Travmatik serebral ödem/şişme

Özet

Kafa travması sonrası gelişen fokal veya yaygın parankim şişmesi, erken BT’de yalnız kitle etkisiyle başlayabilir ve ilerleyen ödemle yoğunluk değişikliği belirginleşebilir. Kontrastsız BT, eşlik eden kanamayı ve beyin dokusunun sulkus, ventrikül ve sisternlere yaptığı basıyı hızlıca gösterir. Sulkusların ve bazal sisternlerin kaybı, ventrikül basısı veya gri-beyaz cevher ayrımının silinmesi kafa içi basınç artışını düşündürür. Bu değişiklikler gözden kaçarsa hızla ilerleyen herniasyon ve beyin sapı basısı fark edilmeyebilir.

Faz ve pencere

Kontrastsız tanısal

Şişmiş parankimde sulkuslar daralır, ventriküller basılanır ve bazal sisternler silinebilir; erken şişmede gri-beyaz ayrım korunabilir, sitotoksik ödemde ayrım azalır ve ödemli alan hipodensleşebilir.

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

BT bulguları

• Konveksite sulkuslarında iki taraflı yaygın daralma veya silinme
• Suprasellar, ambient veya prepontin sisternlerde kitle etkisine bağlı daralma
• Lateral ventrikül gövdeleri ve temporal hornlarda basılanma
• Korteks ile komşu beyaz cevher arasındaki dansite farkının silinmesi
• Fokal kontüzyon çevresinde bölgesel ödem ve lokal sulkal effasman
• Tek taraflı kitle etkisi varsa septum pellucidumun karşı tarafa itilmesi
• İleri olguda tentoryal veya foramen magnum düzeyine uzanan doku yer değiştirmesi

Normalde

Her anatomik düzeyde normal BT ile karşı tarafı kıyaslayın: konveksitede kortikal sulkuslar seçilir, lateral ventriküller benzer genişliktedir ve gri-beyaz sınır nettir. Daha alt kesitlerde bazal sisternler BOS dansitesindeki açıklığını korur.

Ayırıcı tanı

Yaygın hipoksik-iskemik hasar

global hipoperfüzyona bağlı olarak korteks ve derin gri çekirdeklerde gri-beyaz dansite oranında azalma ile gri-beyaz ayrım kaybı belirgin olabilir.

Beyin hiperemisi

travmatik beyin hasarında etkilenen bölgelerde artmış perfüzyon görülebilir.

Fokal kontüzyon

yüzeyel, çoğu kez hemorajik odak ve çevresinde sınırlı ödem oluşturur

Obstrüktif hidrosefali

ventriküller basılanmak yerine genişler; temporal hornlar ve periventriküler hipodensite eşlik edebilir

Tuzaklar

• Erken travmatik şişmede gri-beyaz ayrımın korunması ödemi dışlamaz; sulkus, ventrikül ve sistern basısını birlikte ara.
• Orta hat kaymasının belirgin olmaması yaygın beyin şişmesini tek başına dışlamaz; sulkal effasman, ventrikül basısı ve gri-beyaz cevher ayrımının kaybı da ödemle ilişkili BT bulgularıdır.

Kendini dene

1. Travma sonrası iki hemisferde sulkuslar silik ve ventriküller basılı; gri-beyaz sınır hâlâ seçiliyor. En uygun yorum nedir?

   • Erken yaygın beyin şişmesi
   • Obstrüktif hidrosefali
   • Akut subdural hematom
   • Travmatik subaraknoid kanama
   Cevabı göster

   Erken yaygın beyin şişmesi. Yaygın sulkal ve ventriküler bası şişmeyi gösterir; erken evrede gri-beyaz ayrım korunabilir. Hidrosefalide ventriküller genişler; kanama tanıları için ekstraaksiyel veya sulkal hiperdens kan beklenir.

2. Yaygın sulkal silinmeye ek olarak korteks ile beyaz cevher sınırları seçilemiyor. Hangi değişiklik belirginleşmiştir?

   • Sitotoksik ödem
   • Kronik subdural koleksiyon
   • Vazojenik kalsifikasyon
   • Normal yaşa bağlı atrofi
   Cevabı göster

   Sitotoksik ödem. Gri-beyaz ayrımın silinmesi sitotoksik ödem/iskemik hücresel şişmeyle uyumludur. Atrofide sulkuslar ve ventriküller genişler; subdural koleksiyon ekstraaksiyel yerleşimlidir.

