中枢外伤医学知识讲座专家讲座

CentralNervousSystem

1/1/20241中枢外伤医学知识讲座第1页ClassificationofHeadInjuryExtracerebrallesions:SubduralhematomaSubduraleffusionEpiduralhematomaIntracerebrallesions:Braincontusion(edema,

hemorrhage..)Subarachnoidhemorrhage

(SAH)Intraventricularhemorrhage

(IVH)Opencranialinjury.

SkullfracturePneumoencephalus1/1/20242中枢外伤医学知识讲座第2页颅脑外伤braintrauma硬膜外血肿(epiduralhematoma)硬膜下血肿（subduralhematoma）脑挫裂伤（lacerationandcontusionofbrain）蛛网膜下腔出血Subarachnoidhaemorrhage1/1/20243中枢外伤医学知识讲座第3页硬膜外血肿

(extraduralhematoma)

Thesearisebetweentheinnertableoftheskullandthedura.Theyusuallydevelopfrominjurytothemiddlemeningealarteryoroneofitsbranches,andthereforeareusuallytemporoparietalinlocation.Atemporalbonefractureisoftenthecause,butisnotessential.Theexpandinghaematomastripsthedurafromtheskull;thisattachmentisquitestrongsuchthatthehaematomaisconfined,givingrisetoitscharacteristicbiconvexshape,withawelldefinedmargin.1/1/20244中枢外伤医学知识讲座第4页CT征象：颅板内侧梭形(双凸透镜)高密度影(与脑实质比)，CT值50~90Hu；(范围小而厚)密度普通较均匀边缘清楚、光滑锐利局部常见脑水肿征局部蛛网膜下腔常见出血征局部有颅骨骨折征含有占位征：局部脑回受压内移，中线结构向对侧移位1/1/20245中枢外伤医学知识讲座第5页

biconvexshape,withawelldefinedmargin.1/1/20246中枢外伤医学知识讲座第6页1/1/20247中枢外伤医学知识讲座第7页血块内含较灰区(箭)，

代表正在出血中，有未凝结血块EDH：纺垂型，高浓度血块头皮肿(箭)，撞击处1/1/20248中枢外伤医学知识讲座第8页硬膜外血肿MRI平扫、Gd-DTPA增强1/1/20249中枢外伤医学知识讲座第9页硬膜下血肿

（subduralhematoma）Thesearisebetweentheduraandarachnoid,oftenfromrupturedveinscrossingthispotentialspace.Thespaceenlargesasthebrainatrophiesandsosubduralhaematomasaremorecommonintheelderly.1/1/202410中枢外伤医学知识讲座第10页CT征象颅内板内侧新月状(或带状)高密度影(与脑实质比)，CT值50~90Hu，范围广而薄密度普通较均匀边界清楚，但不光滑锐利局部可有或无脑水肿局部可有或无蛛网膜下腔出血局部普通无颅骨骨折，常为对冲伤出血较多时含有占位效应，局部脑实质受压内移，中线结构向对侧移位1/1/202411中枢外伤医学知识讲座第11页

thecrescentichighdensitycollectiontypicalofaacutesubduralhaematoma,withassociatedmidlineshift.

1/1/202412中枢外伤医学知识讲座第12页急性硬膜下血肿（SDH）SDH：新月型(A.B)SDH可能在大脑镰内(C)。SDH也可在幕下(D)(不要误为脑內出血)ABCD1/1/202413中枢外伤医学知识讲座第13页A.SDH，显著占位效应B.术后，占位效应消失AcutesubduralhematomawithmasseffectAB1/1/202414中枢外伤医学知识讲座第14页等密度PlainCTIVcontrast1/1/202415中枢外伤医学知识讲座第15页1/1/202416中枢外伤医学知识讲座第16页0209术后02191/1/202417中枢外伤医学知识讲座第17页同一个病人，07281/1/202418中枢外伤医学知识讲座第18页Notethecrescenticlowdensitycollectiontypicalofachronicsubduralhaematoma,withassociatedmidlineshift.1/1/202419中枢外伤医学知识讲座第19页subduralhematoma1/1/202420中枢外伤医学知识讲座第20页脑挫裂伤（lacerationandcontusionofbrain）Theseoccurduetostretchingandshearinginjury,oftenduetoimpactionofthebrainagainsttheskullonthesideoppositetotheinjury.Thustheymaybeseendirectlyoppositetheimpactsite,subcutaneoushaematoma,fracture,orextraduralhaematoma(contrecoupinjury).Theinferiorfrontallobesandanteriortemporallobesarecommonsitesafterablowtothebackofthehead.1/1/202421中枢外伤医学知识讲座第21页

