自发性硬脊膜外血肿的诊断与治疗

目的 探讨自发性硬脊膜外血肿的出血原因、临床表现、MRI特征、治疗及预后相关因素。方法 结合相关文献,回顾性分析6例自发性硬脊膜外血肿（SSEH）的发病机制、临床特征、术前神经功能状态及发病到手术的时间间隔与预后因素。结果 SSEH好发于年轻患者,多急性起病。MRI显示椎管后方或后外方半月形占位影。患者预后与术前神经功能状态及发病到手术的时间间隔密切相关,与年龄、血肿部位、血肿大小无关。患者术前的神经功能状态越好预后越佳,发病到手术的时间间隔越短预后越好。结论 MRI检查是诊断本病最佳方法。及时的脊髓减压手术是改善预后的关键。     

自发性脊髓硬膜外和硬膜下血肿

目的 探讨自发性脊髓硬膜外血肿（SSEH)及硬膜下血肿(SSSH)的病因、临床特点、诊治方法及预后相关因素。方法 自1995～2002年收治的4例SSEH及2例SSSH患者．均在静息或轻微活动后发病，发病前均无感染或服药史，其中1例63岁患者诉有高血压病史．1例65岁患者入院检查后发现患有Ⅱ型精尿病．余均否认患有其他疾病。所有患者均表现为突发性的颈、肩、胸、背部疼痛，数分钟到数小时内出现肢体运动、感觉障碍、大小便障碍及潴留，5例患者有抻经根放射痛症状．有3例行腰穿，压力无明显增高．均行手术治疗．手术距发病时间10～16d．平均12.5d，手术均在局麻下进行．4例SSEH患者行患部全椎板切除血肿清除术．2例SSSH患者行全椎板切除并硬静膜切开血肿清除，硬脊膜修补术。结果 均经MR检查、手术及病理证实。MRI显示椎管后方或后外方占位性病变，T1加权能特征性地反映血肿随时间发生的信号变化而最有价值．T22加权可很好地判断血肿的位置，患者预后与术前的神经功能状态及发病至手术的时间密切相关，本组患者随访6～18个月，平均10个月．6例患者除大、小便功能有不同程度的改善外．5例患者肢体的运动、感觉功能无明显恢复，1例SSSH患者感觉消失平面下降，右上肢肌力较前增强，结论 自发性脊髓硬膜外及硬膜下血肿是一种少见病，MRI是其首选的检查方法，应当注意的是早期诊断并及时手术是治疗SSEH和SSSH．防止永久性神经功能障碍的关健。     

自发性椎管硬膜内血肿

目的：探讨自发性椎管硬膜内血肿(SSDH)的临床特点及治疗。方法：2例患者，均为女性，年龄分别为65、58岁；均以突发性腰痛伴有双下肢疼痛、无力就诊，MRI示分别于脊柱腰段及胸腰段椎管硬膜内血肿。明确诊断后均于以手术治疗，行血肿清除术。结果：术后2例患者症状、体征均明显改善；经过6个月～1年的随访，2例患者完全康复．结论：自发性椎管硬膜内血肿发病急，症状重；MRI是确诊最可靠的手段；有脊髓压迫症状的患者，需要急诊手术。     

自发性椎管内硬膜外血肿5例的诊疗体会

[目的]探讨自发性椎管内硬膜外血肿的临床表现及诊治过程。[方法]回顾性调查2014年9月～2017年4月共5例诊断为自发性椎管内硬膜外血肿在本院脊柱骨科住院治疗的患者。记录患者的流行病学资料、临床特征、实验室检查、影像学表现及治疗方法,评价治疗效果与预后。[结果] 5例患者中男性2例,女性3例,平均年龄(69.82±10.74)岁,自发性血肿发生的部位:颈段1例,胸段以及胸腰段4例。ASIA分级:3例A级,1例C级,1例D级。按血肿MRI分期:超急性期1例,亚急性早期1例,亚急性晚期3例。3例行椎板减压血肿清除术,2例行保守治疗。所有患者经至少1年以上随访。末次随访时ASIA评分:A级1例,B级1例,E级3例。[结论]自发性椎管内硬膜外血肿应及早做出诊断和治疗,防止延误治疗的最佳时机。     

