脑弥漫性轴索损伤的临床及CT诊断

The clinical findings and CT diagnosis of diffuse axonal injury

目的探讨脑弥漫性轴索损伤的临床表现、特殊CT表现及病理机制。方法分析58例脑弥漫性轴索损伤的临床及CT图像资料。结果脑弥漫性轴索损伤临床表现:①头部受加速性或减速性旋转性损伤;②伤后即刻昏迷;③生命体征紊乱;④四肢肌张力改变;⑤无明确的神经定位体征。CT诊断标准:①大脑皮髓质交界处和(或)大脑中轴区多个直径<2cm的出血灶;②弥漫性脑肿胀;③脑室、脑池普遍受压变小/消失;④中线无移位或轻度移位(<5mm);⑤合并其他颅脑损伤。结论临床表现结合CT表现可明确诊断脑弥漫性轴索损伤;外伤导致原发性下丘脑和脑干血管运动中枢受损所致的弥漫性脑肿胀属于弥漫性轴索损伤的特殊类型。

Objective To investigate the clinical manifestations, characteristic CT findings and pathologic mechanism of diffuse axonal injury（DAI） . Methods The clinical materials and CT images of 58 cases of DAI were analyzed. Results The clinical findings of DAI： ①an acceleration or deceleration and spiral injury of head; ②immediate coma after injury; ③abnormalities of vital sign; ④alternated muscle tone of extremities; ⑤absence of local neurological sign. The diagnostic criterions of CT images： ①multiple hemorrhagic lesions smaller than 2cm in diameter at the cortex- medulla junction or the axial area; ②diffuse cerebral swellings; ③general decompression and even disappearance of ventricles and cisterns; ④non or moderate median structures dislocation （less than 5mm）; ⑤coexistence of other intra- cranial trauma. Conclusion Combining with clinical findings and CT signs, a diagnosis of DAI can be established. Diffuse brain swelling （DBS） occurred by primary hypothalamus and vasomotor center of brain stem damaged is a special type.