外伤致大脑间纵裂血肿临床特点及救治

目的探讨大脑间纵裂血肿(interhemispheric subdural hematoma，ISH)的临床特征、发生机理和治疗。方法回顾性分析1996年以来收治的大脑问纵裂血肿患者的临床特点和救治情况。结果本组治愈29例，死亡2例．分别死于多脏器功能衰竭和脑疝，治疗后复查有6例出现纵裂硬膜下积液。结论在大脑纵裂间积血达20mL以上，或出血厚度超过1cm，有明显的占位效应的，可以作为大脑间纵裂血肿诊断的一个参考标准。治疗方法包括保守治疗和手术治疗，手术治疗多以功能障碍或病情稳定与否来考虑选择手术的依据。

Clinical characteristics and treatment of the traumatic interhemispheric subdural hematoma

Objective To analyze retrospectively the clinical characteristics, pathogeny and therapy of traumatic interhemispheric subdural hematoma (ISH). Methods 31 ISH cases admitted since 1996 were reviewed and analyzed retrospectively concerning the clinical characteristics and therapies. Typically, ISH manifested itself with hemiplegia or monoplegia in the contralateral lower limb, called the falx syndrome, and unconsciousness was infrequent at the initial stage of the head injury. The pathogeny of ISH involved cracks of the bridging vein, hematomas in the interhemispheric small arteries and veins and probably coagulation dysfunction or anticoagulant therapy. Results In all 31 patients, 29 were cured and 2 died of multisystem organ failure (MSOF) and cerebral hernia respectively. The follow-up revealed that 6 cured patients developed interhemispheric subdural effusion. Conclusion CT scanning showing the interhemispheric hematoma exceeds 20 mL, or the interhemispheric hematoma is thicker than 1 cm can be referential to the diagnosis of ISH. For the ISH treatment, surgery and conservative management are suggested based on the functional disturbance or the stability of the disease. Patients with progressive neurologic deterioration should be operated without delay.