小儿外伤性迟发性脑内血肿

目的 探讨小儿外伤性迟发性脑内血肿的临床特点，诊断和治疗。方法 回顾性分析我院1987年1月-1998年12月收治的27例小儿外伤性迟发性脑内血肿。结果 27例小儿外伤性迟发性脑内血肿中，行血肿清除术13例，颅骨钻孔血肿内置管 增强尿激酶外引流术6例，非手术治疗8例，26例治愈，1例死亡，死亡率3.70%。结论 进行性意识障碍，头痛，呕吐，贫血加重和生命体征不稳定是小儿迟发性脑内血肿的基本临床特征，高度警惕本病的发生，及时再次CF扫描有利于早期诊断，掌握好手术和非手术治疗的指征，是治愈本病的关键。     

迟发性外伤性硬脑膜外血肿

迟发性外伤性硬脑膜外血肿２００００３上海第二军医大学长征医院梁玉敏卢亦成朱诚江基尧张光霁杨中坚白如林丁学华关键词血肿，硬膜外；诊断学中国图书资料分类号Ｒ６５１．１５我院１９８４年４月～１９９２年８月收治１８例迟发性外伤性硬脑膜外血肿（ＥＴＥＤＨ），占...     

迟发性外伤性颅内血肿的诊治探讨(附46例报告)

分析 4 6例迟发性外伤性颅内血肿临床资料。观察发现中老年易发生迟发性颅内血肿。手术组的迟发性血肿多位于硬膜下和硬膜外 ,术后 6小时发病率高 ;未手术组迟发性血肿多位于额叶、颞叶部 ,伤后 3天内发病率高。早诊断、早治疗是降低死亡率、并发症的关键     

外伤迟发性颅内血肿42例诊治体会

目的：探讨外伤性迟发性颅内血肿的发病机理、临床特点、诊断和治疗。方法：回顾性分析1995年3月～2004年3月收治的42例外伤性迟发性颅内血肿。结果：42例外伤性迟发性颅内血肿中，行开颅血肿清除术20例，锥颅血肿内置管 增强尿激酶引流术12例，非手术治疗10例。40例治愈，2例死亡，死亡率4．78％。结论：进行性意识障碍加重、头痛、呕吐和生命体征不稳定是外伤性迟发性颅内血肿的基本临床特征，高度警惕本病的发生，及时再次CT扫描有利于早期诊断；掌握好手术和非手术治疗的指征，是治愈本病的关键。     

外伤性迟发性颅内血肿

外伤性迟发性颅内血肿，系指头伤后经过一段时间才发生的颅内血肿。自ＣＴ问世后对其发病机理有了新的认识。我科自１９８６年至１９９１年６月共收治外伤性迟发性颅内血肿３１例，占同期颅脑伤住院患者的２．０％，颅内血肿的５．９％。现结合文献对本组资料进行讨论。临...     

外伤性颅内血肿清除术后迟发血肿23例诊治体会

目的探讨迟发性颅内血肿的发病因素及治疗措施。方法对23例迟发外伤性颅内血肿的临床资料进行回顾性分析。结果中老年易发生迟发性颅内血肿,迟发性血肿多位于硬膜下和硬膜外,额叶、颞叶部居多。结论早诊断早治疗是降低死亡率并发症的关键。     

外伤性迟发性颅内血肿的早期诊断

外伤性迟发性颅内血肿的早期诊断唐志放我科自１９９２年４月～１９９５年４月共收治颅内血肿病例３８４例，其中诊断为外伤性迟发性颅内血肿３１例，占同期收治颅内血肿病例数的８．１５％．现结合其诊断特点报告如下．临床资料３１例中男１９例，女１２例；年龄５～８０...     

硬脑膜下血肿清除术后迟发对侧硬脑膜外血肿8例

一侧硬脑膜下血肿清除术后出现对侧迟发性硬脑膜外血肿（DEDH）不常见，我们自1992年1月～1996年1月收治8例，现报告如下。至临床资料1．至一般情况男6例，女2例；年龄15～65岁，平均32．4岁。交通事故伤5例，坠落伤3例。伤后1～5h入院，平均3．4h。入院时格拉斯哥（GCS）评分：3～5分5例，6～8分1例，9～12分2例。一侧瞳孔散大，Babinski征阳性4例。CT扫描结果：均为一侧硬脑膜下血肿，血肿量15～80ml，其中合并脑实质内血肿1例，脑挫伤3例，颅骨骨折2例。确诊为硬脑膜下血肿后立即开颅清除血肿，去除骨瓣。术中发生急性脑肿胀3例，术…     

外伤后肾上腺迟发性出血的诊治

目的探讨外伤后肾上腺迟发性出血的临床特点,提高对外伤后肾上腺迟发性出血的诊治水平。方法回顾性分析2000～2006年6例外伤后肾上腺迟发性出血的临床资料。结果外伤后肾上腺迟发性出血临床表现无特异性,1例出现肾上腺功能下降。CT及MRI无增强改变,3例手术后病理显示肾上腺血肿,手术清除血肿后恢复佳。结论外伤后肾上腺迟发性出血无特异性诊断方法,易误诊,B超、CT和MRI对诊断有一定价值,清除血肿时应尽量保存健康肾上腺组织。     

外伤性迟发性后颅窝血肿的诊断

外伤性迟发性后颅窝血肿的诊断钟鸣瞿宣兴林岩崇郑伟明陈伟建吴恩福我院自１９８６年１月～１９９６年５月间共收治外伤性迟发性后颅窝血肿１７例，占同期外伤性后颅窝血肿的１７％，均经ＣＴ复查发现，笔者结合文献就该病的诊断问题作初步的讨论。临床资料一般资料：男１...     

