脑疝后脑梗死的临床特点与多层螺旋CT分析  

Clinical analysis and multi-slice spiral CT of brain infarction after brain hernia

作　　者：李晓阳[1] 张立君[2] 王洪峰[1] 林秋全[1] 

机构地区：[1]唐山市人民医院CT室,河北省063001 [2]唐山市协和医院ICU室

出　　处：《中华脑科疾病与康复杂志（电子版）》2012年第5期20-23,共4页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

摘　　要：目的 探讨脑疝后脑梗死的原因、形成机制、CT表现及预防措施。方法 回顾性分析2006年1月至2012年6月60例脑外伤后脑疝形成患者的临床与影像学资料,均为颅脑外伤,其中交通伤39例,高处坠落伤13例,头部外伤8例。所有病例均为我院神经外科住院并接受手术治疗的患者,临床手术时间窗记录清晰,影像资料完整。所有患者均采用多层螺旋CT (MSCT)头部扫描,采用螺旋扫描,分析脑疝以及脑疝后脑梗死的影像表现。结果 60例颅脑损伤分别为脑挫裂伤和(或)硬膜外血肿和(或)硬膜下血肿合并脑疝。责任病灶分别为:脑挫裂伤73处,硬膜外血肿42个,硬膜下血肿22个；脑疝为颞叶钩回疝和(或)大脑镰下疝,60例病例共形成81个脑疝,其中颞叶钩回疝合计24个,大脑镰下疝合计57个；脑疝所致脑梗死60例,CT平扫呈边缘模糊的低密度影,形态分别呈斑片状与椭圆状,长径0.8～3.0 cm不等；梗死灶位置位于同侧丘脑13个,对侧丘脑和基底节42个,胼胝体7个,额叶12个,颞叶7个。结论 脑疝的占位效应是造成脑疝后脑梗死的直接原因,MSCT对脑疝以及脑疝后脑梗死的诊断有较高诊断价值,脑外伤后及时就医、密切观察病情变化、及时发现脑疝后及早手术是预防脑疝后脑梗死的首要措施。Objective To explore the cause of brain infarction after brain hernia,and the forming mechanism,the CT manifestations and preventive measures. Methods Clinical and imaging data of 60patients with brain herniation after brain trauma between January 2006 and June 2012 were analyzed retrospectively,all of the 60 cases were craniocerebral trauma,including 39 cases of traffic injury,13 cases of falling injury and 8 cases of head wounded. All cases were from neurosurgery department of our hospital and received the surgical treatment,the clinical operation time window record and image data were clear. All of the patients received multi-slice spiral CT( MSCT) brain scanning,the image performance of brain hernia and brain infarction after brain hernia were analyzed. Results Of the 60 cases of craniocerebral injury,there were cerebral contusion and( or) epidural hematoma and( or) subdural hematoma complicated with cerebral hernia. Responsibility lesions were 73 cases of cerebral contusion,42 cases of epidural hematoma,22 cases of subdural hematoma; Brain hernia were temporal lobe hook back hernia and( or) gyri callousus hernia,81cases of brain hernia were formed from 60 patients,including 24 cases of temporal lobe hook back hernia,57cases of gyri callousus hernia,there were 60 cases of cerebral infarction caused by cerebral hernia. CT scans showed low density shadow with fuzzy edge,the formations were patchy and oval shape with its diameter from0. 8 to 3. 0 cm,13 cases of infarcts located in the lateral thalamus,42 cases in the lateral thalamus and basal ganglia,7 cases in the corpus callosum,12 cases in the frontal lobe,7 cases in the temporal lobe. Conclusion Local mass effect is the direct reason of the brain infarction after brain hernia,MSCT has higher diagnostic value to diagnosis of brain hernia and brain infarction after brain hernia,the primary measures to prevent brain infarction after brain hernia is timely treatment,closely observe of condition changes and timely surgery.

关 键 词：脑疝 脑梗死 体层摄影术 X线计算机 

分 类 号：R651.15[医药卫生—外科学]