中樞外傷醫(yī)學(xué)知識(shí)講座優(yōu)質(zhì)課件

單擊此處編輯母版標(biāo)題樣式,單擊此處編輯母版文本樣式,第二級(jí),第三級(jí),第四級(jí),第五級(jí),*,*,中樞外傷醫(yī)學(xué)知識(shí)講座,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,10/22/2024,2,顱腦外傷brain trauma,硬膜外血腫(epidural hematoma),硬膜下血腫（subdural hematoma）,腦挫裂傷（laceration and contusion of brain）,蛛網(wǎng)膜下腔出血Subarachnoid haemorrhage,10/22/2024,3,硬膜外血腫(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.,10/22/2024,4,CT征象：,顱板內(nèi)側(cè)梭形(雙凸透鏡)高密度影(與腦實(shí)質(zhì)比)，CT值5090Hu；(范圍小而厚),密度一般較均勻,邊緣清楚、光滑銳利,局部常見腦水腫征,局部蛛網(wǎng)膜下腔常見出血征,局部有顱骨骨折征,具有占位征：局部腦回 受壓內(nèi)移，中線結(jié)構(gòu)向?qū)?cè)移位,10/22/2024,5,biconvex shape,with a well defined margin.,10/22/2024,6,10/22/2024,7,血塊內(nèi)含較灰區(qū),(,箭,),，,代表正,在出血中，有未凝結(jié)的血塊,EDH：紡垂型，高濃度血塊,頭皮腫(箭)，撞擊處,10/22/2024,8,硬膜外血腫MRI平掃、Gd-DTPA增強(qiáng),10/22/2024,9,硬膜下血腫（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.,10/22/2024,10,CT征象,顱內(nèi)板內(nèi)側(cè)新月狀(或帶狀)高密度影(與腦實(shí)質(zhì)比)，CT值5090Hu，范圍廣而薄,密度一般較均勻,邊界清楚，但不光滑銳利,局部可有或無(wú)腦水腫,局部可有或無(wú)蛛網(wǎng)膜下腔出血,局部一般無(wú)顱骨骨折，常為對(duì)沖傷,出血較多時(shí)具有占位效應(yīng)，局部腦實(shí)質(zhì)受壓內(nèi)移，中線結(jié)構(gòu)向?qū)?cè)移位,10/22/2024,11,the crescentic high density collection typical of a acute subdural haematoma,with associated midline shift.,10/22/2024,12,急性硬膜下血腫（SDH）,SDH：,新月型(,A.B),SDH,可能在大腦鐮內(nèi)(,C)。,SDH,也可在幕下(,D),(,不要誤為腦內(nèi)出血),A,B,C,D,10/22/2024,13,A.SDH，明顯占位效應(yīng),B.術(shù)后，占位效應(yīng)消失,Acute subdural hematoma with mass effect,A,B,10/22/2024,14,等密度,Plain CT,IV contrast,10/22/2024,15,10/22/2024,16,20080209,術(shù)后20080219,10/22/2024,17,同一個(gè)病人，20080728,10/22/2024,18,Note the crescentic low density collection typical of a chronic subdural haematoma,with associated midline shift.,10/22/2024,19,subdural hematoma,10/22/2024,20,腦挫裂傷（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.,10/22/2024,21,CT,低密度水腫區(qū),散在高密度出血灶,伴有占位效應(yīng)。有的表現(xiàn)為廣泛的腦水腫或腦內(nèi)血腫,MR,腦水腫T1WI呈等低信號(hào),T2WI高信號(hào);腦血腫T1WI,T2WI均呈高信號(hào),10/22/2024,22,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.,10/22/2024,23,出血、異物、氣顱,10/22/2024,24,Intracerebral Haemorrhage,10/22/2024,25,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.,10/22/2024,26,This patient has an acute extradural haematoma on the right side,and acute traumatic subarachnoid haemorrhage on the left side.,10/22/2024,27,Delayed hemorrhage,several hours or days after head injury,8,小時(shí)隨訪,腦外傷后,10/22/2024,28,Head injury with EDH and delayed contusion hemorrhages,6月,22,日,6月,20,日,10/22/2024,29,Contusion hemorrhages and SAH,A.,9月29日,B.,9月30日,延遲性出血在腦挫傷極常見。,腦挫傷：小血塊及腦水腫混雜在一起,A,B,10/22/2024,30,Vault fractures,10/22/2024,31,顱腦外傷后遺癥,1.,腦,萎縮,2.,交通性腦積水，多由于蛛血、腦室內(nèi)出血,3.,腦,軟化或腦穿通性囊腫，多由于腦挫傷,10/22/2024,32,86,5,14,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,10/22/2024,33,86,9,10:,Communicating hydrocephalus,86,2,6:,Traumatic SAH in the,sulci,interhemispheric fissure,SAH caused communicating,hydrocephalus,10/22/2024,34,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