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目的 分析西藏高原地区高血压脑出血引起的小脑幕裂孔下疝CT表现特点 ,探讨其形成机制及预后 ,提高对本病早期的CT诊断水平。材料与方法 :回顾了本院 2 5例资料完整的病例 ,均行轴位CT扫描 ,部分加斜坡垂线扫描。结果 :小脑幕裂孔下疝的CT表现除原发出血、蛛网膜下腔出血、脑室积血、脑水肿外 ,主要有脑干周围脑池突入软组织影、脑池变窄或闭塞、病侧环池增宽、中线结构变形移位、脑干受压变形移位水肿出血、病侧侧脑室狭窄或闭塞及对侧侧脑室扩大、脑沟变窄或闭塞、病侧枕叶梗塞 ,并且血肿的大小与脑水肿的范围、中线移位的程度可不成比例。结论 :脑干周围脑池突入软组织影、病侧环池增宽为小脑幕裂孔下疝早期CT征象。中线移位大于 1 0mm ,病死率高 ;进行性出血 ,病死率高。高原缺氧可使脑出血形成的脑水肿范围加大 ,从而使脑疝加重。
Objective To analyze CT features of suboccipital hernia in patients with hypertensive intracerebral hemorrhage (ICH) in the Tibetan Plateau, and to explore its mechanism of formation and prognosis, and to improve the early CT diagnosis of this disease. MATERIALS AND METHODS: Twenty-five cases with complete data were retrospectively reviewed. All patients underwent axial CT scan, and some of them were scanned with vertical line. Results: In addition to primary bleeding, subarachnoid hemorrhage, ventricular hemorrhage, and cerebral edema, CT manifestations of suboccipitocele and subacute hernia mainly include the soft tissue of the cerebral cistern around the brainstem, narrowing or occlusion of the cerebral cistern, Broadening of the pool, midline deformation and displacement, deformation and displacement of the brainstem edema bleeding, contralateral ventricle stenosis or occlusion and contralateral lateral ventricle expansion, narrowing or occlusion of the sulci, the disease side of the occipital lobe infarction, and hematoma The size and extent of brain edema, the extent of the midline shift can be disproportionate. Conclusions: The brain tissue around the brainstem protrudes into the soft tissue, and the widening of the circumflex cuff enlarges the CT signs of the cerebellar tentorium. Midline shift greater than 10mm, high mortality; progressive bleeding, high mortality. Plateau hypoxia can increase the range of brain edema caused by cerebral hemorrhage, so that increased hernia.