自发性急性硬膜下血肿9例

目的探讨自发性急性硬膜下血肿的原因、发病机理及治疗方法。方法搜集近5年来自发性硬膜下血肿9例病人,分析发病原因以及通过保守和手术两种治疗方法获得的效果,得出相应的结论。结果9例病人均为老年病人,伴有高血压、糖尿病及心血管病史,通过保守及手术治疗恢复良好,按照ADL分级法评价,Ⅰ级6例,Ⅱ级2例,Ⅲ级1例,无1例病人死亡。随访3-6个月,未发现血肿复发现象。结论作者通过本组病例分析及复习相关文献．认为高血压和脑血管病是自发性硬膜下出血的内在因素,皮层小动脉牙枝呈直角发出．容易自发性出血,在剧烈咳嗽、排便时腹压突然增加、体位突然改变等诱因下可导致自发性硬膜下出血：通过保守及手术两种不同的方法,治疗效果良好。     

椎管内髓外占位高场强MRI影像特点分析

目的 总结椎管内髓外占位高场强MRI影像特点,以提高诊断正确率。方法 收集2017年2月～2022年8月本院16例经手术病理证实的椎管内髓外占位,回顾性分析并总结MRI影像特点。所有病例均采用高场强3.0T磁共振仪进行扫描。结果 16例患者中,神经鞘瘤9例,脊膜瘤3例,自发性脊髓硬膜外血肿1例,海绵状血管瘤1例,毛细血管瘤1例,黏液乳头型室管膜瘤1例。12例位于髓外硬膜下,4例位于髓外硬膜外。结论 MRI能全面直接显示椎管内髓外占位的位置、范围、信号等,有助于病灶的定位和定性诊断,为临床选择治疗方案提供可靠的影像学依据。     

自发性硬脊膜外血肿4例报告

自发性硬脊膜外血肿是一种少见的疾病 ,误诊率及漏诊率较高 ,常常由于确诊时间晚而延误了最佳手术时机。随着ＣＴ、ＭＲＩ的普及 ,对本病的认识和诊治水平均有很大提高。我科近两年收治 4例自发性硬脊膜外血肿 ,均经ＭＲＩ确诊 ,手术证实。结合文献报告讨论如下。临床资料　男女各 2例 ,年龄 9～39岁 ,平均 2 4岁。 1例有外伤史 ,另 3例无诱因发病 ,既往均无高血压病史及出血疾患 ,病程数十小时至 1周。 4例均突感阵发性局部针刺或压榨性疼痛 ,用力或变换体位时加重。双下肢瘫 3例 ,四肢瘫 1例。 4例均有感觉障碍平面及病理反射 ,相应棘突叩…     

腰椎间盘术后脑脊液漏的防治

目的 分析腰椎间盘手术中硬脊膜损伤的原因，探讨术后脑脊液漏的防治措施。方法 回顾1997年3月－2001年10月发生的19例腰椎间盘术后脑脊液漏的临床资料并进行分析总结。结果 除1例保守治疗无效须重新修补硬脊膜外，其余经保守治疗而痊愈。结论 防治脑脊液漏的主要措施包括术前充分的准备，术中仔细操作，及时对硬膜损伤进行修补，术后采取正规的保守治疗。大多数脑脊液漏可以保守治愈，少数保守治疗无效者需再次手术重新修补硬膜。     

非外伤性硬脊膜外血肿12例临床分析

硬脊膜外血肿发病率低，但常起病急，病情重，在短时间内导致截瘫或四肢瘫，甚至危及患者生命。自2002年1月至2005年3月，我院共治疗12例非外伤性硬脊膜外血肿患者，现结合文献报告如下。     

