Computed Tomographic Appearance of Cerebral Diffuse Axonal Injury

散在性神經軸突挫傷電腦斷層之表徵

張行遠(H. Y. Chang) ； 陳震宇(C. C. Chen) ； 李超群(C. C. Lee) ； 陳復華(F. W. Chen) ； 周定遠(D. Y. Chou)

《中華放射線醫學雜誌》 17卷3期 (1992/09) Pp. 207-214

摘要

從民國79年9月至80年8月，本院共有25例診斷為散在性神經軸突挫傷。男性18例，女性7例。最小11歲，最大78歲，平均年齡34歲。在所有受傷型態中，以機車肇事率最高占64%。散在性神經軸突挫傷的電腦斷層主要有三個表徵，其中以點狀出血占多數(64%)，次為散在性腦水腫(60%)，以及腦室內出血(28%)，而僅有4例包含前述三種症狀。在頭部合併症中常見者為蜘蛛膜下腔出血，硬腦膜下出血，頭顱骨折，顱內鈍傷，以及硬腦膜上出血。在我們的病例中好，壞預後約各占一半(12/13)。將近五分之四昏迷指數(Glasgow Coma Scale)小於8的病人其預後皆不好，而所有昏迷指數大於8的病人其預後均良好。在早期的神經學檢查（包括昏迷指數，瞳孔反射），昏迷時間之長短，以及腦部電腦斷層檢查之表徵，均可提供預估病人在頭部散在性神經軸突挫傷其預後之依據。

關鍵字

腦外傷 ； 腦出血 ； 腦部電腦斷層攝影

並列摘要

We collected 25 cases of diffuse axonal injury (DAI) in one year from Sep. 1990 to Aug. 1991. There were 18 males and 7 females, from 11 to 78 years of age, mean age to be 34 years. Motorcycle accident was the major cause of injury (64%). There were three cardinal signs in diagnosis of DAI on computed tomography (CT). Petechial hemorrhage (64%) was the most common sign in our series, followed by diffuse brain swelling (60%) and intra-ventricular hemorrhage (IVH) (28%). Only 4 cases had all of these three signs. The most common associated brain injury in DAI was subarachnoid hemorrhage (84%), followed by subdural hemorrhage (64%), skull fracture (36%), contusional hemorrhage (20%), and epidural hemorrhage (12%). Nearly 80% patients with Glasgow Coma Scale (GCS) score below 8 had poor outcome. On the contrary, all of the cases with GCS score above 8 had good outcome. The initial neurologic examination (GCS, pupil sign), duration of coma and radiologic findings in the brain CT might help predict outcome in DAI.

並列關鍵字

brain ； injury ； brain ； hemorrhage ； brain ； computed tomography