Bu konunun yer aldığı turlar

• Kafa travması ve intrakraniyal kanama

İlgili konular

• Perihematomal ödem
• Santral aşağı transtentorial herniasyon

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 4 cümle bu karşılaştırmada düzeltildi (2026-10-08).

1. Computed tomography signs of intracranial hypertension: what intensivists should knowpmc.ncbi.nlm.nih.gov
2. Case Report: Debridement with vacuum sealing drainage for conservative management of post-cranioplasty surgical site infectionpmc.ncbi.nlm.nih.gov
3. Possible delayed neuronal death after seemingly successful evacuation of traumatic acute subdural hematoma: Image reportpmc.ncbi.nlm.nih.gov
4. Serial Changes in CSF Volume Proportion on Brain CT and 6-Month Neurologic Outcomes After Cardiac Arrest: A 72–96-h Landmark Cohort Studypmc.ncbi.nlm.nih.gov
5. Successful endoscopic evacuation of traumatic intracerebral hemorrhage: A report of two casespmc.ncbi.nlm.nih.gov
6. Intraparenchymal Meningioma.pubmed.ncbi.nlm.nih.gov
7. Nonaccidental head injury.pubmed.ncbi.nlm.nih.gov
8. Imaging in Neurocritical Care Practice.pubmed.ncbi.nlm.nih.gov
9. Pathophysiology and treatment of cerebral edema in traumatic brain injury.pubmed.ncbi.nlm.nih.gov
10. Cytotoxic Edema Associated with Hemorrhage Predicts Poor Outcome after Traumatic Brain Injury.pubmed.ncbi.nlm.nih.gov
11. Cerebral Venous Sinus Thrombosis in an Immunocompetent HIV Patient.pubmed.ncbi.nlm.nih.gov
12. Essential Topics About the Imaging Diagnosis and Treatment of Hemorrhagic Stroke: A Comprehensive Review of the 2022 AHA Guidelines.pubmed.ncbi.nlm.nih.gov
13. Structural Neuroimaging Findings in Mild Traumatic Brain Injury.pubmed.ncbi.nlm.nih.gov
14. Intensive management and prognosis of 127 cases with traumatic bilateral frontal contusions.pubmed.ncbi.nlm.nih.gov
15. Decompressive craniectomy in the treatment of post-traumatic intracranial hypertension in children: our philosophy and indications.pubmed.ncbi.nlm.nih.gov
16. Traumatic brain injury in infants and toddlers, 0-3 years old.pubmed.ncbi.nlm.nih.gov
17. Establishment and validation of prognosis model for patients with cerebral contusion.pubmed.ncbi.nlm.nih.gov
18. Risk factors predicting prognosis and outcome of elderly patients with isolated traumatic brain injury.pubmed.ncbi.nlm.nih.gov
19. Conservative management of presumed low-grade gliomas in the asymptomatic pediatric population.pubmed.ncbi.nlm.nih.gov
20. Post-traumatic hydrocephalus in adults: the mechanisms of development, predictors of progression and management strategies. A narrative review and case series analysis.pubmed.ncbi.nlm.nih.gov
21. Intracranial venous thrombosis imaging by anatomical location: an educational review with mimics and diagnostic pitfalls.pubmed.ncbi.nlm.nih.gov
22. Cerebral Hemodynamics in Pediatric Abusive Head Trauma: 3 Severe Cases with Preserved Motor Cortex, Hyperperfusion, and Recovery of Mild Paralysis.pubmed.ncbi.nlm.nih.gov
23. Imaging for the diagnosis and management of traumatic brain injury.pubmed.ncbi.nlm.nih.gov
24. Comparative Study of Antemortem Computed Tomography (CT) Findings With Autopsy Findings in Head Injury Cases.pubmed.ncbi.nlm.nih.gov
25. From Cervical Trauma and Head Injury to Malignant Cerebral Edema: Blunt Cerebrovascular Injury Causing Large-Vessel Occlusion Treated With Thrombectomy and Neurocritical Care.pubmed.ncbi.nlm.nih.gov
26. In-hospital unexpected cerebral herniation-New neurosurgical quality control standards: A case report.pubmed.ncbi.nlm.nih.gov
