外伤性弥漫性脑萎缩的临床特征

目的:探讨外伤性弥漫性脑萎缩的临床特征及其形成机制。方法:外伤性弥漫性脑萎缩患者26例,其中硬膜下血肿19例,广泛脑挫裂伤4例,弥漫性轴索损伤(DAI)3例,合并有蛛网膜下腔出血(SAH)17例,于入院时、伤后3d、1周、3周及1月余行头颅CT检查。结果:本文26例患者在CT复查中均表现为双侧大脑半球不同程度的脑室、脑池、脑沟扩大增宽,脑回变窄,其两侧脑室额角间夹角≥140°,尾状核指数为16.8%-32.1%,(平均24.2%)。结论:本文外伤性弥漫性脑萎缩的主要病因,可能与弥漫性神经元和轴突的原发损伤以及外伤后脑缺血性损害有关。     

高压氧治疗外伤性弥漫性脑萎缩(附3例报道)

我院自1995年以来共收治3例弥漫性脑萎缩病人,均给予高压氧治疗,获得明显疗效,现报道如下。 例1 男性,25岁。因原发脑干伤半月而于1993-11从外院转入,转入时呈浅昏迷状态,气管已切开,呈去大脑强直状态,GCS评分4分,发病当日头颅CT提示:原发脑干伤、急性脑肿胀。入院时CT提示:弥漫性脑萎缩。入院后给予高压氧治疗。1个月后病人意识恢复,2个月后四肢肌张力趋于正常、肌力减退。复查头颅CT提示,脑萎缩较前明显好转。     

红斑狼疮脑室脑沟CT测量研究

目的探讨系统性红斑狼疮（SLE）患者脑萎缩与老年性脑萎缩的关系。方法31例SLE患者和31例健康体检者,通过头颅CT的观察,对具有,临床意义的数据进行测量比较。结果SLE患者的脑室、侧裂池、脑沟较同龄人均有不同程度增宽或扩大。结论SLE患者脑萎缩年龄提前。     

正常与脑发育不良小儿脑室脑沟脑池CT测量结果比较

目的对脑发育不良及脑发育正常小儿脑室脑沟脑池的CT测量结果进行对比研究,为临床诊断小儿脑发育不良提供借鉴经验。方法回顾性分析2015年10月至2017年10月接诊的90例小儿脑发育不良患儿的临床资料,分为研究组,将同期在本院体检的90名健康儿童分为对照组,对两组观察对象行脑室脑沟脑池CT测量,记录测量结果。结果研究组小儿脑室脑沟脑池的CT测量值均高于对照组,差异有统计学意义(P0.05);1岁以下儿童的蛛网膜下腔、额部脑沟和纵裂池CT测量值均比1～3岁儿童大,且能随着年龄的增长各项CT值逐渐降低。结论脑发育不良小儿脑室脑沟脑池的CT测量值均比正儿童高,通过CT测量脑室脑沟脑池可以早期诊断小儿脑发育不良,为小儿脑发育不良的早期治疗提供诊断依据。     

精神分裂症脑结构的CT研究

目的：运用CT分析精神分裂症患者的脑结构影像学改变。方法：对30例精神分裂症患者作头颅CT扫描，并以正常组30例为对照。结果：本组精神分裂症患者脑结构的CT异常率约为60％，在第三脑室最大宽度、顶叶脑沟宽度、两侧脑室前角距离、第三脑室外壁至岛盖面距离及大脑前纵裂宽度存在非常显著差异(P＜0.01)；在隔一尾最大距离、外侧裂最大宽度存在显著差异(P＜0．05)。脑室系统扩大与脑萎缩的发生率明显高于对照组，结论：精神分裂症患者脑结构的异常率较高，以第三脑室扩大及脑萎缩较明显，且脑萎缩同时存在于脑白质和脑皮层。     

