外伤性迟发性颅内血肿临床特点及首次CT的影像学特征分析

Clinical manifestations and initial CT imaging features of delayed traumatic intracerebral hematoma

目的分析外伤性迟发性颅内血肿临床特点及首次CT影像学特征，早期诊断外伤性迟发性颅内血肿，提高疗效。方法回顾性分析我院2005年至2009年经CT证实的外伤性迟发性颅内血肿患者的临床资料，总结临床特点和首次CT影像学特征。结果迟发性血肿多发生在伤后3d内，额颞部好发，老年人容易发生，进行性的意识水平下降或出现新的神经系统体征往往意味着迟发性血肿；首次CT发现头皮血肿、颅骨骨折、气颅、脑挫伤、蛛网膜下腔出血、外侧裂血肿等预警征象时，要警惕迟发性血肿的发生。结论如果首次CT扫描有头皮血肿、颅骨骨折、脑挫伤、蛛网膜下腔出血、外侧裂血肿者，或颅内血肿成功清除后，但临床症状和特征未改善甚至加重者，进行性的意识水平下降者，伤后应将头部CT动态扫描作为常规检查，做到早期诊断、及时治疗。

Objective To examine the clinical manifestations and initial CT imaging features of delayed traumatic intracranial hematoma. Methods Clinical data of 236 patients who were proved to have delayed traumatic intracranial hematoma by CT imaging in our hospital from 2005 to 2009 were retrospectively analyzed. The clinical and CT imaging features were summarized. Results Delayed hematomas usually occurred within 3 days after injury and had frontotemporal predilection. It was more common in the elderly. Progressive decline in consciousness and nerve system signs newly found were more indicative of delayed hematoma. When initial CT imaging showed scalp hematoma, skull fractures, gas skull, brain con- tusion, subarachnoid hemorrhage, hematoma of lateral fissure and other early warning signs, clinicians would be alert to delayed hematomas. Conclusion If the first CT scanning reveals scalp hematoma, crani al fracture, brain contusion, subarachnoid hemorrhage or lateral fissure hematoma, and the clinical symptoms fail to be alleviated and the patients develop progressive decline in the consciousness after successful removal of intracranial hematoma,dynamic CT scanning should be performed as a routine examination in order to make early diagnosis and timely treatment.