Seidel G, Kaps M, Dorndorf W
Department of Neurology, Justus-Liebig-Universität, Giessen, Germany.
Stroke. 1993 Oct;24(10):1519-27. doi: 10.1161/01.str.24.10.1519.
It is well established from pediatric experience and animal experiments that intracerebral blood can be demonstrated by B-mode real-time duplex scanning. This has recently become feasible in adults as well. The present study investigated the changes in the sonographic appearance of intracerebral hematomas over the course of time.
Starting in May 1991, 23 consecutive patients with intracerebral hematoma confirmed by computed tomography (21 spontaneous and 2 traumatic hematomas) were investigated within 1 year. They were monitored by repeated ultrasound scanning via the transtemporal approach. The sonographic appearance of the hematomas on B-mode scans and the angle-corrected blood flow velocity in the basal cerebral arteries were assessed.
There was unequivocal localization of the hematoma in 18 patients (78%). In 3 cases (13%), an adequate acoustic window could not be found. One small intracerebral hemorrhage was overlooked, and one extensive hemorrhage in the basal ganglia was misdiagnosed as a lobar hematoma. There was an alteration of the appearance of the hematoma with time. This was divided into three sonographic stages (initial stage, days 1 to 5; intermediate stage, days 6 to 10; and capsular stage, from day 10). In 14 of the 20 patients with an appropriate acoustic bony echo window, the blood flow velocity in the middle cerebral artery could be measured; in 1 of these patients, the signs of increasing intracranial pressure were apparent from Doppler frequency spectrum. In 5 patients, the intracerebral hematoma could be imaged but not the ipsilateral middle cerebral artery. One female patient showed cerebral circulatory arrest at the time of examination, which took place within 24 hours after the onset of clinical symptoms.
Most intracerebral hematomas in adults can be imaged in B-mode. Their sonographic appearance changes over the course of the disease. The advantages of this noninvasive method are its easy bedside operation and its suitability for follow-up; it is also less stressful than other imaging procedures. It yields a combination of structural and functional diagnostic information. In approximately 13% of the cases, the investigation was not feasible because of inadequate ultrasonic penetration of the intact skull.
儿科经验和动物实验已充分证实，B 型实时双功扫描可显示脑内血液情况。近来在成人中这也已成为可能。本研究调查了脑内血肿超声表现随时间的变化。
从1991年5月开始，对连续23例经计算机断层扫描确诊为脑内血肿的患者（21例自发性血肿和2例创伤性血肿）在1年内进行研究。通过经颞部途径进行反复超声扫描对其进行监测。评估B型扫描时血肿的超声表现以及大脑基底动脉的角度校正血流速度。
18例患者（78%）血肿定位明确。3例（13%）未找到合适的声窗。1例小脑出血被漏诊，1例基底节区广泛出血被误诊为脑叶血肿。血肿外观随时间改变。分为三个超声阶段（初期，第1至5天；中期，第6至10天；包膜期，从第10天开始）。在20例有合适骨回声声窗的患者中，14例可测量大脑中动脉的血流速度；其中1例患者，从多普勒频谱可明显看出颅内压升高的迹象。5例患者可对脑内血肿成像，但同侧大脑中动脉无法成像。1例女性患者在检查时出现脑循环停止，检查在临床症状出现后24小时内进行。
大多数成人脑内血肿可用B型成像。其超声表现在疾病过程中会发生变化。这种非侵入性方法的优点是床边操作简便且适合随访；与其他成像检查相比，压力也较小。它能提供结构和功能诊断信息的组合。在大约13%的病例中，由于完整颅骨超声穿透不足，检查不可行。
