神經(jīng)模塊腦外傷課件

06神經(jīng)模塊-腦外傷HEADTRAUMA06神經(jīng)模塊-腦外傷分類06神經(jīng)模塊-腦外傷

CNStraumaClinicalFeaturesNoLossofconsciousness(L.O.C)(SDH,EDH?,NotDAI)Awakeatthescene,DelayedLOC(SDH,EDH,Swelling,NotDAI)TransientLOC-Wake-up-DelayedLOC)(“Classic”lucidintervalforEDH)ContinousLOCFollowingImpact(“Classic”shearing/DiffuseAxonalinjury)06神經(jīng)模塊-腦外傷CentripetalapproachousidetoinsideScalp-hematoma(頭皮血腫)Calvarium-skullfracture（顱骨骨折）Epidural-hematoma（硬膜外血腫）Subdural-hematoma（硬膜下血腫）Subarachnoid-hemorrhage(蛛網(wǎng)膜下腔出血)Intraparenchymal-,contusion,edema,hemorrhage

（腦挫裂傷、腦內(nèi)血腫）Intraventricular-hemorrhage（腦室出血）06神經(jīng)模塊-腦外傷頭皮腫脹06神經(jīng)模塊-腦外傷

損害在對應的撞擊部位；30%的發(fā)生率.對沖傷06神經(jīng)模塊-腦外傷Calvarium-skullfractureLinearStellateDepressedBasilar06神經(jīng)模塊-腦外傷骨折.線型骨折.凹陷型骨折.CT對凹陷型骨折很重要，常伴其他顱內(nèi)損傷.06神經(jīng)模塊-腦外傷06神經(jīng)模塊-腦外傷額頂骨線樣骨折.06神經(jīng)模塊-腦外傷顱骨骨折、頭皮血腫、對沖傷（急性硬膜下血腫）06神經(jīng)模塊-腦外傷外傷性顱內(nèi)積氣.多個氣泡在蛛網(wǎng)膜下腔.氣體來源.顱骨開放性骨折.顱底骨折（副鼻竇、乳突小房）.06神經(jīng)模塊-腦外傷腦外損傷.06神經(jīng)模塊-腦外傷EPIDURALHEMATOMA(硬膜外血腫)06神經(jīng)模塊-腦外傷EPIDURALHEMATOMADirecttraumatocraniumFracture(90%)-Laceration（撕裂）

ofMeningealA.andV.Locationis66%temporo-parietal（顳頂部）TemporalBone(70-80%)Mortality（死亡率）of15-30%06神經(jīng)模塊-腦外傷EPIDURALHEMATOMAScoureofbloodMenigealVessels（腦膜血管）-A,VDuralsinus（靜脈竇）lucidinterval（中間清醒期40%pts）Bi-convex,Hyperdense-limitedbysutures（顱縫）06神經(jīng)模塊-腦外傷EPIDURALHEMATOMA-CTBiconvexorlens-shaped

（雙凸鏡）homogeneous,heterogeneous,indicatingactivebleedingrarelycrossessutures（縫）fractureline06神經(jīng)模塊-腦外傷急性硬膜外血腫.06神經(jīng)模塊-腦外傷急性硬膜外血腫.

常有大的占位效應.06神經(jīng)模塊-腦外傷急性硬膜外血腫06神經(jīng)模塊-腦外傷血腫包含不凝血或活動出血.血腫內(nèi)可見圓形密度減低影.06神經(jīng)模塊-腦外傷

SUBDURALHEMATOMA

硬膜下血腫06神經(jīng)模塊-腦外傷SUBDURALHEMATOMAScoureofbloodLaceration（撕裂）ofCortical（腦皮層血管）AA.andVV.(Direct:penetratinginjury)(直接穿透傷)Bridging(Cortical)Veins（橋靜脈）Duralsinus（靜脈竇）LargeContusions(Direct/indirect:PulpedBrain06神經(jīng)模塊-腦外傷SUBDURALHEMATOMA