27. Neonatal herpes simplex virus encephalitis: a single-center retrospective study of 14 cases.pubmed.ncbi.nlm.nih.gov
28. Pathophysiology-driven neuroimaging: decoding brain injury in sepsis.pubmed.ncbi.nlm.nih.gov
29. Choking leading to cardiac arrest and subsequent atypical radiological features of brain damage: A case report.pubmed.ncbi.nlm.nih.gov
30. Bilateral Subdural Hygromas Following Rupture of a Temporal Arachnoid Cyst in a 16-Year-Old Boy: A Case Report.pubmed.ncbi.nlm.nih.gov
31. Chronic Subdural Hematoma: Pathophysiology, Diagnosis, and the Emerging Role of Middle Meningeal Artery Embolization.pubmed.ncbi.nlm.nih.gov
32. The laminar subarachnoid hemorrhage of infant venous stroke: Evidence of a 4^th meningeal layer?pubmed.ncbi.nlm.nih.gov
33. Endoscopic transclival decompression for ventral brainstem tuberculous abscess: illustrative case.pubmed.ncbi.nlm.nih.gov
34. Leptomeninges: Anatomy, Mechanisms of Disease and Neuroimaging.pubmed.ncbi.nlm.nih.gov
35. Unilateral Hearing Loss as the Sole Presentation of Extensive Intracranial Epidermoid Cyst: A Case Report.pubmed.ncbi.nlm.nih.gov
36. Rapid spontaneous regression of a massive post-thrombolysis intracerebral hemorrhage: A case report.pubmed.ncbi.nlm.nih.gov
37. Delayed Expanding Intracerebral Pneumatocele Following Severe Craniofacial Trauma: A Case Report With Serial Imaging Correlation.pubmed.ncbi.nlm.nih.gov
38. Navigating the challenges of lateral ventricle epidermoid cysts: Diagnostic insights and surgical strategies. patient series.pubmed.ncbi.nlm.nih.gov
39. Posterior Reversible Encephalopathy Syndrome Following Massive Blood Transfusion in a Case of Pelvic Schwannoma.pubmed.ncbi.nlm.nih.gov
40. Time-specific comparison of gray-white matter ratio models for predicting outcomes after cardiac arrest: basal ganglia as the leading model.pubmed.ncbi.nlm.nih.gov
41. Possible delayed neuronal death after seemingly successful evacuation of traumatic acute subdural hematoma: Image report.pubmed.ncbi.nlm.nih.gov
42. Brain Shift Patterns: Upward, Lateral and Downward Herniation, Its Correlation with Clinical Patterns in Acute Intracranial Pathologies and Neurosurgical Management.pubmed.ncbi.nlm.nih.gov
43. A dynamic nomogram for predicting primary intraoperative brain bulge in patients with traumatic acute subdural hematoma.pubmed.ncbi.nlm.nih.gov
44. Pupillomotor Dysfunction and Outcomes After Decompressive Craniectomy in Pediatric Patients.pubmed.ncbi.nlm.nih.gov
45. Brain Herniationpubmed.ncbi.nlm.nih.gov
46. Case Report: Imaging and pathological features of compartmentalized subdural empyema and pachymeningitis within pre-existing porencephaly in a dog.pubmed.ncbi.nlm.nih.gov
47. Uncal Herniationpubmed.ncbi.nlm.nih.gov
48. Parasagittal subdural space: a novel quantitative marker of spontaneous intracranial hypotension syndrome-induced chronic subdural hematoma.pubmed.ncbi.nlm.nih.gov
49. Branch-Critical Clipping of a Ruptured Carotid-Posterior Communicating Aneurysm with Fetal PCA Configuration.pubmed.ncbi.nlm.nih.gov
50. Anatomically Precise Microsurgical Resection of a Posterior Fossa Cerebellar Metastasis in an Elderly Patient with Preservation of Venous Outflow, Dentate Nucleus, and Cerebrospinal Fluid Pathways.pubmed.ncbi.nlm.nih.gov
51. Venous-significant intracranial hemorrhage in neonatal HIE treated with therapeutic hypothermia: imaging phenotypes, diagnostic pitfalls, and prognostic implications.pubmed.ncbi.nlm.nih.gov
52. Clinical Reasoning: A 66-Year-Old Female Patient With Rapidly Progressive Memory Changes.pubmed.ncbi.nlm.nih.gov
