Ono J, Yamaura A, Horie T, Makino H, Nakamura T, Isobe K, Shinohara Y, Watanabe Y, Ariga N
No Shinkei Geka. 1983 Apr;11(4):379-87.
CT scan demonstrates the invaluable information about the parenchymal lesions of head injuries. The parenchymal lesions were classified into 6 categories; 1) isodensity without mass effect: I(-), 2) isodensity with mass effect: I(+), 3)high density: H, 4) high-low density complex: H-L, 5) low density: L, 6) diffuse cerebral swelling: DCS. Glasgow coma scale (GCS) and outcome scale (GOS) were international practical scales for the evaluation of severity and prognosis of severe head injuries. One hundred and seventy-four cases with severe head injury were analysed. I(+), H and H-L were common findings in the group of GCS 3-6, and I(-) was in GCS 7-12 and GCS 13-15. H and H-L were not related with GCS. DCS was most common in GCS 7-12. Acute epidural hematoma was frequent in the group of GCS 13-15, and acute subdural hematoma was in GCS 3-6. The prognosis was significantly poor in the group of GCS 3-6, with the mortality of 72 percents. On the other hand, the prognosis was quite good in GCS 7-12 and GCS 13-15. There were few reports about the traumatic subarachnoid hemorrhage (SAH). SAH was one of the important risk factors in severe head injuries and it was frequently associated with I(+), H and H-L. The prognosis of the patients with SAH was most unfavorable in the presence of I(+). Number of analyses were reported about the traumatic intraventricular hemorrhage (IVH). IVH was also one of the powerful risk factors and this was commonly associated with H and H-L. The prognosis of the patients with IVH was very poor. Finally, the groups of the patients, whose prognoses turned out to be unexpected results from GCS on admission, were analysed. First, the age was an important factor. In the patients, whose prognoses were good in spite of low GCS, I(-) was a mostly common finding, while SAH, IVH and obscured cisterns, esp. basal and quadrigeminal, were less common. In the patients, whose prognoses were poor despite of favorable GCS, H and H-L were common findings. SAH and IVH were also common. The poor prognosis was induced by secondary systemic complications, such as pneumonia and meningitis, etc.
CT扫描能显示有关头部损伤实质病变的重要信息。实质病变分为6类：1）等密度且无占位效应：I（-）；2）等密度且有占位效应：I（+）；3）高密度：H；4）高低密度混合：H-L；5）低密度：L；6）弥漫性脑肿胀：DCS。格拉斯哥昏迷量表（GCS）和结局量表（GOS）是评估重型颅脑损伤严重程度和预后的国际通用量表。对174例重型颅脑损伤患者进行了分析。I（+）、H和H-L在GCS 3 - 6组中是常见表现，I（-）在GCS 7 - 12组和GCS 13 - 15组中出现。H和H-L与GCS无关。DCS在GCS 7 - 12组中最为常见。急性硬膜外血肿在GCS 13 - 15组中较为常见，急性硬膜下血肿在GCS 3 - 6组中出现。GCS 3 - 6组的预后明显较差，死亡率为72%。另一方面，GCS 7 - 12组和GCS 13 - 15组的预后相当好。关于创伤性蛛网膜下腔出血（SAH）的报道较少。SAH是重型颅脑损伤的重要危险因素之一，且常与I（+）、H和H-L相关。SAH患者在出现I（+）时预后最不利。关于创伤性脑室内出血（IVH）有多项分析报道。IVH也是一个重要危险因素，且常与H和H-L相关。IVH患者的预后非常差。最后，对那些预后与入院时GCS结果不符的患者组进行了分析。首先，年龄是一个重要因素。在那些尽管GCS较低但预后良好的患者中，I（-）是最常见的表现，而SAH、IVH和脑池模糊，尤其是基底池和四叠体池模糊则较少见。在那些尽管GCS良好但预后较差的患者中，H和H-L是常见表现。SAH和IVH也很常见。预后不良是由继发性全身并发症引起的，如肺炎和脑膜炎等。