Presentationsignificantheadtrauma,butchronicsubdural-onlyminororremotehistoryoftraumaBilateralin20%adults(commoninelderly),80-85%bilateralininfantsextensionintointerhemisphericfissure（縱裂）,tentorial（小腦幕）marginsbraininjuryin50%;ComplexInjury(DAI)skullfractureinonly1%06神經(jīng)模塊-腦外傷SUBDURALHEMATOMA-CTCrescenticinshape

（新月形）ExtendsbeyondcalvarialsuturesAcuteSDH-HyperdenseSubacuteSDH-Isodense(1-2weeks)ChronicSDH-HypordenseEnhancementofveinsmaybeusefulinidentifyingisodensesubdurals06神經(jīng)模塊-腦外傷SUBDURALHEMATOMA-MRIMaybebetterfordetectioninthesubacutestage,andatestimatingageofsubduralhematomaCanallowdifferentiationofepidural/subduralbecauseofdirectvisualizationofthedura,especiallyoncoronalimaging06神經(jīng)模塊-腦外傷高密度損害占據(jù)大腦半球的大部分.06神經(jīng)模塊-腦外傷急性硬膜下血腫.血腫可以延伸到小腦幕區(qū).06神經(jīng)模塊-腦外傷血腫延伸至大腦鐮部.大腦鐮部硬膜下血腫.06神經(jīng)模塊-腦外傷側(cè)腦室受壓移位.SAH06神經(jīng)模塊-腦外傷VP引流術(shù)導致SDH.腦萎縮、輕度腦積水.VP后雙側(cè)硬膜下血腫.右側(cè)SDH擴大.06神經(jīng)模塊-腦外傷06神經(jīng)模塊-腦外傷06神經(jīng)模塊-腦外傷慢性硬膜下血腫.外形：半月形、紡錘形、橢圓形.密度：高密度、等密度、低密度、混雜密度.06神經(jīng)模塊-腦外傷慢性硬膜下血腫.混雜密度（等、高密度）.液液平（再出血）06神經(jīng)模塊-腦外傷慢性硬膜下血腫.高滲透壓性血腫、腦脊液再吸收進入、血腫一天比一天大.06神經(jīng)模塊-腦外傷慢性硬膜下血腫.腦外傷（或輕微外傷）.頭痛、眩暈發(fā)作；煩躁.06神經(jīng)模塊-腦外傷等密度慢性硬膜下血腫.06神經(jīng)模塊-腦外傷高信號硬膜下血腫.高鐵血紅蛋白（T1/T2均為高信號）.06神經(jīng)模塊-腦外傷高密度慢性硬膜下血腫（T1/T2均為高信號）.06神經(jīng)模塊-腦外傷雙側(cè)硬膜下積液.06神經(jīng)模塊-腦外傷明顯占位效應，手術(shù)清除后，占位效應消失.06神經(jīng)模塊-腦外傷硬膜下積液.發(fā)生在老人及幼兒.外傷幾天后形成.常雙側(cè).自發(fā)吸收.穿顱術(shù)、VP、腦膜炎也可發(fā)生.06神經(jīng)模塊-腦外傷硬膜下積液.06神經(jīng)模塊-腦外傷硬膜下積液轉(zhuǎn)變成慢性硬膜下血腫.06神經(jīng)模塊-腦外傷慢性硬膜下血腫伴出血.液液平（高低密度混雜）.06神經(jīng)模塊-腦外傷

