神经模块脑外伤ppt课件.ppt

HEADTRAUMA CNStraumaClinicalFeatures NoLossofconsciousness L O C SDH EDH NotDAI Awakeatthescene DelayedLOC SDH EDH Swelling NotDAI TransientLOC Wake up DelayedLOC Classic lucidintervalforEDH ContinousLOCFollowingImpact Classic shearing DiffuseAxonalinjury Centripetalapproachousidetoinside Scalp hematomaCalvarium skullfractureEpidural hematomaSubdural hematomaSubarachnoid hemorrhageIntraparenchymal contusion edema hemorrhageIntraventricular hemorrhage Calvarium skullfracture LinearStellateDepressedBasilarEggshell EPIDURALHEMATOMA EPIDURALHEMATOMA ScoureofbloodMenigealVessels A VDuralsinuslucidinterval 40 pts Bi convex Hyperdense limitedbysutures EPIDURALHEMATOMA DirecttraumatocraniumFracture 90 LacerationofMeningealA andV Locationis66 temporo parietalTemporalBone 70 80 Mortalityof15 30 EPIDURALHEMATOMA CT Biconvexorlens shapedhomogeneous heterogeneous indicatingactivebleedingrarelycrossessuturesfractureline SUBDURALHEMATOMA SUBDURALHEMATOMA ScoureofbloodLacerationofCorticalAA andVV Direct penetratinginjury LargeContusions Direct indirect PulpedBrainBridging Cortical Veins SUBDURALHEMATOMAPresentation significantheadtrauma butchronicsubdural onlyminororremotehistoryoftraumaBilateralin20 adults commoninelderly 80 85 bilateralininfantsextensionintointerhemisphericfissure tentorialmarginsbraininjuryin50 ComplexInjury DAI skullfractureinonly1 SUBDURALHEMATOMA CT CrescenticinshapeExtendsbeyondcalvarialsuturesAcuteSDH HyperdenseSubacuteSDH Isodense 1 2weeks ChronicSDH HypordenseEnhancementofveinsmaybeusefulinidentifyingisodensesubdurals SUBDURALHEMATOMA MRI Maybebetterfordetectioninthesubacutestage andatestimatingageofsubduralhematomaCanallowdifferentiationofepidural subduralbecauseofdirectvisualizationofthedura especiallyoncoronalimaging Subarachnoidhemorrhage Subarachnoidhemorrhage ThesensitivityofCThasbeenreportedtorangefrom85to100 highdensitylesionwasdemonstratedincerebralcisterns Subarachnoidspaceovercerebralconvexity Suprasellacistem interpeduncularcistern pontinecistern cisternofthelateralfissure byplainCTscanComputedtomography CT isthemethodofchoicetodetectacutesubarachnoidhemorrhage SAH Subarachnoidhemorrhage MRI Magneticresonanceimaging MRI usingFLAIRsequencesshowsacomparablesensitivityinacuteSAHevenbesuperiortoCT hyperintenseonT2FLAIR InsubacuteSAH startingfromday5afterthesuspectedhemorrhage thesensitivityofMRIisclearlysuperiortoCT hyperintenseonT1WIandT2WI CEREBRALCORTICALCONTUSION Scoureofblood Traumatic MechanicalDisruptionofsmall capillary VesselsAdmixtureofbloodmixedwithNativeTissue Petechialhemorrage Mottle SpeckledDensity Saltandpepper onCT CEREBRALCORTICALCONTUSION PresentationLossofconsciousness headache mentalstatuschangeUsuallyinasuperficialcorticallocation50 occurintemporallobe33 infrontallobe frontalpoleandinferiorsurface Delayedhemorrhageseenin20 CEREBRALCORTICALCONTUSION CT Ill definedmixedhypodenseandhyperdenselesions hemorrhageandedemaMaycoalesce1 2daysaftertraumaEdemaandmasseffectrelatedtocontusion CEREBRALCORTICALCONTUSION MRI MoresensitivethanCTinidentifyingnonhemorrhagiclesionsMultipleareassuperficialT2hyperintensityindicatingedemaHeterogeneousT1 T2signalintensitydependentuponageofhemorrhagicfoci DIFFUSEAXONALSHEARINGINJURY 弥漫性轴索损伤 DIFFUSEAXONALSHEARINGINJURY Followsseveredeceleratingclosedheadtrauma patientsaregenerallyunconsciousfromthetimeoftheeventLocationofinjuriesaretypicallyinareasoflargenumbersofparallelaxonssuchasthecorpuscallosum internalcapsule brainstem basalgangliaandsubcorticalwhitematter DIFFUSEAXONALSHEARINGINJURY CT Usuallypunctatehyperdensitiesareseeninthecorpuscallosum graywhiteinterfaces androstralbrainstemTheaxonalinjuryitselfisnotvisualized buttheassociatedmicro andmacro hemorrhagesinthecharacteristicdistributionareseen detectingandcharacterizingbrainstemlesions specificallyandpredominatelynon hemorrhagiccontusionsAppearancedependsonpresenceorabsenceofhemorrhageT1 weightedsequencesoftennormal multiplehyperintensefociatgray whitejunctionsandcorpuscallosumonT2WI DIFFUSEAXONALSHEARINGINJURY MRI QUESTIONS AllofthefollowingarerelatedtothepathogenesisofepiduralhematomaEXCEPT A Disruptionofbridgingveins ThisistheetiologyofasubduralhematomaB Lacerationofthemiddlemeningealartery ThatstatementistrueC Disruptionoftheduralvenoussinuses ThatstatementistrueD Frequentincidenceofassociatedskullfracture Thatstatementistrue SUBDURALHEMATOMA WhichofthefollowingstatementsisCORRECT A Itisassociatedwithunderlyingbraininjuryapproximately20 ofthetime 50 areassociatedwithunderlyingbraininjuryB ItisassociatedwithalucentintervalwithregardstopatientpresentationNo epiduralhematomaisassociatedwithalucentintervalC ItisassociatedwithabetteroverallprognosisthanisanepiduralhematomaTheprognosisofasubduralhematomaisgenerallyworsethananepiduralhematomaduetohighrateofunderlyingbraininjuries AllofthefollowingconcerningcorticalcontusionsaretrueEXCEPT A Occurmostcommonlyinthefrontallobes TheyoccurmorecommonlyinthetemporallobesB Secondarytobrainimpactingagainstboneorduraafteracceleration decelerationinjury ThisstatementistrueC Ill definedmixedhypodenseandhyperdenselesionsincorticalsurfaceonCT ThisstatementistrueD MRIismoresensitivethanCTinidentifyingnonhemorrhagiclesions Thisstatementistrue 颅脑外伤 总结 硬膜外血肿 EpiduralHematoma 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 可伴有骨折血肿压迫邻近血管 可出现脑水肿或脑梗塞 硬膜下血肿 SubduralHematoma 概述