神经模块-脑外伤新

1、HEAD TRAUMARadiology, The Second Affiliated Hospital ,Shantou University , Medical College郑文斌 CNS trauma Clinical FeaturesNo 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 E

2、DH) Continous LOC Following Impact (“Classic” shearing/Diffuse Axonal injury)Centripetal approach ouside to insideScalp-hematomaCalvarium-skull fractureEpidural-hematomaSubdural-hematomaSubarachnoid-hemorrhageIntraparenchymal-, contusion, edema,hemorrhageIntraventricular-hemorrhageCalvarium-skull fr

3、actureLinearStellateDepressedBasilarEggshellEPIDURAL HEMATOMAEPIDURAL HEMATOMAScoure of blood Menigeal Vessels-A,V Dural sinus lucid interval（40%pts）Bi-convex, Hyperdense -limited by suturesEPIDURAL HEMATOMADirect trauma to craniumFracture(90%) -Laceration of Meningeal A. and V.Location is 66% tempo

4、ro-parietalTemporal Bone(70-80%)Mortality of 15-30%EPIDURAL HEMATOMA-CTBiconvex or lens-shaped homogeneous , heterogeneous, indicating active bleedingrarely crosses suturesfracture line SUBDURAL HEMATOMASUBDURAL HEMATOMAScoure of bloodLaceration of Cortical A A. and V V. (Direct: penetrating injury)

5、Large Contusions(Direct/indirect:Pulped BrainBridging(Cortical)VeinsSUBDURAL HEMATOMA Presentationsignificant head trauma, but chronic subdural- only minor or remote history of traumaBilateral in 20% adults (common in elderly), 80-85% bilateral in infantsextension into interhemispheric fissure, tent

6、orial marginsbrain injury in 50%; Complex Injury (DAI) skull fracture in only 1%SUBDURAL HEMATOMA-CTCrescentic in shape Extends beyond calvarial suturesAcute SDH - HyperdenseSubacute SDH - Isodense (1-2 weeks)Chronic SDH - HypordenseEnhancement of veins may be useful in identifying isodense subdural

7、sSUBDURAL HEMATOMA-MRIMay be better for detection in the subacute stage, and at estimating age of subdural hematomaCan allow differentiation of epidural/subdural because of direct visualization of the dura , especially on coronal imaging Subarachnoid hemorrhageSubarachnoid hemorrhageThe sensitivity

8、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 metho

9、d of choice to detect acute subarachnoid hemorrhage (SAH). Subarachnoid hemorrhage-MRIMagnetic 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 hemorrh

10、age, the sensitivity of MRI is clearly superior to CT. (hyperintense on T1WI and T2WI) CEREBRAL CORTICAL CONTUSIONScoure of bloodTraumatic/Mechanical Disruption of small (capillary) VesselsAdmixture of blood mixed with Native Tissue(Petechial hemorrage)Mottle/Speckled Density(“Salt and pepper” on CT

11、)CEREBRAL CORTICAL CONTUSIONPresentation Loss of consciousness, headache, mental status changeUsually in a superficial cortical location50% occur in temporal lobe 33% in frontal lobe (frontal pole and inferior surface)Delayed hemorrhage seen in 20%CEREBRAL CORTICAL CONTUSION-CTIll-defined mixed hypo

12、dense and hyperdense lesions -hemorrhage and edemaMay coalesce 1-2 days after trauma Edema and mass effect related to contusionCEREBRAL CORTICAL CONTUSION-MRIMore sensitive than CT in identifying nonhemorrhagic lesionsMultiple areas superficial T2 hyperintensity indicating edemaHeterogeneous T1/T2 s

13、ignal intensity dependent upon age of hemorrhagic foci DIFFUSE AXONAL SHEARING INJURY（弥漫性轴索损伤）DIFFUSE AXONAL SHEARING INJURYFollows severe decelerating closed head trauma, patients are generally unconscious from the time of the eventLocation of injuries are typically in areas of large numbers of par

14、allel axons such as the corpus callosum, internal capsule, brain stem, basal ganglia and subcortical white matterDIFFUSE AXONAL SHEARING INJURY-CTUsually punctate hyperdensities are seen in the corpus callosum, gray white interfaces, and rostral brainstemThe axonal injury itself is not visualized, b

15、ut the associated micro (and macro) hemorrhages in the characteristic distribution are seendetecting and characterizing brainstem lesions, specifically and predominately non-hemorrhagic contusionsAppearance depends on presence or absence of hemorrhage T1-weighted sequences often normal; multiple hyp

16、erintense foci at gray-white junctions and corpus callosum on T2WI DIFFUSE AXONAL SHEARING INJURY-MRI QUESTIONSAll 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 m

17、eningeal 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 trueSUBDURAL HEMATOMA- Which of the following statements is CORRECTA . It is associated with underlying brain injury appro

18、ximately 20% of the time - 50% are associated with underlying brain injuryB . It is associated with a lucent interval with regards to patient presentationNo, epidural hematoma is associated with a lucent intervalC. It is associated with a better overall prognosis than is an epidural hematomaThe prog

19、nosis of a subdural hematoma is generally worse than an epidural hematoma due to high rate of underlying brain injuriesAll of the following concerning cortical contusions are true EXCEPT:A. Occur most commonly in the frontal lobes+ They occur more commonly in the temporal lobesB. Secondary to brain

20、impacting against bone or dura after acceleration/deceleration injury- This statement is trueC. Ill-defined mixed hypodense and hyperdense lesions in cortical surface on CT- This statement is trueD. 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