神经模块脑外伤课件

06神经模块-脑外伤HEADTRAUMA06神经模块-脑外伤分类06神经模块-脑外伤

CNStraumaClinicalFeaturesNoLossofconsciousness(L.O.C)(SDH,EDH?,NotDAI)Awakeatthescene,DelayedLOC(SDH,EDH,Swelling,NotDAI)TransientLOC-Wake-up-DelayedLOC)(“Classic”lucidintervalforEDH)ContinousLOCFollowingImpact(“Classic”shearing/DiffuseAxonalinjury)06神经模块-脑外伤CentripetalapproachousidetoinsideScalp-hematoma(头皮血肿)Calvarium-skullfracture（颅骨骨折）Epidural-hematoma（硬膜外血肿）Subdural-hematoma（硬膜下血肿）Subarachnoid-hemorrhage(蛛网膜下腔出血)Intraparenchymal-,contusion,edema,hemorrhage

（脑挫裂伤、脑内血肿）Intraventricular-hemorrhage（脑室出血）06神经模块-脑外伤头皮肿胀06神经模块-脑外伤

损害在对应的撞击部位；30%的发生率.对冲伤06神经模块-脑外伤Calvarium-skullfractureLinearStellateDepressedBasilar06神经模块-脑外伤骨折.线型骨折.凹陷型骨折.CT对凹陷型骨折很重要，常伴其他颅内损伤.06神经模块-脑外伤06神经模块-脑外伤额顶骨线样骨折.06神经模块-脑外伤颅骨骨折、头皮血肿、对冲伤（急性硬膜下血肿）06神经模块-脑外伤外伤性颅内积气.多个气泡在蛛网膜下腔.气体来源.颅骨开放性骨折.颅底骨折（副鼻窦、乳突小房）.06神经模块-脑外伤脑外损伤.06神经模块-脑外伤EPIDURALHEMATOMA(硬膜外血肿)06神经模块-脑外伤EPIDURALHEMATOMADirecttraumatocraniumFracture(90%)-Laceration（撕裂）

ofMeningealA.andV.Locationis66%temporo-parietal（颞顶部）TemporalBone(70-80%)Mortality（死亡率）of15-30%06神经模块-脑外伤EPIDURALHEMATOMAScoureofbloodMenigealVessels（脑膜血管）-A,VDuralsinus（静脉窦）lucidinterval（中间清醒期40%pts）Bi-convex,Hyperdense-limitedbysutures（颅缝）06神经模块-脑外伤EPIDURALHEMATOMA-CTBiconvexorlens-shaped

（双凸镜）homogeneous,heterogeneous,indicatingactivebleedingrarelycrossessutures（缝）fractureline06神经模块-脑外伤急性硬膜外血肿.06神经模块-脑外伤急性硬膜外血肿.

常有大的占位效应.06神经模块-脑外伤急性硬膜外血肿06神经模块-脑外伤血肿包含不凝血或活动出血.血肿内可见圆形密度减低影.06神经模块-脑外伤

SUBDURALHEMATOMA

硬膜下血肿06神经模块-脑外伤SUBDURALHEMATOMAScoureofbloodLaceration（撕裂）ofCortical（脑皮层血管）AA.andVV.(Direct:penetratinginjury)(直接穿透伤)Bridging(Cortical)Veins（桥静脉）Duralsinus（静脉窦）LargeContusions(Direct/indirect:PulpedBrain06神经模块-脑外伤SUBDURALHEMATOMA

Presentationsignificantheadtrauma,butchronicsubdural-onlyminororremotehistoryoftraumaBilateralin20%adults(commoninelderly),80-85%bilateralininfantsextensionintointerhemisphericfissure（纵裂）,tentorial（小脑幕）marginsbraininjuryin50%;ComplexInjury(DAI)skullfractureinonly1%06神经模块-脑外伤SUBDURALHEMATOMA-CTCrescenticinshape

