Akut subdural hematom BT bulguları

Özet

Akut subdural hematom, çoğunlukla travmada köprü venlerinin gerilmesi veya kortikal damar yaralanmasıyla dura ile araknoid arasındaki potansiyel aralıkta kan birikmesidir. Kontrastsız BT'de kanın hiperdens hilal biçimi, komşu korteks üzerindeki etkisi ve eşlik eden parankim yaralanması birlikte incelenir. BT'de akut subdural kanama geniş bir hemisfer yüzeyine yayılabilir; bu nedenle çoklu kesitlerin ve koronal planların incelenmesi yayılımı değerlendirmede önemlidir. Tanının gecikmesi, progresif beyin ödeminin ve kitle etkisinin zamanında fark edilmemesine yol açabilir.

Faz ve pencere

Kontrastsız tanısal: Akut dönemde kan, komşu beyin dokusuna kıyasla hiperdens görünümlü, konveksiteye doğru çıkıntı yapan konkav iç sınırlı hilal şeklinde bir koleksiyon oluşturur; eşlik eden pıhtılaşma bozuklukları ise kanamanın hacmini ve klinik seyri belirleyici faktörlerdir. Akut travmada tanı ve ilk değerlendirme için kontrastsız BT yeterlidir; kitle efekti, orta hat kayması ve parankim yaralanmaları bu yöntemle saptanır.

Önerilen pencereler: Beyin (G 80 / M 40), Subdural (G 200 / M 75), Kemik (G 1800 / M 400).

BT bulguları

Akut subdural hematom dura ile beyin arasında yer alır ve örneğin frontoparietal bölgeyi kapsayacak şekilde genişleyebilir.
Subdural kanamalar interhemisferik fissürde ve tentoryumda lokalize olabilir; BT incelemelerinde koronal planlarda koleksiyonun uzanımı ve sınırları değerlendirilebilir.
Hematomun yarattığı kitle etkisi, komşu sulkusların basıya bağlı silikleşmesi, bazal sisternlerin daralması veya kaybolması ve beyin dokusunun komşu boşluklara doğru yer değiştirmesi ile ortaya çıkar.
Orta hat kayması, hemisferler arası yapıların (septum pellucidum gibi) yer değiştirmesidir ve şiddeti milimetre cinsinden ölçülerek değerlendirilir.
Hemisferik kitle etkisi, orta hat kaymasına ve bazal sisternlere bası yapmaya yol açarak artan intrakraniyal basınca neden olabilir.
Hematom komşuluğundaki kortikal kontüzyon, travmatik subaraknoid kan veya kemik kırığı eşlik eden diğer yaralanma örüntülerini belirler.

Normalde

Kontrastsız BT, ekstraaksiyel kanamaların varlığını, intraparenkimal veya subaraknoid kanamanın eşlik edip etmediğini ve diğer patolojik bulguları değerlendirmek için acil travma değerlendirmesinde ilk başvurulacak görüntüleme yöntemidir. Aynı seviyede iki hemisferin sulkus genişliğini, lateral ventrikül gövdelerinin biçimini ve septum pellucidumun orta hatta olup olmadığını kıyasla.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s0103; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Epidural hematom, akut travmada subdural hematomdan farklı olarak sıklıkla kemik kırıkları ve orta meningeal arter yaralanması ile ilişkili olarak lokalize kanamalar şeklinde ortaya çıkar.
Subaraknoid kanama, beyin yüzeyindeki sulkuslar ve fissürlerde kan birikimi ile karakterizedir ve akut subdural hematom ile birlikte görülebilir.
Hemorajik kontüzyon: gri-beyaz bileşke çevresinde parankim içi düzensiz kanama ve ödem vardır.
Subdural higroma: BOS'a yakın yoğunluklu, çoğu kez korteksin iç kenarını izleyen sıvı koleksiyonudur.

Tuzaklar

Subdural hematom, özellikle kafa tabanı yakınında diğer kanama türleri veya kemik kırıkları ile karışabilir; tanı için çoklu kesitlerin ve ilgili klinik bulguların birlikte değerlendirilmesi önemlidir.
Pıhtılaşma bozuklukları ve antikoagülan kullanım, akut subdural hematomun büyümesini ve cerrahi yönetimini etkileyerek kötü prognoz ile ilişkilendirilebilir.
Bilateral subdural hematomlar, özellikle spontane intrakraniyal hipotansiyon veya travma sonrası gelişebilir; her iki tarafta da kitle etkisi yaratarak nörolojik bozulmaya yol açabilir ve takibi zorlaşabilir.

Kendini dene

Olgu sunumunda 86 yaşındaki erkekte akut subdural hematom hangi bölgelerde bildirilmiştir?
Cevabı göster
İnterhemisferik ve tentorial bölgelerde. Kaynak, bu olguda interhemisferik ve tentorial subdural hematomlar bildirildiğini belirtiyor.
Kaynağa göre travmatik akut subdural hematom hızlı nörolojik kötüleşmeyle hangi bulgular nedeniyle ilişkili olabilir?
Cevabı göster
Kitle etkisi ve artmış intrakraniyal basınç. Kaynak, travmatik akut subdural hematomun kitle etkisi ve artmış intrakraniyal basınç nedeniyle hızlı nörolojik kötüleşmeyle ilişkili olabileceğini bildiriyor.

Bu konunun yer aldığı turlar

İlgili konular

Epidural hematom

Kaynaklar

Bu sayfadaki 31 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 14 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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