等密度硬膜下血肿的CT诊断(附47例分析)

本文分析了47例等密度硬膜下血肿的CT表现,观测的各种CT征象,发现(1)bolus增强扫描显示的血肿、血肿膜及表面移位血管;(2)中线结构的特征性偏移;(3)表面脑回聚拢内移;(4)脑灰白质界面内移;(5)侧脑室变形和脑—脑室指数变小,对等密度硬膜下血肿的诊断和鉴别诊断有重要意义。     

Long-Term Subdural Strip Electrocorticographic Monitoring of Ictal Déjà Vu

Summary: We report a series of 8 patients with ictal déjà vu. Subdural strip electrocorticographic (ECoG) monitoring localized the ictal epileptogenic focus as follows: right (n = 6) and left (n = 2) mesiotemporal lobe. In all 8 patients, the left hemisphere was dominant for language function based on intracarotid amytal testing. In 6 right-handed patients, ictal déjà vu was associated with a right temporal lobe focus. However, in the 2 left-handed patients, the ictal focus was left temporal lobe. Although ictal déjà vu localizes the epileptic focus to temporal lobe, this experiential phenomenon appears to lateralize to the hemisphere nondominant for handedness.     

钻颅注氧置换治疗慢性硬膜下血肿

目的观察钻颅注氧置换治疗慢性硬膜下血肿的临床疗效.方法30例患者局麻后,用颅锥穿颅骨内板,穿刺置入双腔管,先用生理盐水进行血肿冲洗,再注入氧气(每次20m1),使血肿腔内残留液体流出,如此反复操作,直至无液体换出为止.结果术后1周内全部病例的临床症状全部或绝大部分消失.术后2个月后CT复查结果全部病例血气体均基本吸收,无1例复发.随访半年,无1例复发及并发症发生.结论钻颅注氧置换治疗慢性硬膜下血肿是一种操作简便、创伤小、安全可靠、疗效显著确切、适应症宽、所需器械少、易于推广的术式.     

Life threatening hyponatraemia following evacuation of spontaneous chronic subdural haematoma

We report the case of a 43-year-old woman who developed life threatening hyponatraemia 4 days following burr hole drainage of a spontaneous chronic subdural haematoma (CSDH). Syndrome of inappropriate secretion of antidiuretic hormone was confirmed. This is the first report of delayed life threatening hyponatraemia developing postoperatively in CSDH. The mechanism remains unclear but may involve brain shift on the pituitary stalk following subdural evacuation.     

硬膜下积脓的临床特点及治疗分析

目的探讨硬膜下积脓(Subdural empyema,SDE)的临床特点,为临床治疗提供借鉴。方法回顾性分析本科保守治疗的硬膜下积脓病例1例,并对已有文献报道进行综述,总结其临床、影像学表现及治疗。结果文献报道共50例患者,48例外科手术治疗,2例内科保守治疗。SDE起病急,主要临床表现为大脑镰综合征、抽搐,意识障碍。头磁共振表现:大脑镰及小脑幕下积脓呈长T1,长T2信号,FLAIR呈高信号,DWI呈高信号,积脓周围脑膜强化。治疗上主要以外科手术为主,少数病例通过合理的抗菌药物治疗也可好转。结论镰幕硬膜下积脓的临床特点是大脑镰综合征和镰幕下积脓;以外科治疗为主,内科保守治疗也是一种可行的治疗方法。     

Temporal changes in extra-axial brain hematoma's signal intensity in magnetic resonance images of trauma patients: A preliminary,technical study