Subarachnoidhemorrhage

（蛛網(wǎng)膜下腔出血）06神經(jīng)模塊-腦外傷外傷性蛛網(wǎng)膜下腔出血.常伴腦內(nèi)腦外損傷.蛛網(wǎng)膜下腔線狀高密度.溝、裂、池可以引起腦積水.06神經(jīng)模塊-腦外傷SubarachnoidhemorrhageThesensitivityofCThasbeenreportedtorangefrom85to100%.highdensitylesionwasdemonstratedincerebralcisterns（Subarachnoidspaceovercerebralconvexity,Suprasellacistem（鞍上池）,interpeduncularcistern（腳間池）,pontinecistern,cisternofthelateralfissure（側(cè)裂池）byplainCTscanComputedtomography(CT)isthemethodofchoicetodetectacutesubarachnoidhemorrhage(SAH).06神經(jīng)模塊-腦外傷Subarachnoidhemorrhage-MRIMagneticresonanceimaging(MRI)usingFLAIRsequencesshowsacomparablesensitivityinacuteSAHevenbesuperiortoCT.(hyperintenseonT2FLAIR)InsubacuteSAH,startingfromday5afterthesuspectedhemorrhage,thesensitivityofMRIisclearlysuperiortoCT.(hyperintenseonT1WIandT2WI)06神經(jīng)模塊-腦外傷縱裂池、腦溝SAHSAH一引起交通性腦積水.交通性腦積水.06神經(jīng)模塊-腦外傷外傷性腦室出血.常伴發(fā)腦內(nèi)腦外損傷.腦室出血.可引起急性梗阻性或慢性交通性腦積水.06神經(jīng)模塊-腦外傷

CEREBRALCORTICALCONTUSION（腦挫傷）06神經(jīng)模塊-腦外傷腦挫傷.局限性腦水腫腦水腫內(nèi)混雜多個小的出血.孤立的血腫.彌漫性腦水腫.彌漫性軸索損傷（剪切傷）.06神經(jīng)模塊-腦外傷ScoureofbloodTraumatic/MechanicalDisruptionofsmall(capillary)VesselsAdmixtureofbloodmixedwithNativeTissue(Petechialhemorrage點狀出血)Mottle/SpeckledDensity斑點混雜(“Saltandpepper”onCT)鹽、胡椒06神經(jīng)模塊-腦外傷CEREBRALCORTICALCONTUSIONPresentation

Lossofconsciousness,headache,mentalstatuschangeUsuallyinasuperficialcorticallocation50%occurintemporallobe33%infrontallobe(frontalpoleandinferiorsurface)Delayedhemorrhageseenin20%06神經(jīng)模塊-腦外傷CEREBRALCORTICALCONTUSION-CTIll-definedmixedhypodenseandhyperdenselesions-hemorrhageandedemaMaycoalesce（融合）1-2daysaftertraumaEdemaandmasseffectrelatedtocontusion06神經(jīng)模塊-腦外傷CEREBRALCORTICALCONTUSION-MRIMoresensitivethanCTinidentifyingnonhemorrhagiclesionsMultipleareassuperficialT2hyperintensityindicatingedemaHeterogeneousT1/T2signalintensitydependentuponageofhemorrhagicfoci06神經(jīng)模塊-腦外傷06神經(jīng)模塊-腦外傷DIFFUSEAXONALSHEARINGINJURY（彌漫性軸索損傷）06神經(jīng)模塊-腦外傷DIFFUSEAXONALSHEARINGINJURY（彌漫性軸索損傷）Followsseveredeceleratingclosedheadtrauma,patientsaregenerallyunconsciousfromthetimeoftheeventLocationofinjuriesaretypicallyinareasoflargenumbersofparallelaxonssuchasthecorpuscallosum,internalcapsule,brainstem,basalgangliaandsubcorticalwhitematter06神經(jīng)模塊-腦外傷DIFFUSEAXONALSHEARINGINJURY-CTUsuallypunctatehyperdensitiesareseeninthecorpuscallosum,graywhiteinterfaces,androstralbrainstemTheaxonalinjuryitselfisnotvisualized,buttheassociatedmicro(andmacro)hemorrhagesinthecharacteristicdistributionareseen06神經(jīng)模塊-腦外傷小斑點狀出血、水腫（胼胝體、半卵圓中心、基底節(jié)區(qū)）.06神經(jīng)模塊-腦外傷多個點狀出血.腦外傷后昏迷.腦萎縮.06神經(jīng)模塊-腦外傷左側(cè)額葉皮層下白質(zhì).胼胝體.小斑點狀出血水腫.06神經(jīng)模塊-腦外傷detectingandcharacterizingbrainstemlesions,specificallyandpredominatelynon-hemorrhagiccontusionsAppearancedependsonpresenceorabsenceofhemorrhageT1-weightedsequencesoftennormal;multiplehyperintensefociatgray-whitejunctionsandcorpuscallosumonT2WIDIFFUSEAXONALSHEARINGINJURY-MRI06神經(jīng)模塊-腦外傷DIFFUSEAXONALSHEARINGINJURY-MRI06神經(jīng)模塊-腦外傷03－5－3騎摩托車與另一摩托車相撞，入院時為淺昏迷，GCS評分6分，

