颅脑损伤合并多发伤的临床分析

颅脑损伤合并伤在诊断时往往会掩盖和影响合并伤的诊断，特别在昏迷和休克情况下更易造成漏诊，延误治疗。因此不能只注重本专业范围内的检查，而忽略其他部位的检查，对待颅脑伤，必须及时做出诊断，尽快合理地处理合并伤，以取得更好的疗效。     

颅脑损伤合并上颈椎损伤的诊治

颅脑损伤患者中约1／3合并有上颈椎损伤，在临床工作中应引起高度重视。笔者对1997年8月-2006年5月间收治的28例颅脑损伤合并上颈椎损伤患者进行回顾性分析。现报告如下。     

颅脑损伤患者的临床诊断及预后

目的:探讨外伤后颅脑损伤的临床诊断与预后分析。方法选取2017年11月至2018年12月我院收治的外伤致颅脑损伤患者49例作为本次研究的对象,入院后立即对患者进行快速的诊断和相应的治疗,观察患者的临床效果及预后。结果49例颅脑损伤患者通过有效治疗后,全部恢复的患者有19例(38.78%),恢复较好的患者有24例(48.98%),无效患者有6例(12.24%),治疗总有效率是87.76%。结论临床诊断与治疗外伤致颅脑损伤患者,必须予以及时抢救,能够有效保障患者生命安全,提高患者治愈率,改善患者预后水平,值得在临床上大力推广应用。     

重型颅脑损伤合并上颈椎损伤临床分析

目的 了解重型颅脑损伤合并上颈椎损伤患者的临床特点，以提高对其认识和警惕性。方法 对29例重型颅脑损伤合并上颈椎损伤患者进行临床分析。结果 致伤原因：交通伤26例，高处坠落伤1例，高处陡坡滚落伤1例，矿井塌方致伤1例。治疗结果：生存16例，死亡13例。按格拉斯哥预后评分(GOS)评定：Ⅴ级2例，Ⅳ级7例，Ⅲ级6例，Ⅱ级1例，Ⅰ级13例。结论 重型颅脑损伤合并上颈椎损伤，伤情严重而复杂，颅脑损伤容易受到重视被及时诊断、及时抢救治疗；而上颈椎损伤临床表现容易被掩盖、相对隐蔽，极易漏诊，不能及时处理，死亡率高，严重并发症是死亡的主要原因。     

颅脑损伤合并脑肿瘤卒中的临床分析

回顾分析12例颅脑损伤伴脑肿瘤卒中患者的临床资料,卒中主要表现为脑内血肿、蛛网膜下腔出血等。8例患者好转,2例植物生存,2例死亡。了解脑肿瘤卒中的临床特点,根据临床、影像学表现与颅脑损伤鉴别,有利于提高早期诊治水平。     

颅脑损伤合并严重颌面损伤的急诊救治

颅脑损伤合并颌面部损伤是一种常见而复杂的颅脑损伤,死亡率高,其急诊救治时保持呼吸道通畅是关键,抗休克和脑疝的救治是重点,同时积极防止并发症及加强基础护理,才能真正、全面地提高患者生存率及生存质量。     

重型颅脑损伤合并低钠血症52例临床分析

回顾性分析52例重型颅脑损伤术后合并低钠血症的临床资料,其中抗利尿激素不适当分泌综合征(SI-ADH)35例,脑性盐耗综合征(CSW S)17例。认为尽快查明原因,采取正确治疗措施,低钠血症多能得到纠正。     

