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[摘要]目的探讨外伤性迟发性大脑半球间纵裂血肿(DTISH)的发生机制、临床特点和治疗方法。方法回顾性分析1998年以来收治的24例外伤性大脑半球间纵裂血肿患者的临床特点... [摘要] 目的 探讨外伤性迟发性大脑半球间纵裂血肿(DTISH)的发生机制、临床特点和治疗方法。 方法 回顾性分析1998年以来收治的24例外伤性大脑半球间纵裂血肿患者 的临床特点和救治情况。结果 本组24例,19例因头痛进行性加重(其中伴不完全性下肢瘫3例,不全偏瘫1例,排尿困难2例),GCS评分下降,复查CT发现DTISH;另5例在清除血肿及去骨瓣减压术中出现缓慢的脑膨出,术后复查头CT发现DTISH。治愈22例,其中9例行开颅血肿清除,3例行钻孔引流,10例保守治疗;2例死于突发呼吸停止,脑中心疝。结论 本病早期症状和体征不重,以进行性头痛加重,突发病情恶化,血肿对侧肢体单瘫或偏瘫,下肢重于上肢,排尿困难为其特点。开颅血肿清除或去骨瓣减压术中,脑组织缓慢膨出,应想到本病的可能性。CT动态观察,可以明确诊断。只要提高对本病的认识,早期发现,早期诊断,无论手术还是保守治疗效果良好。
[关键词] 血肿, 硬膜下, 颅内;早期诊断;治疗结果
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2009-06-27
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[Abstract] Objective To investigate the delayed traumatic interhemispheric hematoma between the brain hemispheres (DTISH) mechanism, clinical features and treatment. Methods A retrospective analysis of 1998 treated 24 cases of traumatic interhemispheric hematoma between hemispheres in patients with clinical features and treatment of the situation. Results The 24 cases, 19 cases of aggravated sexual headache (one with incomplete paralysis of lower limbs of three cases, one cases of incomplete paralysis, 2 cases of dysuria), GCS score decreased, CT review found DTISH; another five cases of hematoma in the clear and decompressive craniectomy to appear slow encephalocele, CT was found after the first review DTISH. 22 cases cured,
9 routine craniotomy hematoma removal, 3 routine drill drainage, 10 cases of conservative treatment; 2 cases died of sudden respiratory arrest, brain hernia centers. Conclusion The early symptoms and signs of disease but not to increase headache, sudden deterioration in their conditions, hematoma contralateral limb or hemiplegia monoplegia and lower limbs than upper limbs, characterized by dysuria. Craniotomy hematoma removal or to decompressive craniectomy, the brain tissue bulging slow, should think of the possibility of this disease. Dynamic CT observation, the diagnosis is clear. So long as to raise awareness of this disease, early detection, early diagnosis, whether surgery or conservative treatment results.
[Key words] Hematoma, Subdural, Intracranial; early diagnosis; treatment outcome
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