急性硬膜下血肿近期预后因素分析

急性硬膜下血肿是颅脑损伤常见的继发性损害 ,因其伤后病情变化急剧 ,治疗难度较大 ,治疗效果较差 ,故病残率与死亡率较高。本文将我科自1998年 3月至 2 0 0 2年 3月收治的急性硬膜下血肿71例手术后病人作一回顾性分析 ,以出院时ＧＣＳ、ＧＯＳ评分为标准 ,对影响急性硬膜下血肿的可能因素 ,用Ｌｏｇｉｓｔｉｃ回归分析方法进行评价 ,现报告如下。临床资料　　 1.一般资料 :本组男性 5 0例 ,女性 2 1例。年龄 3～ 74岁 ,平均 4 0 2岁。2 .临床资料 :致伤原因 :交通事故伤 32例 ,高处坠落伤 2 5例 ,打击伤、重物砸击伤及挤压伤等 14例。受伤…     

急性硬膜下血肿的CT表现和预后

急性硬膜下血肿的ＣＴ表现和预后李学时，陈少琼本文总结１９９３年４～１９９５年１２我院收治的临床和ＣＴ资料完整的急性硬膜下血肿（ＡＳＨ）３２例，伴有弥漫性脑肿胀（ＤＢＳ）１２例。通过分析脑外血肿量，厚度，脑移位，基底池消失评分（ＣＥＳ）及ＤＢＳ等因素．...     

外伤性急性硬膜下血肿术后迟发脑内血肿27例报告

外伤性急性硬膜下血肿术后迟发脑内血肿在临床工作中时有发生,再出血使原有的脑损伤进一步加重,多发生于中老年患者,该病预后差,致残率高.我院自2006年以来外伤性急性硬膜下血肿435例,其中术后出现迟发脑内血肿共27例,现报告如下.     

老年人外伤性慢性硬膜下血肿的形成机理和诊疗探讨

集我院58例60岁以上外伤性慢性硬膜下血肿病例作临床分析和病理研究,以探讨其发病机理和治疗原则。 一、资料和方法 (一)临床资料:男47例,女11例,男:女=4.3:1。年龄60～86岁,平均65.3岁,占同期外伤性慢性硬膜下血肿病人的67.8％。致伤原因:交通事故伤23例,跌伤21例,击伤6例,碰撞伤8例。血肿部位:左侧21例,右侧23例,双侧14例。外伤当时情况,无意识障碍26例,仅一过性精神恍惚12例,昏迷1～30分钟18例。昏     

急性硬膜下血肿及其预后评估

分析２３７例急性外伤性硬膜下血肿病人的预后，出院时（伤后２个月）１２４例恢复良好，轻残与重残２８例，８５例死亡。选择病人入院时的有关临床指标，应用Ｌｏｇｉｓｔｉｃ回归分析方法研究表明，入院时的ＧＣＳ评分和瞳孔大小及光反应与病人的预后密切相关，ＧＣＳ评分和瞳孔变化相结合应用可以尽早而准确地预测急性硬膜下血肿病人的预后，为治疗提供依据。     

外伤性大脑半球间硬膜下血肿2例

外伤性大脑半球间硬膜下血肿(Interhemispheric subduralhematoma ,ISH)是一种特殊的硬膜下血肿,较为少见。由于解剖位置的特殊性,直到1940年才由Airrng和Erans首次在尸检中发现。自Jacobsen于1955年首次报道该病以来,至今仅有110例[1]。我科新近收治ISH患者2例,现将诊治情况报告如下。     

外伤性亚急性硬膜下血肿45例报告

亚急性硬膜下血肿（SASDH）约占硬膜下血肿5％,发生率较低。本文总结了我科于1997年1月至2006年6月期间收治的45例外伤性亚急性硬膜下血肿,并结合文献资料对发病机制进行探讨。     

外伤性后颅窝硬膜下血肿的治疗探讨

目的探讨外伤性后颅窝硬膜下血肿的诊断、治疗及预后。方法对24例外伤性后颅窝硬膜下血肿患者的临床和影像学资料进行回顾性分析。结果24例患者中,手术治疗19例,保守治疗5例。14例预后不良,10例预后良好。其中GCS>8分组中预后不良者25.0%(3/12),而GCS≤8分组中预后不良者91.7%(11/12)。结论GCS评分、血肿量、中脑周围池和第四脑室改变、幕上脑积水与外伤性后颅窝硬膜下血肿患者的预后有关,其中GCS评分是影响其预后的最重要因素。     

急性外伤性硬膜下血肿48例快速自行消退的护理观察

急性外伤性硬膜下血肿占颅脑损伤的10%～30%,病死率高达50%～90%,其快速自行消退在临床上甚为少见,我院五年共收治急性外伤性硬膜下血肿1548例,其中48例快速消退,仅占3.1‰,本文对其自行消退过程中护理要点进行分析。1临床资料1.1一般资料男37例,女11例。年龄:4岁～52岁,18岁以     

