外科-头的各类损害PPT.ppt

Epidural Hematoma (EDH) 1% of head trauma admissions Source of bleeding: 85% Arterial bleeding (most common: Middle Meningeal Artery) Overall mortality: 20-55%. Optimal diagnosis and treatment within hours results in 5-10% mortality Presentation of EDH Brief posttraumatic loss of consiousness Followed by a “lucid interval” for several hours High ICP, contralateral hemiparesis, ipsilateral pupillary dialation and herniation Symptoms and Signs Headache Vomiting Papilledema Varying degrees of cranial nerve palsies Vital signs (Cushing’s triad) Evaluation Plain skull X-rays (40% no fracture) CT scan: High density biconvex shape adjacent to the skull Epidural Hematoma (EDH) biconvex shape high density High density biconvex shape adjacent to the skull Epidural Hematoma (EDH) Acute Subdural Hematoma Two times the incidence of acute EDH Impact damage is usually much higher than in EDH. More lethal! Symptoms due to: 1. Compression of underlying brain 2. Parenchymal brain injury 3. Cerebral edema Acute Subdural Hematoma Presentations Severe underlying primary brain injury Often no “lucid interval” Focal signs usually occur later than EDH Symptoms and Signs Headache Vomiting Papilledema Varying degrees of cranial nerve palsies Vital signs (Cushing’s triad) Evaluation CT: 1. Crescentic(新月形) mass, increased attenuation adjacent to inner table 2. Edema Subdural Hematoma Crescentic mass, increased attenuation adjacent to inner table Acute Intracerebral Hematoma Impact damage is usually much higher than in subdural hematoma. Worst! Symptoms due to: 1. Primary parenchymal brain injury 2. Compression of surrounding brain tissue 3. Cerebral edema Acute Intracerebral Hematoma Presentations Severe underlying primary brain injury No “lucid interval” Focal signs: Hemiparesis, et al. Symptoms and Signs Headache Vomiting Papilledema Varying degrees of cranial nerve palsies Vital signs (Cushing’s triad) Evaluation CT: 1. Intra-cerebral high density