神经模块-脑外伤新.ppt

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,*,HEAD TRAUMA,Radiology,The Second Affiliated Hospital,Shantou,University,Medical College,郑文斌,CNS trauma Clinical Features,No 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 EDH),Continous,LOC Following Impact,(“Classic”shearing/Diffuse Axonal injury),Centripetal approach,ouside,to inside,Scalp-,hematoma,Calvarium,-skull fracture,Epidural-,hematoma,Subdural-hematoma,Subarachnoid,-hemorrhage,Intraparenchymal,-,contusion,edema,hemorrhage,Intraventricular,-hemorrhage,Calvarium,-skull fracture,Linear,Stellate,Depressed,Basilar,Eggshell,EPIDURAL HEMATOMA,EPIDURAL HEMATOMA,Scoure,of blood,Menigeal,Vessels-A,V,Dural,sinus,lucid interval,（,40%pts,）,Bi-convex,Hyperdense,-limited by sutures,EPIDURAL HEMATOMA,Direct trauma to cranium,Fracture(90%),-Laceration of,Meningeal,A.and V.,Location is 66%,temporo,-parietal,Temporal,Bone(70-80%),Mortality of 15-30%,EPIDURAL HEMATOMA-CT,Biconvex or lens-shaped,homogeneous,heterogeneous,indicating active bleeding,rarely crosses sutures,fracture line,SUBDURAL HEMATOMA,SUBDURAL HEMATOMA,Scoure,of blood,Laceration of Cortical A A.and V V.(Direct:penetrating injury),Large,Contusions(Direct/indirect:Pulped,Brain,Bridging(Cortical)Veins,SUBDURAL HEMATOMA,Presentation,significant head trauma,but chronic,subdural,-only minor or remote history of trauma,Bilateral in 20%adults(common in elderly),8085%bilateral in infants,extension into,interhemispheric,fissure,tentorial,margins,brain injury in 50%;Complex Injury(DAI),skull fracture in only 1%,SUBDURAL HEMATOMA-CT,Crescentic,in shape,Extends beyond,calvarial,sutures,Acute SDH -,Hyperdense,Subacute,SDH-,Isodense,(1-2 weeks),Chronic SDH -,Hypordense,Enhancement of veins may be useful in identifying,isodense,subdurals,SUBDURAL HEMATOMA-MRI,May be better for detection in the,subacute,stage,and at estimating age of,subdural,hematoma,Can allow differentiation of epidural/,subdural,because of direct visualization of the,dura,especially on coronal imaging,Subarachnoid,hemorrhage,Subarachnoid,hemorrhage,The sensitivity 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 method of choice to detect,acute,subarachnoid,hemorrhage(SAH).,Subarachnoid,hemorrhage-MRI,Magnetic 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 hemorrhage,the sensitivity of MRI is clearly superior to CT.(,hyperintense,on T1WI and T2WI),CEREBRAL CORTICAL CONTUSION,Scoure,of blood,Traumatic/Mechanical Disruption of small(capillary)Vessels,Admixture of blood mixed with Native,Tissue(Petechial,hemorrage,),Mottle/Speckled Density,(“Salt and pepper”on CT),CEREBRAL CORTICAL CONTUSION,Presentation,Loss of consciousness,headache,mental status change,Usually in a superficial cortical location,50%occur in temporal lobe,33%in frontal lobe(frontal pole and inferior surface),Delayed hemorrhage seen in 20%,CEREBRAL CORTICAL CONTUSION-CT,Ill-defined mixed,hypodense,and,hyperdense,lesions-hemorrhage and edema,May coalesce 1-2 days after trauma,Edema and mass effect related to contusion,CEREBRAL CORTICAL CONTUSION-MRI,More sensitive than CT in identifying,nonhemorrhagic,lesions,Multiple areas superficial T2 hyperintensity indicating edema,Heterogeneous T1/T2 signal intensity dependent upon age of hemorrhagic foci,DIFFUSE AXONAL SHEARING INJURY,（弥漫性轴索损伤）,DIFFUSE AXONAL SHEARING INJURY,Follows severe decelerating closed head trauma,patients are generally,unconscious,from the time of the event,Location,of injuries are typically in areas of large numbers of,parallel axons,such as the corpus,callosum,internal capsule,brain stem,basal ganglia and,subcortical,white matter,DIFFUSE AXONAL SHEARING INJURY-CT,Usually,punctate,hyperdensities,are seen in the corpus,callosum,gray white interfaces,and,rostral,brainstem,The axonal injury itself is not visualized,but the associated micro(and macro)hemorrhages in the characteristic distribution are seen,detecting and characterizing brainstem lesions,specifically and predominately,non-hemorrhagic contusions,Appearance depends on presence or absence of hemorrhage,T1-weighted sequences often normal;multiple,hyperintense,foci at gray-white junctions and corpus,callosum,on T2WI,DIFFUSE AXONAL SHEARING INJURY-MRI,QUESTIONS,All 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,meningeal,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 true,SUBDURAL HEMATOMA-,Which of the following statements is CORRECT,A.It is associated with underlying brain injury approximately 20%of the time,-50%are associated with underlying brain injury,B.It is associated with a lucent interval with regards to patient presentation,No,epidural,hematoma,is associated with a lucent interval,C.It is associated with a better overall prognosis than is an epidural,hematoma,The prognosis of a,subdural,hematoma,is generally worse than an epidural,hematoma,due to high rate of underlying brain injuries,All of the following concerning cortical,contusions,are true EXCEPT:,A.Occur most commonly in the frontal lobes,+They occur more commonly in the temporal lobes,B.Secondary to brain impacting against bone or,dura,after acceleration/deceleration injury,-This statement is true,C.Ill-defined mixed,hypodense,and,hyperdense,lesions in cortical surface on CT,-This statement is true,D.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,（,Subdural,Hematoma,）,概述,：,发生于硬脑膜与蛛网膜之间，占颅脑损伤的,36%,。,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。,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。,脑挫裂伤,（,Cerebral Contusion,）,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，小病灶由疤痕修复，大的可形成囊腔，邻近脑组织萎缩,。,脑挫裂伤（,Cerebral Contusion,）,-,CT,损伤局部,呈低密度,改变：其大小可从几厘米至全脑，形态不一，边缘模糊，白质区明显，数天至数周后有的可以恢复为正常脑组织，有的可发展为脑软化以及脑内囊腔。,散在,点片状出血,：位于低密度区内，形态不规则，有些可融化成较大血肿,。,血肿,MRI,（,磁场强度有关,）,急性早期血肿（小于,24h,）：,T1WI,等信号，,T2WI,等信号,急性期（,1-3d,）,:T1WI,等信号，,T2WI,低信号,亚急性血肿（,3d,2,周）：,T1WI,高信号，,T2WI,高信号,(,中心部低信号,),慢性早期血肿（,2,周,-3,周后）：,T1WI,高信号，,T2WI,高信号,慢性期血肿,(3,周后,):T1WI,高信号，,T2WI,高信号（周边低信号环）,-,THANKS,