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目的 分析和评价颅脑外伤后继发癫 (PTE)患儿的临床、CT、MRI特征及其危险因素。方法 通过随访和EEG、CT及MRI等辅助检查 ,对患儿的年龄、临床发作史、意识、神经体征、头颅骨折、脑损伤程度及颅内并发症等方面进行分析和评价。结果 1 8例中 ,男 1 2例、女 6例 ;首发年龄 :2个月～ 1 2岁 ,平均 3岁 8个月。其中小于 5岁的婴幼儿多于伤后 6～ 1 2个月发病。 1 8例中呈部分及继发全身大发作共 1 3例 ,局灶神经征及偏瘫 1 2例 ;脑外伤后昏迷大于 1 2h 1 1例 ,凹陷性及粉碎性骨折 1 0例 ;CT示颅内血肿及皮层下混合损伤各 1 2例 ;5例做MRI检查 ,其中 4例有局限性长T2 高信号 ;EEG示外伤后 6～ 1 2周局限性慢波异常或性放电明显增多 ,局灶或多灶性棘 (尖 )波或棘 (尖 )慢复合波 1 3例 ,单一节律放电 2例。结论 PTE可发生于各年龄期 ,婴幼儿发病较早 ,年长儿较晚 ;PTE发生的主要危险因素包括 :昏迷 >1 2h的严重脑外伤、早期惊厥反复发作、局灶性神经征、凹陷性颅骨骨折、皮层及皮层下同时损伤、硬膜下及脑内出血等。PTE发作主要表现为部分或继发全身大发作 ;EEG具有早期诊断及预后判断价值
Objective To analyze and evaluate the clinical, CT and MRI features of children with secondary epilepsy (PTE) after traumatic brain injury and its risk factors. Methods Follow-up, EEG, CT and MRI were used to analyze and evaluate the age, clinical history, consciousness, neurological signs, skull fracture, brain injury and intracranial complications in children. Results In 18 cases, there were 12 males and 6 females. The starting age ranged from 2 months to 12 years, with an average of 3 years and 8 months. More than 5 years of infants and young children more than 6 to 12 months after injury onset. In 18 cases, 13 cases of partial and secondary generalized major episodes and 12 cases of focal neurological symptoms and hemiplegia were observed. Coma was greater than 1 2 hours after traumatic brain injury and 10 cases of sagittal and comminuted fractures. CT showed Intracranial hematoma and subcortical hybrid injury in each of 12 cases; 5 cases to do MRI examination, of which 4 cases of limited long T2 high signal; EEG showed 6 to 12 weeks after trauma localized slow wave abnormalities or discharge was significantly increased , Focal or multifocal spine (sharp) wave or spine (sharp) complex 13 cases, single rhythm discharge in 2 cases. Conclusions PTE can occur in all age groups. Infants and young children have earlier onset and later children older. The main risk factors for PTE include severe traumatic brain injury in coma> 12 h, recurrent seizures in early period, focal neurological signs, depression Sexual skull fracture, cortical and subcortical damage, subdural and intracerebral hemorrhage. PTE attack is mainly manifested as partial or secondary panic attack; EEG with early diagnosis and prognostic value