小儿脑部CT诊断探讨

目的分析研究14岁以下儿童不同年龄正常脑CT图像中灰、白质关系，探讨小儿脑发育不全、脑萎缩诊断的各项客观和可靠依据。方法回顾性分析151例14岁以下儿童脑部CT图像，分组对脑组织的CT值、脑室及脑室上层面，大脑前角的宽度、脑室与脑横径比率、脑沟回计数、脑应层最大深度进行测量并进行统计学处理。结果小儿脑白质CT值22～28Hu，灰质为30～35Hu。0～5岁组53例，脑室与脑横径比率约9％，皮质最深厚度约40～50mm，侧脑室前角的宽度〈5mm，可见3～5个脑沟5例，生理性钙化2例；6～10岁组47例，脑室与脑横径比率约9．5％～10％，皮质厚度约35～40mm，侧脑室前角的宽度〈6～7mm，生理性钙化17例，见3～5个脑沟13例；11～14岁年龄组42例，脑室与脑横径比率〉11％，皮质厚度约30～35mm，脑室前角的宽度7～9mm，生理性钙化23例。结论小儿脑组织的CT值不论白质和灰质均低与成人。5岁以下小儿脑沟数超过5个以上且大脑前角的宽度超过8mm，脑室与脑横径比率〉10％可诊断脑萎缩。5岁以上小儿脑前角的宽度超过11mm，脑室与脑横径比率〉11％，可考虑脑萎缩脑发育不全。10岁以上小儿皮质最人深度仍在35mm以上，皮、髓质分界不清可诊断大脑皮质发育不全。     

原发性脑干伤肺部并发症危险因素分析与防治

原发性脑干伤是急性颅脑损伤中极为严重的致命损伤 ,病死率高达 77.1 % [1 ]。除脑损伤严重外 ,肺部并发症亦是死亡的重要原因之一。我院 1 993～ 1 999年共收住原发性脑干损伤患者 35例。出现肺部并发症 30例 ( 85.7% ) ,其中存活 2 1例 ( 70 .0 % )。本文对其并发症防治重要性问题 ,结合文献分析如下。1　临床资料1 .1　一般资料　本组中男 2 6例 ,女 9例 ;年龄 1 2～ 61岁 ,平均 36.5岁。致伤原因 :交通伤 1 9例 ,跌伤 1 2例 ,砸伤 4例。1 .2　实验室检查　全组病例均行头颅 CT、MRI检查 ,2 5例可见脑干点片状混杂密度影 ,1 4例见环池…     

CT在新生儿缺血缺氧性脑病中的应用90例分析

目的 探讨新生儿缺血缺氧性脑病(简称HIE)的CT诊断分度及其预后情况.方法 选择有围产期窒息史,首次影像检查选择CT扫描并诊断为不同程度HIE的新生儿90例,分别于＜1个月、1～3个月、3～6个月、6个月～1岁、1～2岁进行头颅CT或MRI复查(主要以CT复查为主),同时结合临床体检.结果 3个月以内复查59.5％影像表现异常,主要为外部性脑积水,30.9％有神经系统症状或体征.6个月时40％有影像表现异常,基本都伴有神经系统症状或体征.1岁以后20％的病例有CT异常,主要表现不可逆的脑部影像,并有相应的临床表现.结论 (1)HIE是造成儿童永久性神经功能障碍的主要原因.(2) HIE复查时所表现的头颅影像异常,1岁以前所主要表现的外部性脑积水,可以恢复.1岁以后仍存在的脑萎缩、脑室系统积水,脑梗死、脑软化和脑囊性变,成为不可逆的严重后遗症.(3)HIE的预后与首诊CT分度关系密切,轻度者预后良好,中、重度者预后差.     

颅内多发性脂肪瘤误诊1例

1　病例报告男 ,38岁。因头痛、呕吐 ,伴视力下降、行走不稳 6个月于1997- 0 4- 0 3到我院就诊。查体 :神志清 ,反应迟钝 ,表情淡漠 ,双眼底视乳头边界不清 ,余正常。头颅 CT扫描见脑室广泛扩大 ,双侧脑室额角、左侧脑室三角区及脑干周围低密度区 ,双侧脑室额角有一液平 ,双顶叶皮层下小点状低密度影。 CT诊断 :脑积水并及脑室内积气 (未作增强扫描 )。入院后 X线片示颅底、乳突、蝶鞍骨质无异常 ,耳鼻喉科会诊外耳、乳突、鼻部无异常。入院后行了脑室腹腔转流术 ,术后患者恢复良好 ,出院后重新工作。术后 3a(2 0 0 0 - 0 8)患者再次出现…     

