自发性硬膜下血肿的临床CT诊断

目的探讨自发性硬膜下血肿的临床、CT表现及其发病机理，提高对自发性硬膜下血肿的诊断水平。方法搜集经手术或cT动态观察证实的17例自发性硬膜下血肿病例，男15例，女2例，其中16例年龄37—77岁，平均61岁，另1例4岁，所有病例均行cT平扫，回顾性分析其临床及CT表现。使用Siemens SOMATOM P1us4型CT扫描机，扫描条件140KV，189MA，自OM线向上连续扫描10-12层，层厚10mm。结亲临床表现：17例患者中，3例患者快速进入昏迷，其余患者症状包括头痛头晕，恶心呕吐，记忆力下降，视物模糊，肢体乏力、疼痛、麻木，行走不稳，言语不清，5例患者症状表现为进行性加重，其中1例发展为偏瘫，另1例逐渐进展至昏迷。cT表现：血肿多位于大脑突面，双侧出现血肿的4例，单侧13例。额颞部血肿9例，额颞枕顶部血肿6例，额顶部2例，其中3例有大脑镰区血肿。13例单侧发病病例中10例位于左侧，3例位于右侧。血肿位于颅内板与脑皮质问，呈新月形、带状、镰状、梭形，或表现为大脑镰增厚。血肿CT值17—57Hu，等密度5例，低密度5例，高密度3例，混杂密度4例，其中一例出现分层征。17例中，4例占位效应轻微，9例占位效应较明显，4例形成脑镰下疝。17例均无颅骨骨折表现。结论自发性硬膜下血肿的临床表现无特征性，CT可显示血肿的直接征象和占位效应等间接征象，具有一定的诊断价值。

Clinical and CT Diagnosis of the spontaneous subdural hematoma

Objective To investigate clinical, CT features and pathogenesis of tile spontaneous subdural hematoma and to improve the diagnostic ability for the spontaneous subdural hematoma. Methods 17 cases, inculded 15males, 2 female, of which males 15, females 2, age 37-77, the average 61, except one 4 years old. proved with spontaneous subdural hematoma by operation or dynainic observation with CT, were collected, CT plain scanning was performed in all cases. The clinical manifestations and CT features of aU cases were retrospeclively analyzed. All cases were examined with a Siemens SOMATOM Plus4 scanner. Scanning conditions for 140KV,189MA. 10-12 layers were scanned from OM line upperword, thickness for 10mm. Results The clinic appearances：3 of the 17 cases were quickly in a coma, the remaining 14 cases had headache, dizzy, nausea, vomiting, memory decline,blur and physicl fatigue, pain, numbness, unstable walking, and barylalia. 5 cases with symptoms progressed, of which one got worse to hemiplegia, another one progressed gradually in a coma. CTmanifestations..Most of the hematomas were on the convex brain, bilateral hematomas occurred in 4 cases and unilateral in 13 cases. Frontotemporal hematomas was in 9, frontotemporal-occipitalapical hematomas in 6, frontoapical hematoma in 2, 3 of the 17 cases had hematomas beside the cerebral falx. Of the 13 unilateral occurred 10 located in left side, and 3 in right side.The hematomas were between the skull and the cerebral cortex. They were creseent,band-shaped, sickle-shaped, fusiform, or performanced of cerebral falx thickening. CT value of the hematomas are ranged from 17 Hu to 57Hu, isodensity of 5 cases,low-density 5 cases, high-density 3 cases, and mixed density 4 cases, in which one＇ s appeared layered-sign. Of thel7 cases, 4 appeared mild mass effect, 9 cases appeared more visible mass effect, and hernia under the cerebral falx were seen in another 4 severe cases. No skull fracture was found in all 17 cases. Conclusion The clinical manifestations of the spontaneous