Chronic subdural hematoma preceded by traumatic subdural hygroma

Patients with traumatic subdural hygroma (SDG) are at an increased risk of developing chronic subdural hematoma (CSDH). However, the mechanism by which this occurs is still not fully understood. The purpose of this paper is to investigate the clinical characteristics and pathogenesis of CSDH, as well as the relationship between CSDH and SDG. We review the pertinent literature and retrospectively examine a series of cases in which CSDH had been preceded by SDG to understand the natural history and developmental mechanisms of these lesions. We discuss the cases of 24 patients in whom CSDH developed from traumatic SDG between 2001 and 2005. Headache was the most common symptom, and the mean Glasgow Coma Scale score was 14.1. Increases in SDG volume were observed in CT scans of 17 patients, and increased density and volume was observed in five patients. The mean interval between the two diseases was 57.6 days, and 13 patients developed new symptoms after the development of CSDH. The most common symptoms at that time were headache and hemiparesis. All patients underwent an operation, which resulted in good recovery in all but one case. The cycle of persistent SDG, rebleeding, coagulation and fibrinolysis contributes to the development of CSDH from SDG. It is important to understand the natural history of CSDH and carefully follow up patients with head injury, especially if it is associated with SDG, and the potential for the development of CSDH should be considered.     

急性硬脑膜下血肿减压术后对侧进展性硬脑膜外血肿的早期诊治

目的 探讨颅脑外伤去骨瓣减压术(DC)后对侧进展性硬脑膜外血肿(EDH)的临床特点和早期诊治方法.方法 对23例颅脑外伤术后对侧进展性EDH患者的资料进行回顾性分析.结果 术后对侧进展性EDH的平均确诊时间为(4±3)h;EDH的部位为颞顶部12例,枕顶部9例,额颞部2例;主要表现为术中脑肿胀8例,术后对侧瞳孔散大4例,术后ICP逐渐增高4例,神经系统无明显异常改变者7例.保守治疗1例,再手术22例,21例确认血肿处骨折存在.出院时GOS评分5分5例,4分7例,3分7例,2分者1例,1分3例.结论 急性外伤性硬脑膜下血肿(SDH)术后对侧进展性EDH以颞顶和枕顶部最多见,冲击部位颅骨骨折处出血是最主要的机制,早期确诊和治疗有助于改善预后.     

Infantile acute subdural hematoma

A retrospective analysis of the infantile acute subdural hematoma was made with special reference to its pathogenesis. In 11 of 15 cases, the hematomas were bilateral or a contralateral subdural fluid collection was present. In 7 of 11 patients who underwent operation the collection was bloody fluid and/or clotted blood. In 3 patients, a subdural membrane, as seen in adult chronic subdural hematoma, was found. In only 1 patient with unilateral hematoma was clotted blood present without subdural membrane. The thickest collection of clotted blood was in the parasagittal region. It is postulated that in most cases hemorrhage occurs after minor head injury, from the bridging veins near the superior sagittal sinus, into a pre-existing subdural fluid collection such as chronic subdural hematoma or subdural effusion with craniocerebral disproportion, and that infants without intracranial disproportion are unlikely to have acute subdural hematoma caused by minor head injury.     

外伤性硬膜下积液在向慢性硬膜下血肿转化过程中的相关因素配对回归分析

目的 回顾性研究外伤性硬膜下积液向慢性硬膜下血肿(CSDH)转化过程中相关因素的影响.方法 对22例慢性硬膜下血肿中明确有外伤性硬膜下积液(TSE)的患者根据性别、年龄、职业配对单纯外伤性硬膜下积液的患者(1∶2配对,共44例).多因素回归分析外伤性硬膜下积液转化为慢性硬膜下血肿组与单纯外伤性硬膜下积液组间在硬膜下积液CT值、积液部位、积液体积、凝血功能4种相关因素间有无差异.结果 外伤性硬膜下积液转化为慢性硬膜下血肿组与单纯外伤性硬膜下积液组间患者的伤后硬膜下积液CT值、积液部位间差异存在统计学意义.结论 外伤性硬膜下积液存在向慢性硬膜下血肿转化的趋势,患者硬膜下积液的CT值相对较高、积液位于额颞部患者这一趋势尤为明显.     

Immediate development of a contralateral acute subdural hematoma following acute subdural hematoma evacuation

Contralateral hematoma formation following acute subdural hematoma (ASDH) evacuation is a well-described complication. The most common type of contralateral hematoma is an epidural hematoma. Rarely, ASDH develops on the contralateral side. We report an elderly woman who presented with a post-traumatic ASDH and underwent ipsilateral hematoma evacuation by craniotomy and subsequently developed a contralateral ASDH. Because of the potential consequences of a delayed ASDH, there should be a low threshold for early post-operative imaging following ASDH evacuation, especially in elderly patients and those with additional associated intracranial injuries.     

