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急性硬膜外血肿 CT 检查表现单纯低密度影者较少见,本文报告2例。例1:男,65岁,行走时被车撞伤头部,头痛1 h 入院。查体神志清,右顶枕部巨大头皮血肿,双瞳孔直径4 mm,光反应正常,无肢瘫。头颅 CT 示右顶枕骨骨折,右顶枕急性硬膜外血肿,低密度影且呈新月形,量约10 ml,予止血、甘露醇脱水对症治疗。10余分钟后患者迅速转入昏迷,右瞳散大,左肢体瘫痪,肌力Ⅲ级。复查头颅 CT 示顶枕部硬膜外血肿明显增多,仍呈混杂密度影,量约100ml,予急症开颅。右顶枕马蹄形切口,皮瓣、肌骨瓣分别成型,见右顶枕骨线性骨折,骨折线分离明显,骨膜及皮下均见大量血肿。清除血肿,见骨折线处板障明显活动性出血,骨蜡涂抹止血。探查硬膜下未见出血。术后第2 d,患者完全清醒,肌体肌力正常。7 d 后拆线,痊愈出院。血液系统各项检查均未见异常。
Acute epidural hematoma CT examination showed only low-density shadow is rare, this article reports 2 cases. Example 1: Male, 65 years old, was hit by a car while walking headache, headache 1 h admission. Conscious physical examination, the right top of the occipital giant scalp hematoma, double pupil diameter 4 mm, light reaction was normal, no limb paralysis. Head CT showed the right top of the occipital fracture, right epicardial acute epidural hematoma, low density and was crescent, about 10 ml, to stop bleeding, mannitol dehydration symptomatic treatment. More than 10 minutes after the patient quickly into a coma, right pupil loose, paralyzed left limb, muscle strength grade. Review head CT showed the occipital occipital epidural hematoma was significantly increased, still mixed density shadow, the amount of about 100ml, emergency craniotomy. Right top of the pillow horseshoe-shaped incision, respectively, flap, muscular flap were molded, see the right top of the occipital linear fracture, fracture line separation was obvious, a large number of periosteal and subcutaneous hematoma. Clear the hematoma, see the fracture line active platelet bleeding, bone smear bleeding. No subdural hemorrhage was detected. On the 2nd postoperative day, the patient was completely awake and his body muscle strength was normal. After 7 days stitches, healed and discharged. Blood tests were no abnormalities.