53. Neuroimaging Findings in Children and Young Adults With Neurotoxicity After CAR T-Cell Therapy for B-Cell Malignancies.pubmed.ncbi.nlm.nih.gov
54. Neuromonitoring after Pediatric Cardiac Arrest: Cerebral Physiology and Injury Stratification.pubmed.ncbi.nlm.nih.gov
55. Imaging Guidance for Therapeutic Delivery: The Dawn of Neuroenergetics.pubmed.ncbi.nlm.nih.gov
56. Telemetric intracranial pressure monitoring in patients with hydrocephalus: a systematic literature review.pubmed.ncbi.nlm.nih.gov
57. A Sub-acute Cerebral Contusion Presenting with Medication-resistant Psychosis.pubmed.ncbi.nlm.nih.gov
58. Neuroimaging in epilepsy.pubmed.ncbi.nlm.nih.gov
59. PITCH (pediatric infratentorial tumors - hydrocephalus-related complications) registry study design: observational, prospective, multicenter study evaluating the number of surgeries associated with the treatment of hydrocephalus secondary to infratentorial tumors in childhood and adolescence.pubmed.ncbi.nlm.nih.gov
60. Hydrocephalus: Molecular and Neuroimaging Biomarkers in Diagnosis and Management.pubmed.ncbi.nlm.nih.gov
61. Portable Bedside Low-Field MRI for Assessment of Ventricular Size.pubmed.ncbi.nlm.nih.gov
62. Massive brain swelling after cranioplasty in the setting of severe sunken flap syndrome: illustrative case.pubmed.ncbi.nlm.nih.gov
63. Fulminant cerebral edema in the setting of acute dengue fever after mechanical thrombectomy in a patient with massive stroke and severe hypoalbuminemia: a case report.pubmed.ncbi.nlm.nih.gov
64. Case Report: Stepwise quantitative assessment of intraoperative intracranial pressure after perforation, craniotomy, dural incision, and hematoma removal in acute subdural hematoma.pubmed.ncbi.nlm.nih.gov
65. Ruptured Vertebral-Anterior Spinal Artery Junction Aneurysm Presenting With Diffuse Subarachnoid Hemorrhage: Diagnostic Limitations of CT Angiography (CTA) and the Role of Digital Subtraction Angiography (DSA) in Management-Related Decision-Making.pubmed.ncbi.nlm.nih.gov
66. Taking the EEG Back Into the Brain: The Power of Multiple Discrete Sources.pubmed.ncbi.nlm.nih.gov
67. Cranial ultrasound for beginners.pubmed.ncbi.nlm.nih.gov
68. Bilateral lesions of the basal ganglia and thalami (central grey matter)-pictorial review.pubmed.ncbi.nlm.nih.gov
69. An ABC for decision making.pubmed.ncbi.nlm.nih.gov
70. Magnetic resonance imaging in central nervous system tuberculosis.pubmed.ncbi.nlm.nih.gov
71. Impact of lumbar cerebrospinal fluid drainage to control intracranial hypertension in patients with severe traumatic brain injury: a retrospective monocentric cohort.pubmed.ncbi.nlm.nih.gov
72. Traumatic Brain Injury With Concomitant Myocardial Infarction: A Clinical Dilemma.pubmed.ncbi.nlm.nih.gov
73. Computational Approaches for Acute Traumatic Brain Injury Image Recognition.pubmed.ncbi.nlm.nih.gov
74. Anatomy-Guided Microsurgical Resection of a Dominant Frontal Lobe Tumor Without Intraoperative Adjuncts: A Case Report from a Resource-Limited Context.pubmed.ncbi.nlm.nih.gov
75. A Case of Acute Hemorrhagic Necrotizing Encephalitis in the Neonatal Period: Case Report with Autopsy Findings.pubmed.ncbi.nlm.nih.gov
76. Alternating Hemispheric Episodes in Bilateral Rasmussen Encephalitis: The Crucial Role of Sequential Multimodal Neuroimaging.pubmed.ncbi.nlm.nih.gov
77. Magnetic Resonance Imaging of the Neonatal Brain: Modalities, Scoring Systems, and Clinical Applications.pubmed.ncbi.nlm.nih.gov
