八年制中枢实习2014课件见习t颅脑外伤诊断.pptxVIP

颅脑外伤的CT诊断CT Diagnosis of Head Trauma华中科技大学同济医学院附属同济医院放射科陈 唯 唯Who?戴安娜王妃How did she die?车祸 脑外伤 ---- 发生率 死亡率 时 间 就 是 生 命 !!!What shall we do?110/120　急救快速诊断，快速治疗平片CT MRI DSA 普及，快速，首选脑外伤有哪些？?AnatomyScalpSkullCerebral Dura MaterCerebral Arachnoid MaterSubarachnoid space Cerebral Pia MaterBrain Tissue头皮血肿Scalp hematoma What can we find? 线性骨折Linear Skull Fracture凹陷性骨折Depressed skull fracture 颅骨局限性凹入颅内伴随局部脑挫伤出血内外板内凹大于1cm 需行手术颅缝分离Sutural Diastasis往往出现在颅缝闭合前， 儿童常见 1. 颅缝宽＞3mm （正常1~2mm） 2.两侧颅缝不对称，相差大于1mm Case 1：患者，女，车祸伤Panda eyes筛板骨折Case 2:患者，女，车祸伤Battle’s Sign乳突骨折Case 3:患者，车祸伤后一月，低头时鼻子流“清水”脑脊液鼻漏前颅窝底骨折Evidence of skull base fractures:Panda eyes/Raccoon eyesBattle’s SignBlood/CSF leakage from nose or earsSkull base fractures!颅骨骨折的CT三维成像颅骨骨折分类Classification of skull fracture 按骨折线的形态分类 According to the shape of the fracture line 线性/凹陷性/颅缝分离 按骨折的部位分类 According to the location of the fracure 颅盖骨骨折/颅底骨骨折请说出以下图片的相同点和异同点相同点：高密度灶不同点：病灶的部位和形态不同颅内出血－Basic AnatomyScalpSkullCerebral Dura MaterCerebral Arachnoid MaterSubarachnoid space Cerebral Pia MaterBrain Tissue颅内出血－硬膜外血肿Epidural hematoma外伤后血肿聚集于硬膜外腔临床症状：伤后短时原发昏迷，中间清醒期(lucid interval)，再昏迷硬膜外血肿的CT表现⑴颅骨内板下梭形高密度区，边界锐利，CT值为50-70Hu⑵血肿范围一般不超过颅缝⑶颅骨骨折⑷占位效应，中线结构移位⑸继发改变：脑疝，脑梗塞，脑水肿，脑积水Biconvex or spindle-shaped，hyperdense，well-marginated，cannot extend across the sutures of skull硬脑膜在颅缝处与骨结合紧密Firm adherence of the dura mater to the inner table of the skull限制血肿蔓延 Resistance to the hematoma硬膜外血肿不能超过颅缝Epidural hematoma cannot extend across the sutures of the skull颅内出血－硬膜下血肿Subdural hematoma外伤后血肿聚集于硬脑膜与蛛网膜之间由于蛛网膜无张力，血肿范围较广，多呈新月形或半月形，可越过颅缝硬膜下血肿的CT表现颅骨内板下，呈新月形高密度灶血肿大，范围广，可越过颅缝占位效应：灰质内移，脑沟消失，脑室闭塞，移位常伴有脑挫伤，V窦撕裂 Crescent- shaped，hyperdense，diffuse , can extend across the sutures of skull, and even overlie an entire surface of brain双侧慢性硬膜下血肿增强CT颅内出血－蛛网膜下腔出血Subarachnoid hemorrhage 外伤后出血聚集于蛛网膜下腔Hemorrhage within the subarachnoid space 蛛网膜下腔－不规则形The subarachnoid space isirregular蛛网膜下腔出血CT表现脑沟/脑池内铸型高密度影Cast formHyperdensityin the cortical sulcus and cister