中枢外伤医学知识讲座专家讲座.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,Central Nervous System,2/11/2025,1,中枢外伤医学知识讲座,第1页,Classification of Head Injury,Extracerebral lesions:,Subdural hematoma,Subdural effusion,Epidural hematoma,Intracerebral lesions:,Brain contusion(edema,hemorrhage.),Subarachnoid hemorrhage (SAH),Intraventricular hemorrhage (IVH),Open cranial injury.,Skull fracture,Pneumoencephalus,2/11/2025,2,中枢外伤医学知识讲座,第2页,颅脑外伤brain trauma,硬膜外血肿(epidural hematoma),硬膜下血肿（subdural hematoma）,脑挫裂伤（laceration and contusion of brain）,蛛网膜下腔出血Subarachnoid haemorrhage,2/11/2025,3,中枢外伤医学知识讲座,第3页,硬膜外血肿(extradural hematoma),These arise between the inner table of the skull and the dura.They usually develop from injury to the middle meningeal artery or one of its branches,and therefore are usually temporoparietal in location.A temporal bone fracture is often the cause,but is not essential.The expanding haematoma strips the dura from the skull;this attachment is quite strong such that the haematoma is confined,giving rise to its characteristic biconvex shape,with a well defined margin.,2/11/2025,4,中枢外伤医学知识讲座,第4页,CT征象：,颅板内侧梭形(双凸透镜)高密度影(与脑实质比)，CT值5090Hu；(范围小而厚),密度普通较均匀,边缘清楚、光滑锐利,局部常见脑水肿征,局部蛛网膜下腔常见出血征,局部有颅骨骨折征,含有占位征：局部脑回 受压内移，中线结构向对侧移位,2/11/2025,5,中枢外伤医学知识讲座,第5页,biconvex shape,with a well defined margin.,2/11/2025,6,中枢外伤医学知识讲座,第6页,2/11/2025,7,中枢外伤医学知识讲座,第7页,血块内含较灰区,(,箭,),，,代表正,在出血中，有未凝结血块,EDH：纺垂型，高浓度血块,头皮肿(箭)，撞击处,2/11/2025,8,中枢外伤医学知识讲座,第8页,硬膜外血肿MRI平扫、Gd-DTPA增强,2/11/2025,9,中枢外伤医学知识讲座,第9页,硬膜下血肿（subdural hematoma）,These arise between the dura and arachnoid,often from ruptured veins crossing this potential space.The space enlarges as the brain atrophies and so subdural haematomas are more common in the elderly.,2/11/2025,10,中枢外伤医学知识讲座,第10页,CT征象,颅内板内侧新月状(或带状)高密度影(与脑实质比)，CT值5090Hu，范围广而薄,密度普通较均匀,边界清楚，但不光滑锐利,局部可有或无脑水肿,局部可有或无蛛网膜下腔出血,局部普通无颅骨骨折，常为对冲伤,出血较多时含有占位效应，局部脑实质受压内移，中线结构向对侧移位,2/11/2025,11,中枢外伤医学知识讲座,第11页,the crescentic high density collection typical of a acute subdural haematoma,with associated midline shift.,2/11/2025,12,中枢外伤医学知识讲座,第12页,急性硬膜下血肿（SDH）,SDH：,新月型(,A.B),SDH,可能在大脑镰内(,C)。,SDH,也可在幕下(,D),(,不要误为脑內出血),A,B,C,D,2/11/2025,13,中枢外伤医学知识讲座,第13页,A.SDH，显著占位效应,B.术后，占位效应消失,Acute subdural hematoma with mass effect,A,B,2/11/2025,14,中枢外伤医学知识讲座,第14页,等密度,Plain CT,IV contrast,2/11/2025,15,中枢外伤医学知识讲座,第15页,2/11/2025,16,中枢外伤医学知识讲座,第16页,0209,术后0219,2/11/2025,17,中枢外伤医学知识讲座,第17页,同一个病人，0728,2/11/2025,18,中枢外伤医学知识讲座,第18页,Note the crescentic low density collection typical of a chronic subdural haematoma,with associated midline shift.,2/11/2025,19,中枢外伤医学知识讲座,第19页,subdural hematoma,2/11/2025,20,中枢外伤医学知识讲座,第20页,脑挫裂伤（laceration and contusion of brain）,These occur due to stretching and shearing injury,often due to impaction of the brain against the skull on the side opposite to the injury.Thus they may be seen directly opposite the impact site,subcutaneous haematoma,fracture,or extradural haematoma(contre coup injury).The inferior frontal lobes and anterior temporal lobes are common sites after a blow to the back of the head.,2/11/2025,21,中枢外伤医学知识讲座,第21页,CT,低密度水肿区,散在高密度出血灶,伴有占位效应。