复合型颅脑损伤特点与救治分类

目的　探讨复合型颅脑伤的损伤特点与救治关系以及对预后结局的影响。方法　通过创伤评分法 ,对 76 1例多发伤合并有颅脑损伤患者的生理指标和解剖损伤进行伤情量化评定 ,并计算其生存概率(Ps)。依据各部位伤的AIS分值在ISS评分组合作用大小和顺位分为 4类 ,以此对损伤程度、生理改变、组合关系以及预后等方面进行对比与统计学分析。结果　交通伤比较多见 ,常为多重暴力所致 ,颅内损伤与颅外损伤可有组合差异 ,生理状态与解剖损伤常呈不对称相关 ,颅脑性因素与非颅脑性因素多为复合影响。伤员的生存概率与ISS分值组合分布密切相关。结论　明确颅脑损伤与颅外损伤组合特点 ,对认识各部位伤情的组合关系 ,强调整体复合意识 ,指导分类救治是有益的     

Magnetization transfer imaging in the detection of injury associated with mild head trauma

BACKGROUND AND PURPOSE: Most traumatic brain injuries are classified as mild, yet in many instances cognitive deficits result. The purpose of this study was to investigate possible relationships between quantitative magnetization transfer imaging (MTI) and neurocognitive findings in a cohort of patients with mild head trauma but negative findings on conventional MR images. METHODS: We examined 13 patients and 10 healthy volunteers with a standard MR protocol including fast spin-echo and gradient-echo imaging, to which was added quantitative MTI. MTI was performed with a modified gradient-echo sequence incorporating pulsed, off-resonance saturation. Both region-of-interest analysis and contour plots were obtained from the MTI data. A subgroup of nine patients was examined with a battery of neuropsychological tests, comprising 25 measures of neurocognitive ability. RESULTS: The magnetization transfer ratio (MTR) in the splenium of the corpus callosum was lower in the patient group as compared with the control group, but no significant reduction in MTR was found in the pons. Individual regional MTR values were significantly reduced in two cases, and contour plot analysis revealed focal areas of abnormality in the splenium of four patients. All the patients showed impairment on at least three measures of the neuropsychological test battery, and in two cases a significant correlation was found between regional MTR values and neuropsychological performance. CONCLUSION: Our results suggest that MTI and contour plot analysis may add sensitivity to the MR imaging examination of patients with traumatic brain injury.     

APACHEⅡ评估无颅脑损伤的严重腹部损伤及其临床意义

APACHEⅡ（急性生理学与健康评价）评估系统是反映急性危重病员的生理紊乱程度的生理参数，其分值的高低与受伤的严重程度大体相关，总分值（包括年龄项和慢性健康评分项）越高，预后越差。     

Major depressive disorder with psychotic features in an aviator after head trauma

We present a case in which a Naval aviator suffered an unusual sequence of neuropsychiatric symptoms after head trauma. He demonstrated subtle deficits on several measures 1 mo after the trauma. Repeat testing at 8 mo showed apparent recovery, and the patient was cleared to return to flight status. Unbeknownst to medical staff, the patient was still experiencing difficulties. He was found in a severely debilitated state and exhibiting psychotic features 12 mo after his initial trauma. The patient was hospitalized in a psychiatric ward, and with prolonged inpatient and outpatient treatment, he eventually recovered.     

Optic nerve trauma with unilateral edema as a result of head injury

We encountered a patient who suffered a head injury that translated to the optic nerves, leading to dramatic unilateral right optic nerve edema. The decedent was a 20-year-old unsecured passenger in a convertible. The car collided with a pickup truck. The patient survived for 8 h. At autopsy, a comminuted skull fracture involving the right frontal bone including the right orbital plate was found. The right optic nerve measured 1.2 cm in diameter, compared to only 0.4 cm for the left optic nerve. Microscopically, the right optic nerve was markedly edematous, but the nerve fibers and nuclei were viable and intact. The dramatic difference in size between the right and left optic nerves can be attributed to several mechanisms. The survival interval was essential for the asymmetrical swelling to take place. Optic nerve trauma is relatively rare in head injuries, reported to be present in 0.5% of automobile accidents and assaults. Other causes of optic nerve trauma and edema include tumors, osteopetrosis, or reaction to a peripheral hemodialysis shunt.     