IntroductionDating the exact or estimated time of trauma is an important issue facing forensic medicine. Several clinical and radiological methods were used to achieve this purpose. In the recent study, we aimed to track the changes in the signal intensity of the extra-axial brain hematoma using magnetic resonance imaging (MRI) conventional sequences as well as diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC).Materials and methodsConsidering inclusion and exclusion criteria, all patients with blunt head trauma were involved. After proper management., stabilization, and resuscitation, the participants were assessed using conventional sequences of MRI and DWI twenty-four hours, forty-eight hours, and three weeks after the injury. Temporal changes of signal intensity were compared by Wilcoxon ranged test.ResultsSixteen patients sustaining blunt head trauma were included in this study. The study showed that during the time, diffusion restriction could be seen in an extraaxial hematoma. At the first 24 hours, the signal of hematoma was void in 87.5% of DWI and 100% of ADC. On the second day, they were hypo-signal in 75% of DWI and 100% 0f ADCs, and after three weeks, 100% of cases were hyper-signal in DWI and hypo-signal ADCs.ConclusionThis preliminary study has shown that the DWI can be used to detect and track the extra-axial hematoma. The signal intensity was void during the first twentyfour hours, although it became hypo-signal after 48 hours. Of note, the diffusion restriction is noted after three weeks.     

单孔双管闭式引流治疗硬膜下血肿的疗效探讨

目的 探讨单孔双管闭式引流治疗慢性硬膜下血肿的临床疗效.方法 将104例慢性硬膜下血肿患者随机分为三组:单孔双管引流组(观察组,37例)、单孔单管额部引流组(对照组1,34例)及单孔单管顶枕部引流组(对照组2,33例).观察两组患者手术情况及住院时间、术后恢复情况及复发情况等指标.结果 三组患者在手术时间、术中出血量、平均住院时间、术后住院时间及住院费用差异均无统计学意义(均P＞0.05).观察组中线恢复情况均明显高于对照组1、对照组2(均P＜0.05)；颅内积气量由低到高依次为观察组、对照组2、对照组1,残留液体量由低到高依次为观察组、对照组1、对照组2,差异均有统计学意义(均P＜0.05).全部患者均无严重并发症发生.结论 单孔双管闭式引流具有较好的临床疗效,可显著减少术后残留液体量和颅内积气.     

Mathematical formulae to estimate chronic subdural haematoma volume. Flawed assumption regarding ellipsoid morphology

Mathematical formulae are commonly used to estimate intra-cranial haematoma volume. Such formulae tacitly assume an ellipsoid geometrical morphology. Recently, the ‘XYZ/2’ formula has been validated and recommended for chronic subdural haematoma (CSDH) volumetric estimation. We aimed to assess the precision and accuracy of mathematical formulae specifically in estimating CSDH volume, and to determine typical CSDH 3-D morphology. Three extant formulae (‘XYZ/2’, ‘π/6·XYZ’ and ‘2/3S·h’) were compared against computer-assisted 3D volumetric analysis as Gold standard in CTs where CSDH sufficiently contrasted with brain. Scatter-plots (n = 45) indicated that, in contrast to prior reports, all formulae most commonly over-estimated CSDH volume against 3-D Gold standard (‘2/3S·h’: 44.4%, ‘XYZ/2’: 48.84% and ‘π/6·XYZ’: 55.6%). With all formulae, imprecision increased with increased CSDH volume: in particular, with clinically-relevant CSDH volumes (i.e. >50 ml). Deviations >10% of equivalence were observed in 60% of estimates for 2/3S·h, 77.8% for ‘XYZ/2’ and 84.4% for ‘π/6·XYZ’. The maximum error for ‘XYZ/2’ was 142.3% of a clinically-relevant volume. Three-D simulations revealed that only 4/45 (9%) CSDH remotely conformed to ellipsoid geometrical morphology. Most (41/45, 91%) demonstrated highly irregular morphology neither recognisable as ellipsoid, nor as any other regular/non-regular geometric solid. Conclusions: Mathematical formulae, including ‘XYZ/2’, most commonly proved inaccurate and imprecise when applied to CSDH. In contrast to prior studies, all most commonly over-estimated CSDH volume. Imprecision increased with CSDH volume, and was maximal with clinically-relevant CSDH volumes. Errors most commonly related to a flawed assumption regarding ellipsoid 3-D CSDH morphology. The validity of mean comparisons, or correlation analyses, used in prior studies is questioned.