20天后甚至轉(zhuǎn)清，未能言語，

03－6－6言語模糊，亂語

03－6－16對答正常06神經(jīng)模塊-腦外傷DIFFUSEAXONALSHEARINGINJURY-MRI06神經(jīng)模塊-腦外傷遲發(fā)性顱內(nèi)出血06神經(jīng)模塊-腦外傷遲發(fā)血腫.遲發(fā)行腦挫裂傷.06神經(jīng)模塊-腦外傷硬膜外血腫遲發(fā)腦挫裂傷.06神經(jīng)模塊-腦外傷挫裂傷伴蛛網(wǎng)膜下腔出血遲發(fā)性硬膜下、硬膜外血腫同一天，12小時后.06神經(jīng)模塊-腦外傷減壓出血：外科減壓術(shù)后的遲發(fā)出血遲發(fā)性出血.挫傷水腫.穿顱術(shù)后，血腫清除，遲發(fā)挫傷出血.06神經(jīng)模塊-腦外傷穿顱術(shù)后.06神經(jīng)模塊-腦外傷遲發(fā)血腫、自發(fā)吸收.煩躁.亞急性EDH.無手術(shù)，血腫縮小.06神經(jīng)模塊-腦外傷腦挫裂傷所致的：腦萎縮.交通性腦積水.腦軟化、腦穿通囊腫.06神經(jīng)模塊-腦外傷DAI引起的腦萎縮.06神經(jīng)模塊-腦外傷

QUESTIONS06神經(jīng)模塊-腦外傷AllofthefollowingarerelatedtothepathogenesisofepiduralhematomaEXCEPT:

A.Disruptionofbridgingveins+ThisistheetiologyofasubduralhematomaB.Lacerationofthemiddlemeningealartery-ThatstatementistrueC.Disruptionoftheduralvenoussinuses-ThatstatementistrueD.Frequentincidenceofassociatedskullfracture-Thatstatementistrue06神經(jīng)模塊-腦外傷SUBDURALHEMATOMA-

WhichofthefollowingstatementsisCORRECTA.Itisassociatedwithunderlyingbraininjuryapproximately20%ofthetime-50%areassociatedwithunderlyingbraininjuryB.ItisassociatedwithalucentintervalwithregardstopatientpresentationNo,epiduralhematomaisassociatedwithalucentintervalC.ItisassociatedwithabetteroverallprognosisthanisanepiduralhematomaTheprognosisofasubduralhematomaisgenerallyworsethananepiduralhematomaduetohighrateofunderlyingbraininjuries06神經(jīng)模塊-腦外傷AllofthefollowingconcerningcorticalcontusionsaretrueEXCEPT:

A.Occurmostcommonlyinthefrontallobes+TheyoccurmorecommonlyinthetemporallobesB.Secondarytobrainimpactingagainstboneorduraafteracceleration/decelerationinjury-ThisstatementistrueC.Ill-definedmixedhypodenseandhyperdenselesionsincorticalsurfaceonCT-ThisstatementistrueD.MRIismoresensitivethanCTinidentifyingnonhemorrhagiclesions-Thisstatementistrue06神經(jīng)模塊-腦外傷顱腦外傷

總結(jié)06神經(jīng)模塊-腦外傷硬膜外血腫（EpiduralHematoma）概述：顱腦外傷中，硬膜外血腫占3%，急性占86.%，亞急性占10.3%，慢性占3