外伤性骑跨横窦硬脑膜外血肿46例临床分析

目的探讨外伤性骑跨横窦硬脑膜外血肿的形成机制、诊断、临床治疗方法及疗效。方法回顾性分析2006年1月—2012年1月收治的46例外伤性骑跨横窦硬脑膜外血肿患者的临床资料。结果本组46例病人中35例手术治疗,11例非手术治疗。恢复良好38例,中或重度残疾6例,死亡2例。结论骑跨横窦硬脑膜外血肿缺乏典型的临床表现,且病情常急剧恶化,早作头颅CT扫描、早诊断、早治疗,有手术指征者尽早手术,术中充分减压、止血、避免横窦二次受压和注意对冲性损伤,是提高外伤性骑跨横窦硬脑膜外血肿疗效的关键。     

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 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 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.     

外伤性迟发性脑内血肿的早期CT表现

目的　研究外伤性迟发性脑内血肿的早期CT表现 ,评价这些表现对迟发性脑内血肿的预期诊断意义。方法　搜集CT复查证实的外伤性迟发性脑内血肿 31例 ,对其首次CT检查及复查的CT影像特点进行分析。按时间顺序抽取脑外伤后复查无脑内血肿病人 5 0例作为对照。统计处理2组观察结果。结果　 31例迟发性脑内血肿首次CT检查主要异常表现包括 :(1)限局性脑实质密度减低 ,灰白质分界不清 18例。 (2 )限局性蛛网膜下腔出血 2 4例。 (3)局部脑轻度占位效应 16例。 (4 )硬膜下血肿 9例。统计学显示与无迟发性脑内血肿差异有显著性意义 (χ2 =4 5× 10 -10 ,2 7 98,19 5 7,10 5 4,P值均 <0 0 1)。同时盲法测试结果显示 ,作者与盲法观察结果差异无显著性意义 (χ2 =1 0 3,0 34 ,2 81,P值均 >0 0 5 )。结论　脑外伤后首次行CT检查 ,出现局部脑实质密度减低 ,灰白质分界不清 ;局部蛛网膜下腔出血及脑占位效应 ,提示此部位可能出现迟发性脑内血肿 ,应及时做CT复查     

Subdural hematomas in infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse

BACKGROUND AND PURPOSE: Patients who have benign enlargement of the subarachnoid spaces (BESS) have long been suspected of having an increased propensity for subdural hematomas either spontaneously or as a result of accidental injury. Subdural hematomas in infants are often equated with nonaccidental trauma (NAT). A better understanding of the clinical and imaging characteristics of subdural hematomas that occur either spontaneously or as a result of accidental trauma may help distinguish this group of patients from those who suffer subdural hematomas as a result of NAT. The purpose of this study is to describe the clinical and imaging characteristics of subdural hematomas that occur either spontaneously or as a result of accidental injury in infants with BESS. METHODS: We conducted a retrospective review of all patients with BESS complicated by subdural hematomas evaluated at a single institution from 1998 to 2004. Data concerning the patient's clinical presentation, physical findings, imaging, and management are described. RESULTS: During the study period, 7 patients with BESS complicated by subdural hematoma were identified. Their mean age at identification of the subdural hematoma was 7.4 months of age. In 5 cases, there was no recognized trauma before identification of the subdural hematoma. In 3 cases, baseline CT or MR imaging was available, showing prominent subarachnoid spaces without any evidence of subdural hemorrhage. CONCLUSION: Although suspicious for NAT, subdural hematomas can occur in children either spontaneously or as a result of accidental trauma. Caution must be exercised when investigating for NAT based on the sole presence of subdural hematomas, especially in children who are otherwise well and who have BESS.     

Magnetic resonance imaging of the lumbar spine after epidural and nerve root injection therapy: evaluation of soft tissue changes

OBJECTIVE: Magnetic resonance imaging (MRI) was performed to evaluate soft tissue changes after nerve root and epidural injections in lumbar spine in patients with radiculopathy. MATERIALS/METHODS: Patients underwent a multiple-shot injection protocol to nerve root/epidural space. The MRI protocol included T1-weighted, T2-weighted, STIR, and contrast-enhanced, fat-saturated T1-weighted sequences before and after treatment. RESULTS: In all treated patients, a diffuse wedge-shaped edema in paravertebral tissues with a slight contrast enhancement was seen. Two small hematomas in the paravertebral muscle were noted. No changes in the epidural space, the abscess, or a lipodystrophy in epidural/nerve root space occurred. CONCLUSION: Normal tissue changes after injection therapy of lumbar radiculopathy include wedge-shaped tissue edema at the injection level. In a minority of patients, small hematomas may occur.     

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.