30例颅脑损伤所致颅神经损伤患者临床诊疗分析

Clinical analysis of cranial nerve injury induced by traumatic brain injury

目的探讨颅脑损伤所致颅神经损伤的定位诊断与合理处置。方法回顾性总结800例各型颅脑损伤病员中30例发生颅神经损伤病例的临床表现、诊断及治疗过程。结果 30例颅脑损伤所致颅神经损伤病例中面听神经、嗅神经及眼运动神经损伤发生率高,嗅神经损伤易漏诊,眼运动神经损伤表现复杂,除面神经损伤恢复相对较好外,绝大多数颅神经损伤很难完全恢复。结论颅脑损伤致颅神经损伤发生率高,容易漏诊、误诊引起医疗纠纷,应建立一种从周围性损伤、核性损伤、核间性损伤、核上性损伤等层面系统分析的诊断思维,临床应重视高分辨薄层CT及MRI的检查诊断。

Objective To analyze the diagnosis and proper dispose of cranial nerve injury induced by craniocerebral injury. Methods 800 cases of different types of craniocerebral trauma were analyzed. There were 36 cases had cranial nerve injury. Clinical presentation, diagnosis and treatment process were researched. Results The cases of cranial nerve injury induced by traumatic brain injury were in high incidence of auditory, olfactory and ocular motor nerve injury. The olfactory nerve impairment was easily missed diagnosis. Clinical manifestations of oculomotor nerves were complex. Except facial nerve injury restored relatively well, the vast majority of cranial nerve damage is difficult to fully recover. Cranial nerve injury is easily lead to medical dispute. Conclusion The high incidence of cranial nerve injury induced by traumatic brain injury is easily missed diagnosis and cause disputes. The thinking of systemic analysis should be established from different layers of nerve system, such as peripheral paralysis, nuclear or internuclear damage, and central nerve injury. All of the correct diagnosis should rely on the thin slice and high resolution CT and MRI examinations.