颅脑损伤后后颅窝硬膜下血肿临床诊治分析

目的探讨颅脑损伤后后颅窝硬膜下血肿的诊断、治疗及预后。方法回顾性分析32例颅脑损伤后后颅窝硬膜下血肿患者的临床资料。结果 32例患者,手术治疗20例,保守治疗12例。20例预后不良,12例预后良好。结论后颅窝硬膜下血肿的预后与GCS评分、硬膜下血肿量、中脑周围结构、第四脑室改变、幕上脑积水有关。其中GCS评分是影响预后的重要因素。     

Spinal Subdural and Epidural Haematomas: Diagnostic and Therapeutic Aspects in Acute and Subacute Cases

Summary  Background. The diagnosis of spontaneous spinal haematomas mainly depends on magnetic resonance imaging. This study evaluates the MRI characteristics of spinal epidural and subdural haematomas. The results were correlated with medical history, coagulation abnormalities and therapeutic outcome to provide guidelines for early diagnosis and treatment of spinal epidural and subdural hematomas.  Summary of Background Data. Imaging signs of epidural and subdural haematomas have been reported before, however without special attention to the differential-diagnostic and therapeutic implications of haematoma localisation.  Method. Seven patients (3 women, 4 men, age range 55–86 years) with acute progressive neurological deficits and without a history of severe trauma were studied. In all cases neurological examinations were performed after admission followed by MRI studies with T2 and T1 weighted images, before and after administration of contrast agent. Spinal angiography was performed twice to exclude a vascular malformation. All patients underwent open surgery.  Findings. Acute and subacute hematomas were detected once in the cervical spine, in five cases in the thoracic region and once in the lumbar region. The hematomas had an epidural location in three cases and a subdural in four. In the thoracic region subdural haemorrhage was much more common than epidural hematomas. Subdural blood collections were mainly found ventral to the spinal cord. Epidural haemorrhage was always located dorsal to the spinal cord. The evaluation of the haematoma localisation may be difficult occasionally, but delineation of the dura is frequently possible in good quality MRI. The clue to the diagnosis of ventrally located subdural haemorrhage is the absence of the “curtain sign”, which is typical for epidural tumours.  Interpretation. Spontaneous spinal hematomas are frequently located in the thoracic spine. Subdural spinal haemorrhage is more frequent than epidural. Epidural haemorrhage is frequently located dorsal to the spinal cord because of the tight fixation of the dura to the vertebral bodies.     

脊髓纵裂30例诊治分析

目的探讨脊髓纵裂的临床诊治。方法回顾性研究1995—2002年间我院收治的脊髓纵裂病例，分析其临床诊治过程。结果脊髓纵裂30例，女性22例(73．3％)，男性8例(26．7％)，临床表现主要有：脊柱畸形30例(100%)，背部皮肤病变13例(43．3％)，下肢神经缺陷12例(40．0％)。X线片发现椎体异常27例(90%)，脊髓造影、CT、CTM、MRI检查异常表现的比例分别为77．8％(14／18)、88．9％(8／9)、100％(16／16)、91．7％(11／12)。纵裂位于胸段15例，腰段4例，颈段及胸段l例，胸段及腰段9例，颈段、胸段及腰段1例；骨性纵裂6例。纤维性纵裂21例，混合性纵裂3例。治疗方法包括单纯骨嵴切除椎管减压1例(3．3％)。脊柱畸形矫形手术同时切除骨嵴4例(13．3％)，单纯行脊柱畸形矫形手术而未处理脊髓纵裂23例(76．7％)，未行任何手术2例。有神经缺陷者中有4例在术后获得改善。结论脊髓纵裂临床少见，以女性患者较多，往往以脊侧凸为首发表现，患者多合并有背部皮肤异常及下肢神经缺陷，CTM扫描常能明确诊断。纵裂多位于胸段及腰段，在脊柱畸形矫形手术时要注意对脊髓纵裂的影响。     

