Kronik subdural hematom

Özet

Kronik subdural hematom, sıklıkla hafif travmayı izleyen süreçte subdural boşlukta organize olan ve yaşlılarda sinsi nörolojik yakınmalarla ortaya çıkabilen koleksiyondur. Kontrastsız BT koleksiyonun dağılımını, kan ürünlerinin göreli yoğunluğunu, membran-septasyon görünümünü ve beyin üzerindeki basıyı gösterir. Düşük yoğunluklu görünüm higromayla karışabilir; septalı veya bölmeli yapı tek bir homojen sıvı tabakası gibi değerlendirilmemelidir. Yaşlılarda serebral atrofi eşliğinde subdural boşluğun genişlemesi, intrakranial basınçta belirgin artış olmadan koleksiyonun kademeli büyümesine ve nörolojik belirtilerin yavaş gelişmesine yol açabilir.

Faz ve pencere

Kontrastsız tanısal

Kronik koleksiyon sıklıkla BOS'a yakın hipodens veya kortekse izodens hilal görünümündedir; heterojen pıhtı artıkları, laminer kenar, membran ya da septalar seçilebilir. Tanısal başlangıç incelemesi kontrastsızdır; rutin kontrastlı faz gerekmez.

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

BT bulguları

• Konveksite boyunca uzanan hipodens yarımay, komşu frontal veya parietal korteksin konturunu izler.
• Koleksiyonun korteksle izodens olduğu kesimlerde sulkus daralması veya gri-beyaz sınırın içe taşınması yerini belli edebilir.
• İç kenardaki ince hiperdens lamina, organize hematom ile korteks arasındaki membran yüzeyini işaret edebilir.
• İnce bölmeler veya lokülasyonlar tek boşluklu sıvı görünümünü bozar; kompartımanlar farklı dansitede olabilir.
• Karma yoğunluk, yeniden kanama olasılığı dahil farklı bileşimde kan ürünlerini düşündürür; yalnız BT yoğunluğu kesin yaş tayini sağlamaz.
• Beyaz cevherin içe itilmesi, ipsilateral ventrikül basısı ve orta hat yapılarının ötelenmesi koleksiyonun kitle etkisini gösterir.

Ölçütler ve sınıflamalar

Nakaguchi iç mimari (BT örüntüsü) sınıflaması

Kronik subdural hematom BT’de homojen veya ayrışmış iç mimari örüntüler gösterebilir. Bu örüntüler kanamanın kesin yaşını tek başına belirlemez.

Normalde

Normal frontoparietal konveksitede beyin yüzeyiyle kafatası arasında BOS yoğunluğunda geniş bir hilal ve iç membran çizgisi izlenmez; kortikal sulkuslar açık kalır. Aynı seviyedeki iki hemisferde sulkus genişliğini, gri-beyaz sınırın kalvaryuma uzaklığını ve lateral ventrikül biçimini karşılaştırarak kronik koleksiyonun oluşturduğu asimetrik basıyı bul.

Ayırıcı tanı

Subdural higroma

bazı araştırmacılar kronik subdural hematomun subdural higromayı izleyebileceğini öne sürmüştür.

İzodens subakut subdural hematom

bilateral izodens kronik subdural hematomun tanısında MRI, BT’den daha duyarlı olabilir.

Epidural hematom

interdural hematomlar epidural hematom olarak yanlış sınıflandırılabilir.

Subdural ampiyem

dura ile araknoid arasında pürülan materyal birikimiyle seyreden intrakraniyal bir enfeksiyondur.

Tuzaklar

• Kronik subdural hematom BT’de çoğunlukla hilal biçimli hipodens koleksiyon olarak görülür; zamanla yeniden kanama veya membran aktivitesine bağlı heterojenleşebilir ve septasyonlar ya da neovasküler membranlar izlenebilir.
• Kronik subdural hematomda iç septasyonlar ve lokülasyonlar görülebilir; koleksiyonun iç mimarisini değerlendir.
• Karışık yoğunluk mutlaka yeni kanamanın zamanını kanıtlamaz; yoğunluk örüntüsünü klinik zaman çizelgesi olmadan kesin tarihleme için kullanma.

Kendini dene

1. Yavaş ilerleyen yürüme bozukluğu olan hastada BT’de hilal biçimli, heterojen bir subdural koleksiyon görülüyor; koleksiyonda membran ve septalar da mevcut. En olası tanı nedir?

   • Kronik subdural hematom
   • Subdural higroma
   • İzodens akut kanama
   • Epidural hematom
   Cevabı göster

   Kronik subdural hematom. Kronik subdural hematom BT’de hilal biçimli hipodens koleksiyon olarak görülebilir; septasyonlar ve neovasküler membranlar da izlenebilir.

2. Kronik subdural hematom BT’de en sık nasıl görünür?

   • Hilal biçimli, hipoatenüe koleksiyon
   • Merkezinde kalsifikasyon bulunan yuvarlak kitle
   • Beyin parankiminde halka şeklinde kontrastlanan lezyon
   • Sütürlerle sınırlı lentiform koleksiyon
   Cevabı göster

   Hilal biçimli, hipoatenüe koleksiyon. Kaynak, kronik subdural hematomun BT’de en sık hilal biçimli ve hipoatenüe koleksiyon olarak görüldüğünü; zamanla heterojenleşebileceğini bildiriyor.

İlgili konular

• Akut subdural hematom

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 8 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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