（新月形）ExtendsbeyondcalvarialsuturesAcuteSDH-HyperdenseSubacuteSDH-Isodense(1-2weeks)ChronicSDH-HypordenseEnhancementofveinsmaybeusefulinidentifyingisodensesubdurals06神经模块-脑外伤SUBDURALHEMATOMA-MRIMaybebetterfordetectioninthesubacutestage,andatestimatingageofsubduralhematomaCanallowdifferentiationofepidural/subduralbecauseofdirectvisualizationofthedura,especiallyoncoronalimaging06神经模块-脑外伤高密度损害占据大脑半球的大部分.06神经模块-脑外伤急性硬膜下血肿.血肿可以延伸到小脑幕区.06神经模块-脑外伤血肿延伸至大脑镰部.大脑镰部硬膜下血肿.06神经模块-脑外伤侧脑室受压移位.SAH06神经模块-脑外伤VP引流术导致SDH.脑萎缩、轻度脑积水.VP后双侧硬膜下血肿.右侧SDH扩大.06神经模块-脑外伤06神经模块-脑外伤06神经模块-脑外伤慢性硬膜下血肿.外形：半月形、纺锤形、椭圆形.密度：高密度、等密度、低密度、混杂密度.06神经模块-脑外伤慢性硬膜下血肿.混杂密度（等、高密度）.液液平（再出血）06神经模块-脑外伤慢性硬膜下血肿.高渗透压性血肿、脑脊液再吸收进入、血肿一天比一天大.06神经模块-脑外伤慢性硬膜下血肿.脑外伤（或轻微外伤）.头痛、眩晕发作；烦躁.06神经模块-脑外伤等密度慢性硬膜下血肿.06神经模块-脑外伤高信号硬膜下血肿.高铁血红蛋白（T1/T2均为高信号）.06神经模块-脑外伤高密度慢性硬膜下血肿（T1/T2均为高信号）.06神经模块-脑外伤双侧硬膜下积液.06神经模块-脑外伤明显占位效应，手术清除后，占位效应消失.06神经模块-脑外伤硬膜下积液.发生在老人及幼儿.外伤几天后形成.常双侧.自发吸收.穿颅术、VP、脑膜炎也可发生.06神经模块-脑外伤硬膜下积液.06神经模块-脑外伤硬膜下积液转变成慢性硬膜下血肿.06神经模块-脑外伤慢性硬膜下血肿伴出血.液液平（高低密度混杂）.06神经模块-脑外伤

Subarachnoidhemorrhage

（蛛网膜下腔出血）06神经模块-脑外伤外伤性蛛网膜下腔出血.常伴脑内脑外损伤.蛛网膜下腔线状高密度.沟、裂、池可以引起脑积水.06神经模块-脑外伤SubarachnoidhemorrhageThesensitivityofCThasbeenreportedtorangefrom85to100%.highdensitylesionwasdemonstratedincerebralcisterns（Subarachnoidspaceovercerebralconvexity,Suprasellacistem（鞍上池）,interpeduncularcistern（脚间池）,pontinecistern,cisternofthelateralfissure（侧裂池）byplainCTscanComputedtomography(CT)isthemethodofchoicetodetectacutesubarachnoidhemorrhage(SAH).06神经模块-脑外伤Subarachnoidhemorrhage-MRIMagneticresonanceimaging(MRI)usingFLAIRsequencesshowsacomparablesensitivityinacuteSAHevenbesuperiortoCT.(hyperintenseonT2FLAIR)InsubacuteSAH,startingfromday5afterthesuspectedhemorrhage,thesensitivityofMRIisclearlysuperiortoCT.(hyperintenseonT1WIandT2WI)06神经模块-脑外伤纵裂池、脑沟SAHSAH一引起交通性脑积水.交通性脑积水.06神经模块-脑外伤外伤性脑室出血.常伴发脑内脑外损伤.脑室出血.可引起急性梗阻性或慢性交通性脑积水.06神经模块-脑外伤

CEREBRALCORTICALCONTUSION（脑挫伤）06神经模块-脑外伤脑挫伤.局限性脑水肿脑水肿内混杂多个小的出血.孤立的血肿.弥漫性脑水肿.弥漫性轴索损伤（剪切伤）.06神经模块-脑外伤ScoureofbloodTraumatic/MechanicalDisruptionofsmall(capillary)VesselsAdmixtureofbloodmixedwithNativeTissue(Petechialhemorrage点状出血)Mottle/SpeckledDensity斑点混杂(“Saltandpepper”onCT)盐、胡椒06神经模块-脑外伤CEREBRALCORTICALCONTUSIONPresentation

