医学精品课件：Trauma.ppt

1、 Head trauma华中科技大学同济医学院华中科技大学同济医学院同济医院放射科同济医院放射科Zhu Wenzhen Skull fracture Contusion&Laceration Hemorrhage:Intracerebral Intraventricular Subarachnoid Subdural Extradural uAn EDH typically occurs at the site of traumatic impact or“coup”site and is almost always associated with an overlying skull fra

2、cture.uInjury to a meningeal artery/vein,diploic vein,or dural venous sinus results in a classically lentiform-shaped collection of blood that strips the dura away from the inner table of the skull.EDHs are most common in the temporal or temporoparietal regions,often due to laceration of the middle

3、meningeal artery or one of its branches.Epidural Hematoma(EDH)uEDH typically appear lentiform or biconvex in shape.u EDH do not cross cranial sutures because the periosteal layer of the dura adheres tightly to the suture.uEDHs can cross the midline where the periosteal layer of the dura forms the ou

4、ter wall of the superior sagittal sinusuDural line is seenTypical biconvex or lentiform epidural hematoma is present over the left parietal lobe.Homogeneous in density represented clotted blood.Heterogeneous is unclotted blood.EDH exists mass effect.EDHlentiform EDH and dural line signu A subdural h

5、ematoma(SDH)can occur either at the coup or contrecoup site,although the latter is more common.u Injury to superficial bridging veins results in bleeding between the meningeal layer of the dura and arachnoid,and blood may continue to accumulate in this space as bridging veins are progressively stret

6、ched and injured.uSDHs commonly occur over the cerebral convexities.Acute left convexity subdural hematoma,typical crescent shape,more mass effect than EDHSDHSDHuOn imaging,SDHs appear crescentic in shape and homorrhage spread along the entire subdural spaces.udo not cross the midline;uthey can cros

7、s cranial suture lines.uNo dural sign.Subarachnoid hemorrhage(SAH)uAcute SAH is readily identified on noncontrast CT scans as linear areas of high attenuation in the cerebral sulci at the convexities,Sylvian fissures,or basilar cisterns.Right frontal fracture,Contusion&Laceration Hemorrhage:Intracer

8、ebral,Subdural H,SAH,scalp swellingIntracerebral hematoma and intraventricular hemorrhageICA thrombosis and occlusion 血栓形成伴血管闭塞ICA闭塞伴 脑梗死ICA occlusion and cerebral infarction 血栓形成伴血管闭塞uThe mechanism of injury is one of cytoplasmic shear-strain of the axonal cytoskeleton due to sustained acceleration

9、/deceleration,such as that which occurs with a high-speed motor vehicle crash or prolonged shaking.Damage to the neurons occurs not only at the time of mechanical injury but in the hours,days,and weeks,even years,following the traumatic event due to a deleterious cascade of biochemical events and Wa

10、llerian-type degeneration with progressive neuronal loss.uOne of the most common types of primary injury in patients with severe head trauma.uClinically,the patients present severe loss od consciousness.uMultiple small lesions(hemorrhaic or nonhemorrhagic)will be found in the lobar white matter,corpus callosum and brain stem.Diffuse axial injury(DAI),typical location in deep WM,corpus callosun&corona radiata.uThe spine fracture:compression fracturec,omminuted fracture.u Cord contusion:edema,swollen,hemorrhage