颅脑外伤后进展性出血性损伤的研究进展

临床研究发现，颅脑外伤后35％～65％的患者因为继发性脑缺血、出血和水肿而导致进行性临床表现加重。其中进展性出血性损伤（progressive hemorrhagic injury，PHI），可使临床恶化的危险性增加5倍，是导致颅脑外伤患者残疾和死亡的主要原因。现对PHI的研究进展综述如下。     

Association of internal carotid artery injury with carotid canal fractures in patients with head trauma

OBJECTIVE: The purpose of our study was to determine the degree to which carotid canal fracture and other CT findings are associated with internal carotid artery (ICA) injury in patients with head trauma. MATERIALS AND METHODS: Three neuroradiologists retrospectively evaluated CT scans and cerebral angiograms of 43 patients who underwent cerebral angiography within 7 days after blunt cranial trauma over a 5-year period. Seventeen patients underwent unilateral and 26 had bilateral carotid angiography. Angiograms were evaluated for ICA injury and CT scans were evaluated for carotid canal fracture, brain contusion, subarachnoid hemorrhage, basilar skull fracture, subdural hematoma, soft-tissue swelling, sphenoid sinus air-fluid level, and other skull fracture. We recorded the number of true-positive (+CT, +angiogram), true-negative (-CT, -angiogram), false-positive (+CT, -angiogram), and false-negative (-CT, +angiogram) studies. We determined the sensitivity, specificity, positive predictive value, and negative predictive value for each CT finding. RESULTS: We identified 21 carotid canal fractures in 17 patients. Eleven ICA injuries were seen in 10 patients. Six patients with ICA injury had a carotid canal fracture. The presence of a carotid canal fracture had a sensitivity of 60% and specificity of 67% for detection of injury to the ICA passing through that canal. These values were similar to those for other CT findings. CONCLUSION: Sensitivity, specificity, positive predictive value, and negative predictive value of carotid canal fracture were only moderately good for determining the presence of ICA injury and were similar to other CT findings not typically associated with ICA injury.     

Imaging findings in diffuse axonal injury after closed head trauma

Even in patients with closed head trauma, brain parenchyma can be severely injured due to disruption of axonal fibers by shearing forces during acceleration, deceleration, and rotation of the head. In this article we review the spectrum of imaging findings in patients with diffuse axonal injuries (DAI) after closed head trauma. Knowledge of the location and imaging characteristics of DAI is important to radiologists for detection and diagnosis. Common locations of DAI include: cerebral hemispheric gray-white matter interface and subcortical white matter, body and splenium of corpus callosum, basal ganglia, dorsolateral aspect of brainstem, and cerebellum. In the acute phase, CT may show punctate hemorrhages. The true extent of brain involvement is better appreciated with MR imaging, because both hemorrhagic and non-hemorrhagic lesions (gliotic scars) can be detected. The MR appearance of DAI lesions depends on several factors, including age of injury, presence of hemorrhage or blood-breakdown products (e. g., hemosiderin), and type of sequence used. Technical aspects in MR imaging of these patients are discussed. Non-hemorrhagic lesions can be detected with fluid attenuated inversion recovery (FLAIR), proton-density-, or T2-weighted images, whereas gradient echo sequences with long TE increase the visibility of old hemorrhagic lesions. Received 17 September 1997; Revision received 2 December 1997; Accepted 15 December 1997     

Corpus callosum lesions after closed head injury in children: MRI,clinical features and outcome

Summary Thirty-four children who sustained moderate to severe closed head injury underwent magnetic resonance imaging (MRI). Eight (24%) had MRI evidence of corpus callosum injury, most commonly within the posterior body and splenium. In contradistinction to reports in adults, there was no definite relationship between callosal injury and lower initial Glasgow Coma Scale scores, nor was there a significantly higher incidence of primary brain-stem lesions, diffuse axonal shear injury or intraventricular hemorrhage. In none of these 8 children did the initial admission computed tomography show evidence of callosal injury. Callosal injuries on MRI are not necessarily a poor prognostic finding, the majority of the 8 children showing good functional recovery.