Lossofconsciousness,headache,mentalstatuschangeUsuallyinasuperficialcorticallocation50%occurintemporallobe33%infrontallobe(frontalpoleandinferiorsurface)Delayedhemorrhageseenin20%06神经模块-脑外伤CEREBRALCORTICALCONTUSION-CTIll-definedmixedhypodenseandhyperdenselesions-hemorrhageandedemaMaycoalesce（融合）1-2daysaftertraumaEdemaandmasseffectrelatedtocontusion06神经模块-脑外伤CEREBRALCORTICALCONTUSION-MRIMoresensitivethanCTinidentifyingnonhemorrhagiclesionsMultipleareassuperficialT2hyperintensityindicatingedemaHeterogeneousT1/T2signalintensitydependentuponageofhemorrhagicfoci06神经模块-脑外伤06神经模块-脑外伤DIFFUSEAXONALSHEARINGINJURY（弥漫性轴索损伤）06神经模块-脑外伤DIFFUSEAXONALSHEARINGINJURY（弥漫性轴索损伤）Followsseveredeceleratingclosedheadtrauma,patientsaregenerallyunconsciousfromthetimeoftheeventLocationofinjuriesaretypicallyinareasoflargenumbersofparallelaxonssuchasthecorpuscallosum,internalcapsule,brainstem,basalgangliaandsubcorticalwhitematter06神经模块-脑外伤DIFFUSEAXONALSHEARINGINJURY-CTUsuallypunctatehyperdensitiesareseeninthecorpuscallosum,graywhiteinterfaces,androstralbrainstemTheaxonalinjuryitselfisnotvisualized,buttheassociatedmicro(andmacro)hemorrhagesinthecharacteristicdistributionareseen06神经模块-脑外伤小斑点状出血、水肿（胼胝体、半卵圆中心、基底节区）.06神经模块-脑外伤多个点状出血.脑外伤后昏迷.脑萎缩.06神经模块-脑外伤左侧额叶皮层下白质.胼胝体.小斑点状出血水肿.06神经模块-脑外伤detectingandcharacterizingbrainstemlesions,specificallyandpredominatelynon-hemorrhagiccontusionsAppearancedependsonpresenceorabsenceofhemorrhageT1-weightedsequencesoftennormal;multiplehyperintensefociatgray-whitejunctionsandcorpuscallosumonT2WIDIFFUSEAXONALSHEARINGINJURY-MRI06神经模块-脑外伤DIFFUSEAXONALSHEARINGINJURY-MRI06神经模块-脑外伤03－5－3骑摩托车与另一摩托车相撞，入院时为浅昏迷，GCS评分6分，

20天后甚至转清，未能言语，

03－6－6言语模糊，乱语

03－6－16对答正常06神经模块-脑外伤DIFFUSEAXONALSHEARINGINJURY-MRI06神经模块-脑外伤迟发性颅内出血06神经模块-脑外伤迟发血肿.迟发行脑挫裂伤.06神经模块-脑外伤硬膜外血肿迟发脑挫裂伤.06神经模块-脑外伤挫裂伤伴蛛网膜下腔出血迟发性硬膜下、硬膜外血肿同一天，12小时后.06神经模块-脑外伤减压出血：外科减压术后的迟发出血迟发性出血.挫伤水肿.穿颅术后，血肿清除，迟发挫伤出血.06神经模块-脑外伤穿颅术后.06神经模块-脑外伤迟发血肿、自发吸收.烦躁.亚急性EDH.无手术，血肿缩小.06神经模块-脑外伤脑挫裂伤所致的：脑萎缩.交通性脑积水.脑软化、脑穿通囊肿.06神经模块-脑外伤DAI引起的脑萎缩.06神经模块-脑外伤

QUESTIONS06神经模块-脑外伤AllofthefollowingarerelatedtothepathogenesisofepiduralhematomaEXCEPT:

A.Disruptionofbridgingveins+ThisistheetiologyofasubduralhematomaB.Lacerationofthemiddlemeningealartery-ThatstatementistrueC.Disruptionoftheduralvenoussinuses-ThatstatementistrueD.Frequentincidenceofassociatedskullfracture-Thatstatementistrue06神经模块-脑外伤SUBDURALHEMATOMA-

WhichofthefollowingstatementsisCORRECTA.Itisassociatedwithunderlyingbraininjuryapproximately20%ofthetime-50%areassociatedwithunderlyingbraininjuryB.ItisassociatedwithalucentintervalwithregardstopatientpresentationNo,epiduralhematomaisassociatedwithalucentintervalC.ItisassociatedwithabetteroverallprognosisthanisanepiduralhematomaTheprognosisofasubduralhematomaisgenerallyworsethananepiduralhematomaduetohighrateofunderlyingbraininjuries06神经模块-脑外伤AllofthefollowingconcerningcorticalcontusionsaretrueEXCEPT:

A.Occurmostcommonlyinthefrontallobes+TheyoccurmorecommonlyinthetemporallobesB.Secondarytobrainimpactingagainstboneorduraafteracceleration/decelerationinjury-ThisstatementistrueC.Ill-definedmixedhypodenseandhyperdenselesionsincorticalsurfaceonCT-ThisstatementistrueD.MRIismoresensitivethanCTinidentifyingnonhemorrhagiclesions-Thisstatementistrue06神经模块-脑外伤颅脑外伤

总结06神经模块-脑外伤硬膜外血肿（EpiduralHematoma）概述：颅脑外伤中，硬膜外血肿占3%，急性占86.%，亚急性占10.3%，慢性占3