神经模块-脑外伤新PPT资料.ppt
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神经模块-脑外伤新PPT资料.ppt
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HEADTRAUMARadiology,TheSecondAffiliatedHospital,ShantouUniversity,MedicalCollege郑文斌CNStraumaClinicalFeaturesnnNoLossofNoLossofconsciousness(L.O.Cconsciousness(L.O.C)(SDH,EDH?
@#@,NotDAI)(SDH,EDH?
@#@,NotDAI)nnAwakeatthescene,DelayedLOCAwakeatthescene,DelayedLOC(SDH,EDH,Swelling,NotDAI)(SDH,EDH,Swelling,NotDAI)nnTransientLOC-Wake-up-DelayedLOC)TransientLOC-Wake-up-DelayedLOC)(“Classic”lucidintervalforEDH)(“Classic”lucidintervalforEDH)nnContinousContinousLOCFollowingImpactLOCFollowingImpact(“Classic”shearing/DiffuseAxonalinjury)(“Classic”shearing/DiffuseAxonalinjury)CentripetalapproachousidetoinsidennScalp-Scalp-hematomahematomannCalvariumCalvarium-skullfracture-skullfracturennEpidural-Epidural-hematomahematomannSubdural-hematomaSubdural-hematomannSubarachnoidSubarachnoid-hemorrhage-hemorrhagennIntraparenchymalIntraparenchymal-,contusion,-,contusion,edema,hemorrhageedema,hemorrhagennIntraventricularIntraventricular-hemorrhage-hemorrhageCalvarium-skullfracturennLinearnnStellatennDepressednnBasilarnnEggshellEPIDURALHEMATOMAEPIDURALHEMATOMAnnScoureofbloodMenigealVessels-A,VDuralsinusnnlucidinterval(40%pts)nnBi-convex,Hyperdense-limitedbysuturesEPIDURALHEMATOMAnnDirecttraumatocraniumnnFracture(90%)-LacerationofMeningealA.andV.nnLocationis66%temporo-parietalnnTemporalBone(70-80%)nnMortalityof15-30%EPIDURALHEMATOMA-CTnnBiconvexorlens-shapednnhomogeneous,heterogeneous,indicatingactivebleedingnnrarelycrossessuturesnnfracturelineSUBDURALHEMATOMASUBDURALHEMATOMAScoureofbloodnnLacerationofCorticalAA.andVV.(Direct:
@#@penetratinginjury)nnLargeContusions(Direct/indirect:
@#@PulpedBrainnnBridging(Cortical)VeinsSUBDURALHEMATOMAPresentationnnsignificantheadtrauma,significantheadtrauma,butchronicbutchronicsubduralsubdural-onlyminororremote-onlyminororremotehistoryoftraumahistoryoftraumannBilateralin20%adults(commoninelderly),Bilateralin20%adults(commoninelderly),80-85%bilateralininfants80-85%bilateralininfantsnnextensionintoextensionintointerhemisphericinterhemisphericfissure,fissure,tentorialtentorialmarginsmarginsnnbraininjuryin50%;@#@ComplexInjury(DAI)braininjuryin50%;@#@ComplexInjury(DAI)nnskullfractureinonly1%skullfractureinonly1%SUBDURALHEMATOMA-CTnnCrescenticinshapennExtendsbeyondcalvarialsuturesnnAcuteSDH-HyperdensennSubacuteSDH-Isodense(1-2weeks)nnChronicSDH-HypordensennEnhancementofveinsmaybeusefulinidentifyingisodensesubduralsSUBDURALHEMATOMA-MRInnMaybebetterfordetectioninthesubacutestage,andatestimatingageofsubduralhematomannCanallowdifferentiationofepidural/subduralbecauseofdirectvisualizationofthedura,especiallyoncoronalimagingSubarachnoidhemorrhageSubarachnoidhemorrhagennThesensitivityofCThasbeenreportedtorangeThesensitivityofCThasbeenreportedtorangefrom85to100%.from85to100%.nnhighdensityhighdensitylesionwasdemonstratedinlesionwasdemonstratedincerebralcerebralcisternscisterns(SubarachnoidSubarachnoidspaceovercerebralspaceovercerebralconvexity,convexity,SuprasellaSuprasellacistemcistem,interpeduncularinterpeduncularcistern,cistern,pontinepontinecistern,cisternofthelateralcistern,cisternofthelateralfissurefissure)byplainCTscanComputedbyplainCTscanComputedtomography(CT)isthemethodofchoicetotomography(CT)isthemethodofchoicetodetectdetectacuteacutesubarachnoidsubarachnoidhemorrhage(SAH).hemorrhage(SAH).Subarachnoidhemorrhage-MRInnMagneticresonanceimaging(MRI)usingFLAIRsequencesshowsacomparablesensitivityinacuteSAHevenbesuperiortoCT.(hyperintenseonT2FLAIR)nnInsubacuteSAH,startingfromday5afterthesuspectedhemorrhage,thesensitivityofMRIisclearlysuperiortoCT.(hyperintenseonT1WIandT2WI)CEREBRALCORTICALCONTUSIONScoureofbloodnnTraumatic/MechanicalDisruptionofsmall(capillary)VesselsnnAdmixtureofbloodmixedwithNativeTissue(Petechialhemorrage)nnMottle/SpeckledDensitynn(“Saltandpepper”onCT)CEREBRALCORTICALCONTUSIONPresentationnnLossofconsciousness,headache,mentalstatuschangennUsuallyinasuperficialcorticallocationnn50%occurintemporallobenn33%infrontallobe(frontalpoleandinferiorsurface)nnDelayedhemorrhageseenin20%CEREBRALCORTICALCONTUSION-CTnnIll-definedmixedhypodenseandhyperdenselesions-hemorrhageandedemannMaycoalesce1-2daysaftertraumannEdemaandmasseffectrelatedtocontusionCEREBRALCORTICALCONTUSION-MRInnMoresensitivethanCTinidentifyingnonhemorrhagiclesionsnnMultipleareassuperficialT2hyperintensityindicatingedemannHeterogeneousT1/T2signalintensitydependentuponageofhemorrhagicfociDIFFUSEAXONALSHEARINGINJURY(弥漫性轴索损伤)DIFFUSEAXONALSHEARINGINJURYnnFollowsseveredeceleratingclosedheadtrauma,patientsaregenerallyunconsciousfromthetimeoftheeventnnLocationof
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- 神经 模块 脑外伤