脑弥漫性轴索损伤的临床表现及CT诊断

Clinical manifestations and CT diagnosis of diffuse axonal injury after head trauma

目的探讨脑弥漫性轴索损伤(DAI)的临床表现、CT诊断。方法分析32例脑弥漫性轴索损伤的临床资料及CT图像资料。同时对所有病例进行GCS评分。结果DAI的CT征象主要为:a)弥漫性双侧脑白质水肿、脑肿胀、灰白质界限不清;b)脑室、脑池、脑沟及蛛网膜下腔变窄、消失,无中线移位;c)脑弥漫性肿胀,白质内点、片状出血,但未形成血肿,无占位效应;d)脑弥漫性肿胀伴硬脑膜下薄层出血。患者伤后昏迷时间越长,临床表现越重,GCS评分越低,CT显示脑室系统受压程度越重则预后越差。结论DAI根据临床表现及影像学检查可作出临床诊断。但DAI病情与CT表现不一致时需行CT薄层扫描或MRI检查。

Objective To discuss the clinical manifestations and CT diagnosis of diffuse axonal injury (DAI) after head trauma.Methods The clinical data and CT images of 32 patients with DAI were analyzed ,at the same time,all patients were given GCS marks.Results Main CT findings of DAI were found to be diffuse cerebral swelling,bilateral white matter edema,delimitation between grey mattet and white matter clouding,narrowing or disappearance of ventricles and cisterns without median structure shift,diffuse cerebral swelling associated with punctual or patchy hemorrhage in white matter,and subdural thin layer hemorrhage.The longer the patients had coma affer head trauma,the more serious the elinical symptoms were,and the lower the GCS mark was,the more the oppression of brain ventricl was,the worse the prognosis was.Conclusion DAI can be definitely diagnosed by the clinical symptoms and CT findings.When the clinical manifestations of DAI are not corresponding to its CT findings,it is necessary to perform thin slice CT scanning or MRI examination.