神经模块-脑外伤新

HEADTRAUMARadiology,TheSecondAffiliatedHospital,ShantouUniversity,MedicalCollege郑文斌第1页，共46页。

CNStraumaClinicalFeaturesNoLossof)(SDH,EDH?,NotDAI)Awakeatthescene,DelayedLOC(SDH,EDH,Swelling,NotDAI)TransientLOC-Wake-up-DelayedLOC)(“Classic”lucidintervalforEDH)ContinousLOCFollowingImpact(“Classic”shearing/DiffuseAxonalinjury)第2页，共46页。CentripetalapproachousidetoinsideScalp-hematomaCalvarium-skullfractureEpidural-hematomaSubdural-hematomaSubarachnoid-hemorrhageIntraparenchymal-,contusion,edema,hemorrhageIntraventricular-hemorrhage第3页，共46页。Calvarium-skullfractureLinearStellateDepressedBasilarEggshell第4页，共46页。第5页，共46页。EPIDURALHEMATOMA第6页，共46页。EPIDURALHEMATOMAScoureofbloodMenigealVessels-A,VDuralsinuslucidinterval（40%pts）Bi-convex,Hyperdense-limitedbysutures第7页，共46页。EPIDURALHEMATOMADirecttraumatocraniumFracture(90%)-LacerationofMeningealA.andV.Locationis66%temporo-parietalTemporalBone(70-80%)Mortalityof15-30%第8页，共46页。EPIDURALHEMATOMA-CTBiconvexorlens-shaped

homogeneous,heterogeneous,indicatingactivebleedingrarelycrossessuturesfractureline第9页，共46页。第10页，共46页。第11页，共46页。

SUBDURALHEMATOMA第12页，共46页。SUBDURALHEMATOMAScoureofbloodLacerationofCorticalAA.andVV.(Direct:penetratinginjury)LargeContusions(Direct/indirect:PulpedBrainBridging(Cortical)Veins第13页，共46页。SUBDURALHEMATOMAPresentationsignificantheadtrauma,butchronicsubdural-onlyminororremotehistoryoftraumaBilateralin20%adults(commoninelderly),80-85%bilateralininfantsextensionintointerhemisphericfissure,tentorialmarginsbraininjuryin50%;ComplexInjury(DAI)skullfractureinonly1%第14页，共46页。SUBDURALHEMATOMA-CTCrescenticinshape

ExtendsbeyondcalvarialsuturesAcuteSDH-HyperdenseSubacuteSDH-Isodense(1-2weeks)ChronicSDH-HypordenseEnhancementofveinsmaybeusefulinidentifyingisodensesubdurals第15页，共46页。SUBDURALHEMATOMA-MRIMaybebetterfordetectioninthesubacutestage,andatestimatingageofsubduralhematomaCanallowdifferentiationofepidural/subduralbecauseofdirectvisualizationofthedura,especiallyoncoronalimaging第16页，共46页。第17页，共46页。第18页，共46页。

Subarachnoidhemorrhage第19页，共46页。SubarachnoidhemorrhageThesensitivityofCThasbeenreportedtorangefrom85to100%.highdensitylesionwasdemonstratedincerebralcisterns（Subarachnoidspaceovercerebralconvexity,Suprasellacistem,interpeduncularcistern,pontinecistern,cisternofthelateralfissure）byplainCTscanComputedtomography(CT)isthemethodofchoicetodetectacutesubarachnoidhemorrhage(SAH).第20页，共46页。Subarachnoidhemorrhage-MRIMagneticresonanceimaging(MRI)usingFLAIRsequencesshowsacomparablesensitivityinacuteSAHevenbesuperiortoCT.(hyperintenseonT2FLAIR)InsubacuteSAH,startingfromday5afterthesuspectedhemorrhage,thesensitivityofMRIisclearlysuperiortoCT.(hyperintenseonT1WIandT2WI)第21页，共46页。

CEREBRALCORTICALCONTUSION第22页，共46页。ScoureofbloodTraumatic/MechanicalDisruptionofsmall(capillary)VesselsAdmixtureofbloodmixedwithNativeTissue(Petechialhemorrage)Mottle/SpeckledDensity(“Saltandpepper”onCT)第23页，共46页。CEREBRALCORTICALCONTUSIONPresentation

