients were initially managed nonoperatively and 30 (36%) were taken directly to the operating room for craniotomy. Nonoperative management was successful in 47/54 (87%) patients. Failure of initial nonoperative management was not associated with adverse outcome. There were no deaths in patients managed operatively or nonoperatively. Seventy-two (86%) patients were discharged to home with excellent neurologic outcome. CONCLUSIONS: Epidural hematomas can be successfully managed nonoperatively in an appropriately selected group of patients. Moreover, failure of initial nonoperative management has no adverse effect on outcome.     

Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases

Summary Objective. To identify factors that favour spontaneous recovery in patients who suffered a spontaneous spinal epidural hematoma (SSEH).Methods. The literature was reviewed reguarding non-operative cases of SSEH (SSEH^cons). Sixty-two cases from the literature and 2 of our own cases were collected, focusing on sex, age, medical history, position of the hematoma, segmental distribution and length of the hematoma, diagnostic imaging, neurological condition and outcome. Those data were analysed and compared with the data from a literature review of 474 cases operated on because of a SSEH (SSEH^oper).Results. The mean length of the hematoma was significantly higher in SSEH^cons, compared to SSEH^oper (5.4 versus 4.2 vertebral segments; [standard error of the difference (SED) is 0.38 vertebral segments; 95% confidence limits for the difference are 0.45 to 1.95]). Also after exclusion of patients with coagulopathy, mean length of the hematoma was significantly higher in SSEH^cons (4.7 versus 3.9 vertebral segments [SED is 0.39 vertebral segment; 95% confidence limits for the difference are 0.04 to 1.56]). Neurological signs and symptoms in SSEH^cons were significantly less severe (P<0.005) and diagnosis was based on Magnetic Resonance Imaging (MRI) in the majority of cases (P<0.0005), when compared to SSEH^oper. All other patient characteristics showed no correlation with spontaneous recovery.Conclusion. The recent increase of publications of SSEH^cons has to be explained by the introduction of MRI in daily medical practice. As a result, more patients with a mild or benign clinical course are being diagnosed. In earlier times those patients would have escaped medical attention. The mean length of the hematoma in SSEH^cons appears to be significantly higher compared to SSEH^oper. This suggests that spontaneous regression of neurological symptoms may result from decompression of the neural structures by spreading of the (liquid) hematoma along the spinal epidural space in the early stages after haemorrhage. Based on the present review, there appear to be no factors which promote conservative treatment in SSEH. In the majority of cases with SSEH, the mainstay of treatment will remain surgical decompression of the neural structures and removal of the hematoma. The decision for conservative treatment has to be based on the severity of the neurological deficit and on the clinical course. Retrospectively, the length of the hematoma seems to give a clue to the spontaneous recovery which occurs in some cases of SSEH. Nevertheless, hematoma-length can not be used as a guide to treatment.