颅顶部硬膜外血肿临床CT特点及诊断

The characteristics in clinic and CT images and Its diagnosis of vertex epidural hematomas

目的 :为提高颅顶部硬膜外血肿的诊断 ,避免误诊或漏诊。方法 :通过对 6 2例颅顶部硬膜外血肿临床特点的分析 ,综合CT、MRI及治疗结果。结果 :误诊 4例 ,漏诊 6例 ,保守治疗 13例 ,手术治疗 4 9例 ,术后恢复良好 38例 ,重残 5例 ,死亡 4例 ,放弃治疗 2例 ,保守治疗 13例全部治愈。结论 :颅顶部硬膜外血肿临床症状及体征不典型 ,常规头颅CT轴位扫描有时易将顶部遗留 ,且因受颅骨容积效应的影响 ,或错误认为是颅骨肥厚 ,而造成误诊或漏诊 ;CT轴位扫描 +冠状扫描可增加诊断的准确性 ,MRI及MRV对小型或微型血肿更为合适。

Objective: The aim of this article is to improve accuracy rating in diagnosis with vertex epidural hematomas and to avoid misdiagnosis and leakage. Methods:we analyze retrospectively the characteristics in clinic ,CT and MR images and curative effect of 62 cases.Result:there are 4 cases misdiagnosis, 6 cases leakage, 13 cases conservative treatment and 49 cases operation. In operation group 38 cases recovered well ,however, 5cases having heavy disablity and 4cases die while all cases received good curative effect in conservation ones. Conclusions: Vertex epidural hematomas have less typical clinical symptoms and physical signs. It is incline to be misdiagnosed and to be leakage due to easy leaking of vertex in axial CT scan , as well as be affected by volume effect of cranial bones and sometimes hematomas are considered incorrectly as pachynsis of cranial bones. Therefore, the accuracy of diagnosis will be improved in axial CT scan combining with colonal plane. MRI and MRV can usually provide clear images especially fitting for minor and miniature hematomas .