外伤性纵裂区血肿的显微外科治疗

目的 提高外伤性纵裂血肿的临床疗效.方法 回顾性分析21例经显微手术治疗的外伤性纵裂区血肿的临床资料、手术方法和手术疗效.结果 按GOS治疗结果评定,术后随访1-9年,恢复良好16例,中残2例,重残1例,植物生存1例,死亡1例.21例均有明确出血来源,大脑前动脉远段分支破裂出血和纵裂区静脉破裂出血者以全纵裂血肿多见且手术效果较好,纵裂区脑组织挫伤出血者以局部纵裂血肿和挫伤水肿为主,部分患者预后较差.结论 正确掌握外伤性纵裂区血肿的手术指征和手术技巧,及时手术治疗,有助于改善外伤性纵裂血肿患者的预后.

Abstract：

Objective To study the treatment and clinical outcomes of traumatic interhemispheric subdural hematoma ( TISH ). Method The clinical datum, surgical management and outcomes of 21 patients with TISH treated with mircrosurgery were analyzed retrospectively. Results According to Glasgow coma scale(GCS) ,good recovery was found in 16 cases, moderate disability in 2, severe disability in 1, vegetative survival in 1, and death in 1 during postoperative follow - up period (1-9 years ). There were confirmed sources of hemorrhage in all 21 cases. The whole cerebral longitudinal fissure hematoma was more frequently seen in patients with hemorrhage from rupture of the distal part of anterior cerebral artery and veins in the cerebral longitudinal fissure, the prognosis was usually good. Local hematoma, laceration and edema in the cerebral longitudinal fissure were more frequently seen in patients with hemorrhage from brain tissue laceration of the longitudinal fissure, the prognosis was usually poor. Conclusions Good understanding of surgical indications, commanding of surgical skills and timely surgical intervention are helpful in improving the prognosis of TISH patients.     

慢性硬膜下血肿的预后影响因素分析(附214例报告)

目的 探讨影响慢性硬膜下血肿(CSDH)预后的相关危险因素及其防治方法.方法 对2008年1月至2011年1月我院收治的214例CSDH患者的临床资料进行回顾性分析,收集患者的一般情况、临床症状、影像学表现、治疗方法、预后等资料进行统计学分析.结果 214例患者中康复者193例(89.72％),预后不良者22例(10.28％);男性188例(87.85％),女性26例(12.15％).单因素分析显示两组在性别,年龄,凝血功能,血肿位置,血肿量,入院时Markwalder’分级,头晕/头昏,双下肢乏力方面差异有显著性意义.多因素Logistic回归分析显示,影响CSDH预后的因素有性别,年龄,凝血功能,血肿位置,入院时Markwalder’分级.结论 影响CSDH预后的因素较复杂,根据患者的不同病情采取适当的治疗方法可降低血肿复发率.     

Arteriovenous malformation presenting as acute subdural haematoma

Abstract

A case of acute subdural haematoma caused by ruptured arteriovenous malformation is reported. At surgery, there was no association with intracerebral haematoma or definite subarachnoid haemorrhage. The mechanism of acute subdural haematoma in the present case was considered to be rupture of an arteriolized bridging vein drained by arteriovenous malformation. [Neurol Res 1993; 15: 353-355]     

Chronic subdural haematoma associated with disturbance of consciousness: significance of acute-on-chronic subdural haematoma

Abstract

Objective:

Detailed features of chronic subdural haematoma (cSDH) associated with disturbance of consciousness and acute-on-chronic subdural haematoma (a/cSDH), in which acute subdural haematoma overlaps cSDH, remain poorly understood. The object of this study was to clarify both characteristics of cSDH associated with disturbance of consciousness and the significance of a/cSDH.

Methods:

Clinical factors and computed tomography (CT) findings were retrospectively investigated in 349 consecutive patients admitted between 2006 and 2013 and diagnosed with cSDH.

Results:

Glasgow Coma Scale (GCS) was ≤?8 in 21 patients (6.0%) and 9–14 in 29 patients excluding aphasia and/or dementia (8.3%). Multiple logistic regression analysis indicated that a/cSDH, female sex and haemodialysis were significantly related to severe disturbance of consciousness (GCS?≤?8). Predictors for a/cSDH observed in 29 patients (8.3%) were trauma history within 7?days before admission, high prothrombin time–international rate, and use of anticoagulants and/or antiplatelets. Unfavourable outcomes were observed in 29 of 299 patients (9.7%) without consciousness disturbance, compared to 27 of 50 patients (54%) with consciousness disturbance. Predictors of unfavourable outcome were consciousness disturbance, increase in age, malignancy, trauma history within 7?days and haemodialysis.

Discussion:

Disturbance of consciousness associated with cSDH, often caused by either a/cSDH or concomitant disease, frequently resulted in unfavourable outcomes. As a result, in cSDH patients associated with disturbance of consciousness, underlying conditions, especially a/cSDH, which is often caused by haemostatic abnormality, should be clarified and managed.