06神经模块-脑外伤5年-课件.pptVIP

HEAD TRAUMA Radiology, The Second Affiliated Hospital , Shantou University , Medical College 郑文斌  CNS trauma Clinical Features No Loss of consciousness(L.O.C) (SDH, EDH?, Not DAI) Awake at the scene, Delayed LOC (SDH,EDH, Swelling, Not DAI) Transient LOC-Wake-up-Delayed LOC) (“Classic” lucid interval for EDH) Continous LOC Following Impact (“Classic” shearing/Diffuse Axonal injury) Centripetal approach ouside to inside Scalp-hematoma(头皮血肿) Calvarium-skull fracture（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） 损害在对应的撞击部位；30%的发生率. Calvarium-skull fracture Linear Stellate Depressed Basilar EPIDURAL HEMATOMA (硬膜外血肿) EPIDURAL HEMATOMA Direct trauma to cranium Fracture(90%) -Laceration （撕裂） of Meningeal A. and V. Location is 66% temporo-parietal（颞顶部） Temporal Bone (70-80%) Mortality （死亡率）of 15-30% EPIDURAL HEMATOMA Scoure of blood Menigeal Vessels（脑膜血管）-A,V Dural sinus （静脉窦） lucid interval（中间清醒期 40%pts） Bi-convex, Hyperdense -limited by sutures（颅缝） EPIDURAL HEMATOMA-CT Biconvex or lens-shaped （双凸镜） homogeneous , heterogeneous, indicating active bleeding rarely crosses sutures（缝） fracture line 急性硬膜外血肿. 急性硬膜外血肿 SUBDURAL HEMATOMA 硬膜下血肿 SUBDURAL HEMATOMA Scoure of blood Laceration （撕裂） of Cortical（脑皮层血管 ）A A. and V V. (Direct: penetrating injury)(直接穿透伤) Bridging (Cortical) Veins（桥静脉） Dural sinus （静脉窦） Large Contusions (Direct /indirect: Pulped Brain SUBDURAL HEMATOMA Presentation significant head trauma, but chronic subdural- only minor or remote history of trauma Bilateral in 20% adults (common in elderly), 80-85% bilateral in infants extension into interhemispheric fissure（纵裂）, tentorial （小脑幕）margins brain injury in 50%; Complex Injury (DAI) skull fracture in only 1% SUBDURAL HEMATOMA-CT Crescentic in shape （新月形） Extends beyond calvarial sutu