自发性椎管内硬膜外血肿的影像学及临床特征

目的分析自发性椎管内硬膜外血肿(SSEH)的影像学特征及临床治疗效果。方法回顾性分析2008年6月—2018年9月泰州市人民医院脊柱外科收治的SSEH患者临床资料,分析其影像学表现。采用硬膜外脊髓压迫(ESCC)分级评估硬膜外占位对硬膜囊及脊髓的压迫程度,美国脊髓损伤协会(ASIA)分级评估神经功能,疼痛视觉模拟量表(VAS)评分评估疼痛情况。结果本研究共纳入12例患者,年龄25 ～ 74岁,中位年龄64.5岁。MRI显示SSEH大多呈梭形、椭圆形,且多位于脊髓侧后方或后方的硬膜外腔。血肿最多发于颈段(4例)或颈胸段(4例)。血肿累及1 ～ 4个节段,平均2.6个节段。T1WI MRI上7例表现为等信号,4例表现为高信号,1例表现为低信号;T2WI MRI上10例表现为高/混杂信号,2例表现为低信号。血肿压迫脊髓程度(ESCC分级)与患者神经功能损伤程度(AISA分级)密切相关(r=0.85,P 0.01)。7例患者行手术治疗,其中5例术后神经功能有所恢复,2例术前ASIA分级为A级的患者末次随访时仍为A级;5例采用非手术治疗,治疗后神经功能均有所恢复,VAS评分下降。结论 MRI是诊断SSEH的最佳检查方法。根据患者神经功能损伤及进展情形,可选择非手术治疗或尽早手术治疗。     

Spontaneous extradural hematoma localized in the ventral side of the thoracic spinal cord--a case report

A case of spontaneous spinal extradural hematoma was reported. The patient, a 25-year-old housewife, was hospitalized with back pain, followed by paralysis of both legs and urinary disturbance during next 2 hours. A myelogram demonstrated that contrast medium was incompletely blocked at the level from the 3rd to the 4th thoracic spine by extradural mass. Unfortunately X-ray CT scan was not examined, however, a NMR-CT scan excluded disc protrusion and dissecting aneurysm of the aorta. Eight hours after onset, wide laminectomy was performed as emergency operation and an epidural hematoma located in the ventral side with compression of the thoracic cord was removed as completely as possible. She was discharged with excellent recovery after operation. The spontaneous spinal epidural hematoma is rare emergency. The exact etiology is unknown, and no explanation is offered as to why the hematoma is usually dorsal in location. To our knowledge, only three cases of spinal epidural hematoma which located in the ventral side were reported. Considering from our experience and other reports, it seems to be the most important point to avoid the unnecessary pressure on the spinal cord and to search the exact bleeding point in the operative procedure of ventral epidural hematomas.     

Fracture of the spine,spinal epidural haematoma and spondylitis

Summary We report the case of a patient suffering from spinal epidural haematoma and thoracic spinal fracture, and from ankylosing spondylitis. Fourteen cases of spinal epidural haematoma in association with ankylosing spondylitis have been reported in the literature, 12 of them at a cervical level. Spinal epidural haematoma found in patients suffering from ankylosing spondylitis share the same clinical picture as other haematomas, the notion of time being the main feature. Serious neurological complications caused the death of five patients. The case we report is singular for its thoracic localization and two attacks of total paralysis both followed by spontaneous and complete recovery. Today, MRI is the best method to reach a clear and reliable diagnosis. Widespread use of MRI will certainly increase the number of diagnoses made. Our patient underwent operation including osteosynthesis using Cotrel-Dubousset instrumentation. This enabled him to resume his professional activities only 30 days after his accident.     

Intracranial and spinal subdural hematoma: a rare complication of epidural and subarachnoid anesthesia

Subdural and epidural hematomas complicating central blocks are rare but serious complications that can lead to permanent neurological deficits. This review discusses cranial and spinal subdural hematomas, including the history of this complication in the literature. Theories to explain the mechanisms by which hematomas are formed are presented and risk factors are analyzed. The associations between such hematomas and the design of the various needles used for lumbar puncture are evaluated and the most common cranial and spinal locations are discussed. The anatomy of tissues that envelop and contain chronic subdural hematomas are described and the various neurological alterations that can develop are mentioned. Finally, diagnostic imaging options and corrective surgical techniques are reviewed.     

