中枢外伤医学知识讲座.ppt

中枢外伤医学知识讲座

ClassificationofHeadInjuryExtracerebrallesions:SubduralhematomaSubduraleffusionEpiduralhematomaIntracerebrallesions:Braincontusion(edema,

hemorrhage..)Subarachnoidhemorrhage

(SAH)Intraventricularhemorrhage

(IVH)Opencranialinjury.SkullfracturePneumoencephalus9/26/20242

颅脑外伤braintrauma硬膜外血肿(epiduralhematoma)硬膜下血肿（subduralhematoma）脑挫裂伤（lacerationandcontusionofbrain）蛛网膜下腔出血Subarachnoidhaemorrhage9/26/20243

硬膜外血肿

(extraduralhematoma)Thesearisebetweentheinnertableoftheskullandthedura.Theyusuallydevelopfrominjurytothemiddlemeningealarteryoroneofitsbranches,andthereforeareusuallytemporoparietalinlocation.Atemporalbonefractureisoftenthecause,butisnotessential.Theexpandinghaematomastripsthedurafromtheskull;thisattachmentisquitestrongsuchthatthehaematomaisconfined,givingrisetoitscharacteristicbiconvexshape,withawelldefinedmargin.9/26/20244

CT征象：颅板内侧梭形(双凸透镜)高密度影(与脑实质比)，CT值50~90Hu；(范围小而厚)密度一般较均匀边沿清楚、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具有占位征：局部脑回受压内移，中线构造向对侧移位9/26/20245

biconvexshape,withawelldefinedmargin.9/26/20246

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血块内含较灰区(箭)，代表正在出血中，有未凝结旳血块EDH：纺垂型，高浓度血块头皮肿(箭)，撞击处9/26/20248

硬膜外血肿MRI平扫、Gd-DTPA增强9/26/20249

硬膜下血肿

（subduralhematoma）Thesearisebetweentheduraandarachnoid,oftenfromrupturedveinscrossingthispotentialspace.Thespaceenlargesasthebrainatrophiesandsosubduralhaematomasaremorecommonintheelderly.9/26/202410

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50~90Hu，范围广而薄密度一般较均匀边界清楚，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一般无颅骨骨折，常为对冲伤出血较多时具有占位效应，局部脑实质受压内移，中线构造向对侧移位9/26/202411

thecrescentichighdensitycollectiontypicalofaacutesubduralhaematoma,withassociatedmidlineshift.9/26/202412

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)ABCD9/26/202413

A.SDH，明显占位效应B.术后，占位效应消失AcutesubduralhematomawithmasseffectAB9/26/202414

等密度PlainCTIVcontrast9/26/202415

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