8例新生儿缺氧缺血性脑病（NAE）的CT诊断

目的：讨论新生儿缺氧缺血性脑病（NAE）的CT诊断。方法：对8例NAE患儿进行头颅CT平扫，分析CT征象。结果：轻度5例，表现为脑实质内局灶性低密度改变，范围不超过2个脑叶，以额叶、枕叶较多，无明显占位效应，与正常脑组织分界清楚，脑池脑沟形态正常。中度3例，表现为2个脑叶以上的低密度改变，灰白质分界不清，邻近脑池脑沟变浅，部分合并颅内出血。重度2例，表现为大脑半球弥漫性低密度改变，仅基底节、脑干、小脑密度基本正常，灰白质分界不清，脑沟消失，脑室受压变形，常合并颅内出血。结论：CT检查能对新生儿缺血缺氧性脑病做出早期诊断和分度，能对颅内出血做出定性和定量诊断，为临床诊断和治疗新生儿缺血缺氧性脑病及预后评估有重要价值。     

Asymptomatic traumatic rupture of an intracranial dermoid cyst: A case report

BACKGROUNDPrevious studies reported that most of the intracranial dermoid cyst ruptures were spontaneous, and only a few were traumatic, with asymptomatic much rarer than the symptomatic ruptures. Hence, how to deal with the asymptomatic traumatic rupture of intracranial dermoid cyst remains a challenge in the clinic.CASE SUMMARYA 59-year-old man was accidentally diagnosed with intracranial dermoid cyst through a cranial computed tomography (CT) scan due to a car accident. A mixed-density lesion with fat and a calcified margin was observed in the midline of the posterior fossa, accompanied with lipid droplet drifts in brain sulci, fissures, cisterns, and ventricles. After 1 wk of conservative observation, no change was observed on the updated cranial CT scan. After 2 wk of conservative observation, magnetic resonance imaging examination confirmed that the lesion was a traumatic rupture of a posterior fossa dermoid cyst with lipid droplet drifts. As the patient exhibited no adverse symptoms throughout the 2 wk, a 6-mo follow-up visit was arranged for him instead of aggressive treatment. Nonetheless, the patient did not show any abnormal neurological symptoms in the 6 mo of follow-up visits.CONCLUSIONAsymptomatic traumatic rupture of intracranial dermoid cyst could be just followed or treated conservatively rather than treated aggressively.     

慢性乙醇中毒患者血清IL-6,TNF-α水平与脑萎缩的相关性

背景乙醇中毒可致神经系统广泛、严重的损害,并可降低自然杀伤细胞应答而使细胞免疫发生变化.但有关乙醇中毒性免疫损伤和脑损伤关系的研究较少.目的探讨慢性乙醇中毒患者血清白细胞介素-6(Interleukin-6,IL-6)和肿瘤坏死因子α(Tumor necrosisfactor alpha,TNF-α)水平变化及其与乙醇中毒性脑萎缩的关系.设计对照实验研究.地点和对象地点为遵义医学院附属第一医院,对象为1999-02/2001-07门诊和住院的32例慢性乙醇中毒患者,均为男性,年龄24～64岁.发病年龄24～50岁,病程2个月～6年.30例对照系健康体检者,均为男性,年龄30～60岁.干预用双抗体夹心酶联免疫吸附试验测定血清中IL-6和TNF-α水平,并结合头颅CT扫描进行分析.主要观察指标以脑室指数、Huckman值、侧脑室体部指数及三脑室宽度判定脑萎缩程度.根据试剂盒的校正曲线计算血清中相应的IL-6和TNF-α浓度.结果①慢性乙醇中毒组脑萎缩发生率为50%.②慢性乙醇中毒组血清IL-6和TNF-α水平[分别为(286.31±104.79)ng/L,(413.34±66.87)ng/L]显著高于健康对照组[分别为(205.43±48.67)ng/L,(261.36±51.48)ng/L](P＜0.001).③慢性乙醇中毒有脑萎缩者血清IL-6和TNF-α水平[分别为(343.75±99.59)ng/L,(449.38±55.79)ng/L]高于无脑萎缩者[分别为(228.88±75.74)ng/L,(377.31±57.96)ng/L](P＜0.001);慢性乙醇中毒组无脑萎缩者血清TNF-α水平显著高于健康对照(P＜0.001).④慢性乙醇中毒者血清IL-6和TNF-α水平变化与脑萎缩程度相关与三脑室宽度及Huckman值呈正相关;与脑室指数及侧脑室体部指数呈负相关.结论慢性乙醇中毒患者存在免疫功能异常,血清IL-6和TNF-α水平增高与乙醇的萎缩性脑损害有相关性.     