CT低密度水肿区,散在高密度出血灶,伴有占位效应。有表现为广泛脑水肿或脑内血肿MR脑水肿T1WI呈等低信号,T2WI高信号;脑血肿T1WI,T2WI均呈高信号1/1/202422中枢外伤医学知识讲座第22页Thereisafocalareaofhaemorrhagiccontusionintherightfrontallobe,withsurroundinglowdensityduetoinfarctionoroedema.Thisisafrequentlocationforacontre-coupinjuryfollowingablowtothebackofthehead.1/1/202423中枢外伤医学知识讲座第23页出血、异物、气颅1/1/202424中枢外伤医学知识讲座第24页IntracerebralHaemorrhage

1/1/202425中枢外伤医学知识讲座第25页SubarachnoidhaemorrhageThismayoccuraloneorinassociationwithotherintracerebralorextracerebralhaematomas.IncreasedattenuationisseenintheCSFspaces,overthecerebralhemispheres(lookcloselyattheSylvianfissure),inthebasalcisternsorintheventricularsystem.SAHmaybecomplicatedbyhydrocephalus.ConfusioncansometimesarisebetweenSAHduetotraumaandduetoarupturedaneurysmorarteriovenousmalformation(AVM);thepatientmaycollapseandhittheirheadasaresultofableedandthehistory(fromthepatientorawitness)isimportant.1/1/202426中枢外伤医学知识讲座第26页Thispatienthasanacuteextraduralhaematomaontherightside,andacutetraumaticsubarachnoidhaemorrhageontheleftside.1/1/202427中枢外伤医学知识讲座第27页Delayedhemorrhage,severalhoursordaysafterheadinjury8小时随访脑外伤后1/1/202428中枢外伤医学知识讲座第28页HeadinjurywithEDHanddelayedcontusionhemorrhages6月22日6月20日1/1/202429中枢外伤医学知识讲座第29页ContusionhemorrhagesandSAHA.9月29日

B.9月30日延迟性出血在脑挫伤极常见。脑挫伤：小血块及脑水肿混杂在一起

AB1/1/202430中枢外伤医学知识讲座第30页Vaultfractures1/1/202431中枢外伤医学知识讲座第31页颅脑外伤后遗症1.脑萎缩2.交通性脑积水，多因为蛛血、脑室内出血3.脑软化或脑穿通性囊肿，多因为脑挫伤1/1/202432中枢外伤医学知识讲座第32页86,5,14AcuteSDH&contusionhemorrhage86,5,16Post-craniotomy,theSDHdisappeared,delayedhemorrhage;SAHinRt.tentorium86,8,13EncephalomalaciachangewithmildhydrocephalusDecompressionhemorrhagewithencephalomalaciachange1/1/202433中枢外伤医学知识讲座第33页86,9,10:Communicatinghydrocephalus86,2,6:TraumaticSAHinthesulci,interhemisphericfissureSAHcausedcommunicatinghydrocephalus1/1/202434中枢外伤医学知识讲座第34页DiffuseAxonalInjury(DAI)Duetoaxonaldisruptionfromshearingforcesofacceleration/deceleration.MostcommonlyseeninsevereheadinjuryClinical:LossofconsciousnessattimeofinjuryMarkeddiscrepancybetweentheinitialCTandclinicalstatusofthepatientVerysmallDAIhaveprofoundclinicalsequelasincetheyaffectdenselypackedbundlesofaxonslocateddeepwithinthebrain1/1/202435中枢外伤医学知识讲座第35页DiffuseAxonalInjuryRadiographicfeatures:Characteristiclocations:lobargraymatter/whitematterjunction,corpuscallosum,dorsolateralbrainstemInitialCTisoftenreadasnormalDAIlesionscanbeverysmallandprimarilynon-hemorrhagicrenderingthemquiteinconspiciousonthe1stCTscanPetechialhemorrhagedevelopslateronMultifocalT2brightlesions(MRImoresensitive)1/1/202436中枢外伤医学知识讲座第36页DiffuseAxonalInjurySurvivorsofsevereDAIusuallyhavepoorneurologicoutcomes1/1/202437中枢外伤医学知识讲座第37页1stday4monthslater--brainatrophy5thdayComaafterheadinjury4monthslater,semi-vegetatestageMultiplepunctatehemorrhagesDiffuseaxonalinjury(DAI)causedbraina