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1、自发性硬膜下血肿的临床CT诊断作者:向先俊,王成林,黄喋,袁知东,刘鹏程单位:北京大学深圳医院医学影像科,广东深圳【摘要】目的探讨自发性硬膜下血肿的临床、CT表现及其发病机理,提高对自发性硬膜下血肿的诊断水平。方法搜集经手术或CT动态观察证实的17例自发性硬膜下血肿病例,男15例,女2例,其中16例年龄37-77岁,平均61岁,另1例4岁,所有病例均行CT平扫,冋顾性分析其临床及CT表现。使用SiemensSOMATOMPlus4型CT扫描机,扫描条件140KV,189MA,OM线向上连续扫描10
2、・12层,层厚10mm°结杲临床表现:17例患者中,3例患者快速进入昏迷,其余患者症状包括•头痛头晕,恶心呕吐,记忆力下降,视物模糊,肢体乏力、疼痛、麻木,行走不稳,言语不淸,5例患者症状表现为进行性加重,其中1例发展为偏瘫,另1例逐渐进展至昏迷。CT表现:血肿多位于人脑突而,双侧出现血肿的4例,单侧13例。额聂贞部血肿9例,额颗枕顶部血肿6例,额顶部2例,其中3例有大脑镰区血肿。13例单侧发病病例中10例位于左侧,3例位于右侧。血肿位于颅内板与脑皮质间,呈新月形、带状、镰状、梭形,或表现为人脑镰
3、增厚。血肿CT值17-57HU,等密度5例,低密度5例,髙密度3例,混杂密度4例,其中—•例出现分层征。17例中,4例占位效应轻微,9例占位效应较明显,4例形成脑镰下疝。17例均无颅骨骨折表现。结论自发性硬膜下血肿的临床表现无特征性,CT可显示血肿的直接征象和占位效应等间接征象,具有一定的诊断价值。【关键词】硬膜下血肿;体层摄影术ClinicalandCTDiagnosisofthespontaneoussubduralhematomaXIANGXian-jun,WANGCheng-lin,HUA
4、NGRong,etal.DepatrmentofRadiology.PekingUniversityShengzhenHospitol,Shenzhen518039.[Abstract]ObjectiveToinvestigateclinical,CTfeaturesandpathogenesisofthespontaneoussubduralhematomaandtoimprovethediagnosticabilityforthespontaneoussubduralhematoma・Meth
5、ods17cases,inculded15males,2female,ofwhichmales15,females2,age37-77,theaverage61,exceptone4yearsold.provedwithspontaneoussubduralhematomabyoperationordynamicobservationw让hCT,werecollected,CTplainscanningwasperformedinallcases.Theclinicalmanifestations
6、andCTfeaturesofallcaseswereretrospectivelyanalyzed.AllcaseswereexaminedwithaSiemensSOMATOMPlus4scanner.Scanningconditionsfor140KVJ89MA.10-12layerswerescannedfromOMlineupperword,thicknessfor10mm.ResultsTheclinicappearances:3ofthe17caseswerequicklyinaco
7、ma,theremaining14caseshadheadache,dizzy,nausea,vomiting,memorydecline,blurandphysiclfatigue,pain,numbness,unstablewalking,andbarylalia.5caseswithsymptomsprogressed,ofwhichonegotworsetohemiplegia,anotheroneprogressedgraduallyinacoma.CTmanifestations:Mo
8、stofthehematomaswereontheconvexbrain,bilateralhematomasoccurredin4casesandunilateralin13cases・Frontotemporalhematomaswasin9,frontotemporal-occipitalapicalhematomasin6,frontoapicalhematomain2,3ofthe17caseshadhematomasbesidethecerebralfalx・Ofthe