Recurrence of spontaneous intracranial hypotension with subdural hematomas

A 59-year-old man developed postural headache associated with a low CSF pressure. A CT scan revealed no abnormal findings and the orthostatic symptoms resolved without treatment 6 weeks after onset. He was diagnosed as having spontaneous intracranial hypotension (SIH) and remained symptom-free until he experienced recurrence of postural headache 9 months later. A lumbar puncture demonstrated low CSF pressure, and a CT scan revealed slit-like ventricles with narrowing of the sulci, Sylvian fissures, and infratentorial cisterns, in addition to bilateral subdural masses. After draining the hematomas, his symptoms resolved completely, and a follow-up CT scan was normal. We hypothesize that recurrent SIH in this case was due to small recurrent tears of a root sleeve. This case emphasizes the importance of follow-up of SIH for at least 9 months after resolution of symptoms.     

儿童急性淋巴细胞性白血病患者治疗后的脑MRI表现

目的 总结儿童急性淋巴细胞性白血病治疗后的脑MRI表现。方法 搜集了病理证实的10例急性淋巴细胞性白血病患儿,且排除了白血病对中枢神经系统的侵犯。8例静脉化疗加预防性鞘内化疗,2例除行静脉和鞘内化疗外还行头颅放疗,用MRI研究治疗后儿童脑实质的改变。结果 MRI显示5例（50%）患儿脑内有异常改变,2例有脑白质轻度病变,表现为侧脑室旁白质内单发或对称性T1低、T2高信号。1例有脑萎缩,表现为脑室扩大和脑沟增深。2例同时有白质轻度病变和脑萎缩改变。结论 MRI对于显示白血病治疗后的脑内异常改变是很敏感的。儿童白血病患儿治疗中和治疗后可选择性行头颅MRI检查以及时发现病变和指导治疗。     

自体骨髓间充质干细胞移植治疗原发性脑干损伤的近期效果观察

目的 观察自体骨髓间充质干细胞移植治疗原发性脑干损伤的近期有效性和安全性.方法 2007年7月至2010年7月我院收治原发性脑干损伤患者54例.移植组30例患者通过蛛网膜下腔注射方式行自体骨髓间充质干细胞移植,选择同时期入院但未行干细胞移植患者24例作为对照组.两组患者移植后1个月进行NIHSS评分,移植后6个月进行疗效比较.同期检测血常规、凝血机制、生化全项、肿瘤标记物.结果 移植后1个月,移植组患者NIHSS评分与对照组比较差异有统计学意义[分别为(10.86 ±7.48)、(18.26±8.74)分,t=2.681,P＜0.05];移植后6个月进行疗效比较差异有统计学意义(Z=2.306,P ＜0.05).随访各项血液检查结果未出现明显异常.结论 自体骨髓间充质干细胞移植治疗原发性脑干损伤安全且近期疗效确定,远期疗效尚待进一步观察.     