有表现为广泛脑水肿或脑内血肿,MR,脑水肿T1WI呈等低信号,T2WI高信号;脑血肿T1WI,T2WI均呈高信号,2/11/2025,22,中枢外伤医学知识讲座,第22页,There is a focal area of haemorrhagic contusion in the right frontal lobe,with surrounding low density due to infarction or oedema.This is a frequent location for a contre-coup injury following a blow to the back of the head.,2/11/2025,23,中枢外伤医学知识讲座,第23页,出血、异物、气颅,2/11/2025,24,中枢外伤医学知识讲座,第24页,Intracerebral Haemorrhage,2/11/2025,25,中枢外伤医学知识讲座,第25页,Subarachnoid haemorrhage,This may occur alone or in association with other intracerebral or extracerebral haematomas.Increased attenuation is seen in the CSF spaces,over the cerebral hemispheres(look closely at the Sylvian fissure),in the basal cisterns or in the ventricular system.SAH may be complicated by hydrocephalus.Confusion can sometimes arise between SAH due to trauma and due to a ruptured aneurysm or arteriovenous malformation(AVM);the patient may collapse and hit their head as a result of a bleed and the history(from the patient or a witness)is important.,2/11/2025,26,中枢外伤医学知识讲座,第26页,This patient has an acute extradural haematoma on the right side,and acute traumatic subarachnoid haemorrhage on the left side.,2/11/2025,27,中枢外伤医学知识讲座,第27页,Delayed hemorrhage,several hours or days after head injury,8,小时随访,脑外伤后,2/11/2025,28,中枢外伤医学知识讲座,第28页,Head injury with EDH and delayed contusion hemorrhages,6月,22,日,6月,20,日,2/11/2025,29,中枢外伤医学知识讲座,第29页,Contusion hemorrhages and SAH,A.,9月29日,B.,9月30日,延迟性出血在脑挫伤极常见。,脑挫伤：小血块及脑水肿混杂在一起,A,B,2/11/2025,30,中枢外伤医学知识讲座,第30页,Vault fractures,2/11/2025,31,中枢外伤医学知识讲座,第31页,颅脑外伤后遗症,1.脑萎缩,2.交通性脑积水，多因为蛛血、脑室内出血,3.脑软化或脑穿通性囊肿，多因为脑挫伤,2/11/2025,32,中枢外伤医学知识讲座,第32页,86,5,14,Acute SDH&,contusion,hemorrhage,86,5,16,Post-craniotomy,the SDH,disappeared,delayed,hemorrhage;SAH,in Rt.tentorium,86,8,13,Encephalomalacia,change with,mild hydrocephalus,Decompression hemorrhage,with encephalomalacia change,2/11/2025,33,中枢外伤医学知识讲座,第33页,86,9,10:,Communicating hydrocephalus,86,2,6:,Traumatic SAH in the,sulci,interhemispheric fissure,SAH caused communicating,hydrocephalus,2/11/2025,34,中枢外伤医学知识讲座,第34页,Diffuse Axonal Injury(DAI),Due to axonal disruption from shearing forces of acceleration/deceleration.,Most commonly seen in severe head injury,Clinical:Loss of consciousness at time of injury,Marked discrepancy between the initial CT and clinical status of the patient,Very small DAI have profound clinical sequela since they affect densely packed bundles of axons located deep within the brain,2/11/2025,35,中枢外伤医学知识讲座,第35页,Diffuse Axonal Injury,Radiographic features:,Characteristic locations:lobar gray matter/white matter junction,corpus callosum,dorsolateral brainstem,Initial CT is often read as normal,DAI lesions can be very small and primarily non-hemorrhagic rendering them quite inconspicious on the 1st CT scan,Petechial hemorrhage develops later on,Multifocal T2 bright lesions(MRI more sensitive),2/11/2025,36,中枢外伤医学知识讲座,第36页,Diffuse Axonal Injury,Survivors of severe DAI usually have poor neurologic outcomes,2/11/2025,37,中枢外伤医学知识讲座,第37页,1,st day,4,months later-brain atrophy,5,th day,Coma after head injury,4 months later,semi-vegetate stage,Multiple punctate hemorrhages,Diffuse axonal injury(DAI)caused brain atrophy,2/11/2025,38,中枢外伤医学知识讲座,第38页,Schaefer,P.W.et al.Radiology;233:58-66,Transverse MR images in a 17-year-old male patient after traumatic brain injury secondary to motor vehicle crash,2/11/2025,39,中枢外伤医学知识讲座,第39页,DAIMRI,2/11/2025,40,中枢外伤医学知识讲座,第40页,DAIDWI,AJNR 1999,2/11/2025,41,中枢外伤医学知识讲座,第41页,CT of Head Injury,Negative finding,of CT of head injury,1.True negative,2.False negative,Diffuse axonal injury,Brainstem injury,3.Delayed hemorrhage.,Clinincally,closed observation of the patient is mandatory,2/11/2025,42,中枢外伤医学知识讲座,第42页,2/11/2025,43,中枢外伤医学知识讲座,第43页,2/11/2025,44,中枢外伤医学知识讲座,第44页,2/11/2025,45,中枢外伤医学知识讲座,第45页,2/11/2025,46,中枢外伤医学知识讲座,第46页,Thank you！,2/11/2025,47,中枢外伤医学知识讲座,第47页,