Lossofconsciousness,headache,mentalstatuschangeUsuallyinasuperficialcorticallocation50%occurintemporallobe33%infrontallobe(frontalpoleandinferiorsurface)Delayedhemorrhageseenin20%第24页，共46页。CEREBRALCORTICALCONTUSION-CTIll-definedmixedhypodenseandhyperdenselesions-hemorrhageandedemaMaycoalesce1-2daysaftertraumaEdemaandmasseffectrelatedtocontusion第25页，共46页。CEREBRALCORTICALCONTUSION-MRIMoresensitivethanCTinidentifyingnonhemorrhagiclesionsMultipleareassuperficialT2hyperintensityindicatingedemaHeterogeneousT1/T2signalintensitydependentuponageofhemorrhagicfoci第26页，共46页。第27页，共46页。DIFFUSEAXONALSHEARINGINJURY（弥漫性轴索损伤）第28页，共46页。DIFFUSEAXONALSHEARINGINJURYFollowsseveredeceleratingclosedheadtrauma,patientsaregenerallyunconsciousfromthetimeoftheeventLocationofinjuriesaretypicallyinareasoflargenumbersofparallelaxonssuchasthecorpuscallosum,internalcapsule,brainstem,basalgangliaandsubcorticalwhitematter第29页，共46页。DIFFUSEAXONALSHEARINGINJURY-CTUsuallypunctatehyperdensitiesareseeninthecorpuscallosum,graywhiteinterfaces,androstralbrainstemTheaxonalinjuryitselfisnotvisualized,buttheassociatedmicro(andmacro)hemorrhagesinthecharacteristicdistributionareseen第30页，共46页。detectingandcharacterizingbrainstemlesions,specificallyandpredominatelynon-hemorrhagiccontusionsAppearancedependsonpresenceorabsenceofhemorrhageT1-weightedsequencesoftennormal;multiplehyperintensefociatgray-whitejunctionsandcorpuscallosumonT2WIDIFFUSEAXONALSHEARINGINJURY-MRI第31页，共46页。第32页，共46页。

QUESTIONS第33页，共46页。AllofthefollowingarerelatedtothepathogenesisofepiduralhematomaEXCEPT:

A.Disruptionofbridgingveins+ThisistheetiologyofasubduralhematomaB.Lacerationofthemiddlemeningealartery-ThatstatementistrueC.Disruptionoftheduralvenoussinuses-ThatstatementistrueD.Frequentincidenceofassociatedskullfracture-Thatstatementistrue第34页，共46页。SUBDURALHEMATOMA-

WhichofthefollowingstatementsisCORRECTA.Itisassociatedwithunderlyingbraininjuryapproximately20%ofthetime-50%areassociatedwithunderlyingbraininjuryB.ItisassociatedwithalucentintervalwithregardstopatientpresentationNo,epiduralhematomaisassociatedwithalucentintervalC.ItisassociatedwithabetteroverallprognosisthanisanepiduralhematomaTheprognosisofasubduralhematomaisgenerallyworsethananepiduralhematomaduetohighrateofunderlyingbraininjuries第35页，共46页。AllofthefollowingconcerningcorticalcontusionsaretrueEXCEPT:

A.Occurmostcommonlyinthefrontallobes+TheyoccurmorecommonlyinthetemporallobesB.Secondarytobrainimpactingagainstboneorduraafteracceleration/decelerationinjury-ThisstatementistrueC.Ill-definedmixedhypodenseandhyperdenselesionsincorticalsurfaceonCT-ThisstatementistrueD.MRIismoresensitivethanCTinidentifyingnonhemorrhagiclesions-Thisstatementistrue第36页，共46页。颅脑外伤

总结第37页，共46页。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。第38页，共46页。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第39页，共46页。硬膜下血肿（SubduralHematoma）概述：发生于硬脑膜与蛛网膜之间，占颅脑损伤的3~6%。急性小于3天，亚急性为4天-3周，慢性为大于3周，长者可达10年。硬膜下血肿常与脑挫裂伤同时存在，血肿多见于脑凸面。第40页，共46页。CT表现急性血肿：颅板下新月形高密度影，少数为等或低密度，可见于贫血。亚急性和慢性血肿：可表现为高、等、低密度。第41页，共46页。脑挫裂伤（CerebralContusion）

概述：头部受暴力打击而使脑组织发生器质性损伤。早期为伤后数日内，脑组织以出血、水肿、坏死为主要表现.中期为伤后数天至数周，逐步出现修复性病理变化，坏死区组织液化，逐步由疤痕组织修复，大的病灶有肉芽组织修复。晚期经历数月至数年，