Long-term global and regional brain volume changes following severe traumatic brain injury: a longitudinal study with clinical correlates

Traumatic brain injury (TBI) results in neurodegenerative changes that progress for months, perhaps even years post-injury. However, there is little information on the spatial distribution and the clinical significance of this late atrophy. In 24 patients who had sustained severe TBI we acquired 3D T1-weighted MRIs about 8 weeks and 12 months post-injury. For comparison, 14 healthy controls with similar distribution of age, gender and education were scanned with a similar time interval. For each subject, longitudinal atrophy was estimated using SIENA, and atrophy occurring before the first scan time point using SIENAX. Regional distribution of atrophy was evaluated using tensor-based morphometry (TBM). At the first scan time point, brain parenchymal volume was reduced by mean 8.4% in patients as compared to controls. During the scan interval, patients exhibited continued atrophy with percent brain volume change (%BVC) ranging between -0.6% and -9.4% (mean -4.0%). %BVC correlated significantly with injury severity, functional status at both scans, and with 1-year outcome. Moreover, %BVC improved prediction of long-term functional status over and above what could be predicted using functional status at approximately 8 weeks. In patients as compared to controls, TBM (permutation test, FDR 0.05) revealed a large coherent cluster of significant atrophy in the brain stem and cerebellar peduncles extending bilaterally through the thalamus, internal and external capsules, putamen, inferior and superior longitudinal fasciculus, corpus callosum and corona radiata. This indicates that the long-term atrophy is attributable to consequences of traumatic axonal injury. Despite progressive atrophy, remarkable clinical improvement occurred in most patients.     

Epidemiology of blunt head injury victims undergoing ED cranial computed tomographic scanning

STUDY OBJECTIVE: We sought to describe the epidemiology of emergency department (ED) patients with blunt head injury undergoing cranial computed tomography (CT) scanning for the evaluation of possible traumatic brain injury (TBI). METHODS: Prospective, multicenter, observational study of ED patients undergoing cranial CT after blunt head injury. Patient's date of birth, sex, and race/ethnicity were documented before CT scanning. Individual patients were considered to have "significant" TBI if the official radiographic interpretation at the end of all imaging studies associated with the trauma was consistent with any of a set of predefined diagnoses. The relative prevalence of TBI among various prespecified groups from those undergoing cranial CT scanning was also calculated. RESULTS: Of 13728 patients who were enrolled, 8988 (65%) were men and 1193 (8.7%) had a significant acute TBI. Demographic findings associated with increased risk of TBI, among patients selected for scanning, included the following: age below 10 years (relative risk [RR] = 1.44, 95% confidence interval [CI], 1.19-1.77); age above 65 years (RR = 1.59; 95% CI, 1.40-1.80), and male sex (RR = 1.27; 95% CI, 1.30-1.43). CONCLUSION: Among patients selected for cranial CT scanning after blunt head injury, men, patients younger than 10 years, and those older than 65 years have an increased likelihood of significant TBI.     

液体衰减翻转恢复序列（FLAIR）在头颅MR检查中的价值

目的 探讨液体衰减翻转序列(FLAIR序列)在头颅MR检查中的应用价值。方法 对106例病人进行了轴位FSE T2和FLAIR序列的检查,25例做了轴位SE T1增强序列。并分别从不同病种和不同病变部位进行了分析。结果 106例病人中,86例有阳性发现,共显示117个病灶。60例脑梗塞病人,FSE T2和FLAIR序列对病变的敏感性相同,但在FLAIR序列能区分梗塞是否为陈旧性。3例转移瘤病人,FLAIR和SE T1增强序列均比FSE T2序列的敏感性高。3例脑脓肿病人和3例脑膜炎病人,FLAIR和SE T1增强序列能显示FSE T1序列不能显示的累及脑室和脑膜的炎症,且FLAIR序列比SE T1增强序列显示的范围大。13例原发性脑肿瘤病人和2例动静脉畸形病人,FSE T2、FLAIR和SE T1增强序列对病变的敏感性相同。1例癫痫病人,FSE T2、SE T1增强序列均为阴性,而FLAIR序列能显示右颞叶近脑沟的高信号病变。结论 在头颅MR检查中,FLAIR序列对邻近脑室、脑池和脑沟的病变较FSE T2更为敏感。     

外伤性脑肿胀的CT诊断(附105例分析)

本文分析了126例颅脑损伤中105例脑肿胀的CT表现。有脑沟变浅、不清,脑回变粗、模糊,外侧裂池变窄不滑、以至闭塞,脑室细小,脑池变窄、不清以至闭塞五个方面。在复查中当出现脑水肿最明显或脑水肿区与脑室之间有引流带或出现蛛网膜下腔增宽时,脑肿胀均有所减轻或消失。