78. Mechanisms of inflammatory response in secondary brain injury: a review of computational approaches, challenges, and future directions.pubmed.ncbi.nlm.nih.gov
79. Role of neuroimaging in multidisciplinary approach towards Non-Alzheimer's dementia.pubmed.ncbi.nlm.nih.gov
80. Case Report: Debridement with vacuum sealing drainage for conservative management of post-cranioplasty surgical site infection.pubmed.ncbi.nlm.nih.gov
81. Posterior fossa dynamic craniotomy utilizing NuCrani reversibly expandable bone flap fixation plates: patient series.pubmed.ncbi.nlm.nih.gov
82. Imaging Evaluation of Acute Traumatic Brain Injury.pubmed.ncbi.nlm.nih.gov
83. Posterior Reversible Encephalopathy Syndrome Associated With Post-Streptococcal Glomerulonephritis in a Young Adult: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
84. Imaging the efficacy and side effects of CAR T-cell therapy in children and young adults.pubmed.ncbi.nlm.nih.gov
85. Bilateral temporal lobe disease: looking beyond herpes encephalitis.pubmed.ncbi.nlm.nih.gov
86. Use of perfusion imaging and other imaging techniques to assess risks/benefits of acute stroke interventions.pubmed.ncbi.nlm.nih.gov
87. Systematic review of commercial artificial intelligence tools for the detection and volume quantification in intracerebral hemorrhage.pubmed.ncbi.nlm.nih.gov
88. Characteristics of brain computed tomography in dementia with cardiovascular disease and psychological and behavioral symptoms.pubmed.ncbi.nlm.nih.gov
89. Comparative CT Ventricular Morphometrics in Hydrocephalus, Stroke, and Traumatic Brain Injury: A Distortion-Controlled Analysis.pubmed.ncbi.nlm.nih.gov
90. Alzheimer's disease and related dementia: evaluation, diagnosis and acute care management.pubmed.ncbi.nlm.nih.gov
91. The spectrum of neurological derangement due to fat embolism: a case series.pubmed.ncbi.nlm.nih.gov
92. Malignant Posterior Reversible Encephalopathy Syndrome (PRES) After Allogeneic Hematopoietic Stem Cell Transplantation Requiring Emergency Decompressive Craniectomy: A Case Report.pubmed.ncbi.nlm.nih.gov
93. Multifocal intracranial hemorrhage on emergency brain CT in a child with end-stage nephrotic syndrome.pubmed.ncbi.nlm.nih.gov
94. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care.pubmed.ncbi.nlm.nih.gov
95. Lumbar Puncture and Brain Herniation in Acute Bacterial Meningitis: An Updated Narrative Review.pubmed.ncbi.nlm.nih.gov
96. AI assisted reader evaluation in acute CT head interpretation (AI-REACT): protocol for a multireader multicase study.pubmed.ncbi.nlm.nih.gov
97. Radiological predictors of shunt response in the diagnosis and treatment of idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis.pubmed.ncbi.nlm.nih.gov
98. Ophthalmologic assessment and intracranial pressure in children: diagnostic methods, clinical correlations, and future directions.pubmed.ncbi.nlm.nih.gov
99. Paediatric cranial ultrasound: abnormalities of the brain in term neonates and young infants.pubmed.ncbi.nlm.nih.gov
100. Albuminocytologic Dissociation and Intravenous Immunoglobulin Therapy in Parsonage-Turner Syndrome With Bilateral Involvement: A Case Report.pubmed.ncbi.nlm.nih.gov
101. Hyperbaric Oxygen Therapy for Cognitive Impairment Resulting from Neurological Disorders: Mechanisms of Action and Application Advances.pubmed.ncbi.nlm.nih.gov
102. From oxidative stress to epigenetic regulation: Molecular mechanisms of preterm brain injury and neuroprotective strategies (Review).pubmed.ncbi.nlm.nih.gov

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