神经模块脑外伤新课件

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 Calvarium-skull fracture Epidural-hematoma Subdural-hematoma Subarachnoid-hemorrhage Intraparenchymal-, contusion, edema,hemorrhage Intraventricular-hemorrhage,Calvarium-skull fracture,Linear Stellate Depressed Basilar Eggshell,EPIDURAL HEMATOMA,EPIDURAL HEMATOMA,Scoure of blood Menigeal Vessels-A,V Dural sinus lucid interval（40%pts） Bi-convex, Hyperdense -limited by sutures,EPIDURAL HEMATOMA,Direct trauma to cranium Fracture(90%) -Laceration of Meningeal A. and V. Location is 66% temporo-parietal Temporal Bone(70-80%) Mortality of 15-30%,EPIDURAL HEMATOMA-CT,Biconvex or lens-shaped homogeneous , heterogeneous, indicating active bleeding rarely crosses sutures fracture line,SUBDURAL HEMATOMA,SUBDURAL HEMATOMA,Scoure of blood Laceration of Cortical A A. and V V. (Direct: penetrating injury) Large Contusions(Direct/indirect:Pulped Brain Bridging(Cortical)Veins,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, tentorial margins brain injury in 50%; Complex Injury (DAI) skull fracture in only 1%,SUBDURAL HEMATOMA-CT,Crescentic in shape Extends beyond calvarial sutures Acute SDH - Hyperdense Subacute SDH - Isodense (1-2 weeks) Chronic SDH - Hypordense Enhancement of veins may be useful in identifying isodense subdurals,SUBDURAL HEMATOMA-MRI,May be better for detection in the subacute stage, and at estimating age of subdural hematoma Can allow differentiation of epidural/subdural because of direct visualization of the dura , especially on coronal imaging,Subarachnoid hemorrhage,Subarachnoid hemorrhage,The sensitivity of CT has been reported to range from 85 to 100 %. high density lesion was demonstrated in cerebral cisterns（Subarachnoid space over cerebral convexity, Suprasella cistem, interpeduncular cistern, pontine cistern, cistern of the lateral fissure） by plain CT scan Computed tomography (CT) is the method of choice to detect acute subarachnoid hemorrhage (SAH).,Subarachnoid hemorrhage-MRI,Magnetic resonance imaging (MRI) using FLAIR sequences shows a comparable sensitivity in acute SAH even be superior to CT. (hyperintense on T2 FLAIR ) In subacute SAH, starting from day 5 after the suspected hemorrhage, the sensitivity of MRI is clearly superior to CT. (hyperintense on T1WI and T2WI),CEREBRAL CORTICAL CONTUSION,Scoure of blood,Traumatic/Mechanical Disruption of small (capillary) Vessels Admixture of blood mixed with Native Tissue(Petechial hemorrage) Mottle/Speckled Density (“Salt and pepper” on CT),CEREBRAL CORTICAL CONTUSION,Presentation Loss of consciousness, headache, mental status change Usually in a superficial cortical location 50% occur in temporal lobe 33% in frontal lobe (frontal pole and inferior surface) Delayed hemorrhage seen in 20%,CEREBRAL CORTICAL CONTUSION-CT,Ill-defined mixed hypodense and hyperdense lesions -hemorrhage and edema May coalesce 1-2 days after trauma Edema and mass effect related to contusion,CEREBRAL CORTICAL CONTUSION-MRI,More sensitive than CT in identifying nonhemorrhagic lesions Multiple areas superficial T2 hyperintensity indicating edema Heterogeneous T1/T2 signal intensity dependent upon age of hemorrhagic foci,DIFFUSE AXONAL SHEARING INJURY（弥漫性轴索损伤）,DIFFUSE AXONAL SHEARING INJURY,Follows severe decelerating closed head trauma, patients are generally unconscious from the time of the event Location of injuries are typically in areas of large numbers of parallel axons such as the corpus callosum, internal capsule, brain stem, basal ganglia and subcortical white matter,DIFFUSE AXONAL SHEARING INJURY-CT,Usually punctate hyperdensities are seen in the corpus callosum, gray white interfaces, and rostral brainstem The axonal injury itself is not visualized, but the associated micro (and macro) hemorrhages in the characteristic distribution are seen,detecting and characterizing brainstem lesions, specifically and predominately non-hemorrhagic contusions Appearance depends on presence or absence of hemorrhage T1-weighted sequences often normal; multiple hyperintense foci at gray-white junctions and corpus callosum on T2WI,DIFFUSE AXONAL SHEARING INJURY-MRI,QUESTIONS,All of the following are related to the pathogenesis of epidural hematoma EXCEPT:,A. Disruption of bridging veins + This is the etiology of a subdural hematoma B. Laceration of the middle meningeal artery - That statement is true C. Disruption of the dural venous sinuses - That statement is true D.Frequent incidence of associated skull fracture - That statement is true,SUBDURAL HEMATOMA- Which of the following statements is CORRECT,A . It is associated with underlying brain injury approximately 20% of the time - 50% are associated with underlying brain injury B . It is associated with a lucent interval with regards to patient presentation No, epidural hematoma is associated with a lucent interval C. It is associated with a better overall prognosis than is an epidural hematoma The prognosis of a subdural hematoma is generally worse than an epidural hematoma due to high rate of underlying brain injuries,All of the following concerning cortical contusions are true EXCEPT:,A. Occur most commonly in the frontal lobes + They occur more commonly in the temporal lobes B. Secondary to brain impacting against bone or dura after acceleration/deceleration injury - This statement is true C. Ill-defined mixed hypodense and hyperdense lesions in cortical surface on CT - This statement is true D. MRI is more sensitive than CT in identifying nonhemorrhagic lesions - This statement is true,颅脑外伤,总结,硬膜外血肿（Epidural Hematoma）,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3.5%，以脑膜中动脉出血最常见，小孩少见，可能与脑膜中动脉与颅板尚未紧密靠拢有关。血肿部位，多见于颞、额顶。,硬膜外血肿CT表现：,平扫为颅板下双凸形高密度区，血肿密度多均匀，不均匀者，早期可能与血清溢出、脑脊液或气体进入有关。