65例老年慢性硬膜下血肿临床诊断与治疗

目的　回顾性分析老年慢性硬膜下血肿 (CSDH)的诊断和治疗。方法　对 6 5例老年CS DH患者的CSDH患者一般资料、临床表现、CT改变、误诊情况和治疗方法及预后进行探讨。结果　75 .3%明确外伤史 ,主要临床表现为 :头痛 5 2 .3%、头晕 4 7.7%、呕吐 35 .4 %、精神症状 18.4 %、反应迟钝 6 6 .2 %、意识障碍 2 0 .0 %、视乳头水肿 15 .4 %、偏瘫 2 7.7%等。CT显示血肿部位位于额颞顶枕10 .7%、额颞顶 38.5 %等。经钻孔血肿引流或开颅血肿清除术治疗后 ,老年CSDH显效率为 80 .0 %。结论　老年CSDH的临床症状不典型 ,易被误诊 ,预后差。应重视外伤史的调查 ,可疑病例应尽早行头颅CT检查 ,以便及早诊断和治疗 ,改善CSDH的预后

Clinical Diagnosis And Treatment of 65 Cases with Senium Chronic Subdural Hematoma

Objective To analyze the diagnosis and treatment of senium chronic subdural hematoma(CSDH) retrospectively. Methods The common data, clinical manifestations, changes of CT, rate of misdiagnosis, methods of treatment and prognosis were discussed in 65 senior patients with chronic subdural hematoma. Results 75.3% of the patients had clear wounded history. The main clinical manifestations were headache, dizziness, vomit, mental symptoms, bad-response, disturbance of consciousness, papilledema, hemiplegia and so on, with the rate of 52.3%,47.7%,35.4%,18.4%,66.2%, 20.0%, 15.4%,27.7%,respectively. 10.7% of the hematoma were located at temporal lobe, parietal lobe, occipital lobe, frontal lobe, 38.5% so on in CT. With the treatment of draining the hematoma by drilling or cleaning the hematoma by craniotomy, the total effective rate of senium CSDH were 80.0%. Conclusions The clinical symptom of senium CSDH is atypical, and senium CSDH was easily misdiagnosed, its prognosis is bad. It is important to inquire into the wounded history. The skull CT inspection should be carried out as early as possible in order to early diagnose, treat and improve the prognosis in the suspicious cases.