创伤性无骨折脱位型椎管内硬膜外血肿的MRI表现

目的探讨创伤性无骨折脱位型脊髓硬膜外血肿（TSEH）的MRI表现特点及其鉴别诊断。方法对12例TSEH常规行T1WI矢状位，T2WI矢状位及横轴位MRI扫描。结果12例TSEH中，9例位于椎管腹侧，3例位于椎管背侧，呈新月状或长条带状，分别累及2～6个脊髓节段，平均3．5个脊髓节段。血肿位于颈段4例，颈胸段3例，胸段3例，胸腰段2例。7例血肿T1WI上为等信号，T2wI低信号；2例血肿T1WI为稍高信号，T2WI呈不均质性高信号，3例于T1WI及T2WI均为高信号。血肿于T1WI及T2WI与脊髓之间有一低信号带相隔，尤以T2WI显示最佳。结论MRI是诊断TSEH的最佳检查方法，不仅可以清楚地显示血肿的部位及范围，而且可以清楚地显示血肿新旧程度及脊髓受损的情况。     

Extra dural arachnoid cyst: case report

Extradural arachnoid cysts are uncommon expanding lesions in the spinal canal, which may communicate with the subarachnoid space. Usually located in the lower thoracic spine, they may cause symptoms by compressing the spinal cord or nerve roots. We report a case of an extradural thoracic arachnoid cyst revealed by progressive spinal cord compression. CT myelography and MRI enabled diagnosis. Rapid neurological improvement was observed after surgical resection.     

Spontaneous spinal epidural hematoma diagnosed by MRI: a case report

Appropriate diagnostic procedure for spinal epidural hematomas has not been established yet. The authors reported a case of spontaneous epidural hematomas at the thoracic level, in which correct diagnosis was made with MRI and good results were obtained by surgery. A 63-year-old female experienced a severe back pain which appeared suddenly during a walk and was followed by motor weakness in both legs deteriorating quickly to paraplegia. The patient had no history of hypertension, trauma or bleeding tendency. The laboratory data were normal. On admission, neurological examination revealed flaccid paraplegia, total sensory loss below the level of Th 6 and urinary and fecal incontinence. Myelograms showed incomplete block at the Th 6 level and postmyelographic CT scan showed an isodense mass, which was suspected to be an epidural tumor located behind the spinal cord. Emergent MRI confirmed an epidural hematoma as a high intensity area extending from Th 3 through Th 11. Sixty-five hours after onset, laminectomy of Th 4 through Th 11 and the evacuation of epidural hematoma were performed without identification of the origin of the bleeding. Neither vascular malformation nor tumor was recognized during operation. Neither was it noticed on histological examination. The patient made favorable progress after the surgery. During the first two weeks in the postoperative period, she regained muscle strength enough to do standing exercise, and satisfactory improvement was made in sensory function including urination and defecation. We emphasize that MRI is indispensable to make a differential diagnosis of thoracic lesions. In the reported case, a correct diagnosis was made with MRI, and an extremely good result was obtained by an emergency operation.     

自发性脊髓硬膜外血肿的MRI诊断及鉴别诊断

目的探讨自发性脊髓硬膜外血肿的MRI表现及鉴别诊断。方法11例自发性脊髓硬膜外血肿，男7例，女4例，年龄27～74岁，均无明确外伤史。常规行SET1WI、T2WI矢状位及T2WI轴位，部分病例行脂肪抑制扫描，6例注射Gd-DTPA后行增强扫描。结果11例自发性脊髓硬膜外血肿中，9例位于椎管内背侧脊髓后方，2例位于椎管内背外侧。病变范围覆盖4～5个锥体节段，颈段8例，胸段3例。血肿呈长条状及长梭形，5例血肿呈T1WI、T2WI高信号，4例血肿呈T1WI、T2WI等、低、高混杂信号，2例呈T1WI及T2WI等信号。增强扫描2例血肿壁强化，4例未见强化。结论MRI是脊髓硬膜外血肿最佳检查方法，能清楚显示血肿部位，范围，区分急慢性血肿，判定脊髓受压受损情况