İzole travmatik sulkal kanama BT bulguları

Özet

Kafa travmasından sonra küçük miktarda subaraknoid kanama, başka intrakraniyal kanama odağı olmadan kortikal konveksite sulkuslarında izlenebilir. Kontrastsız BT, travmatik subaraknoid kanamanın sık görüldüğü orta-ağır beyin travmasında akut intrakraniyal patolojileri tespit etmek için altın standarttır ve hiperdensiteler kanamayı işaret eder. Tek başına küçük kanama bile travmatik beyin hasarının bir bulgusudur ve ilk BT'de ince olabilir. Bazal sistern kanamasını veya kontüzyonla ilişkili kanı gözden kaçırmak, kanama örüntüsünü ve travma yükünü yanlış sınıflandırabilir.

Okuma sırası

Frontal kortikal sulkuslar. Konveksiteye yakın kesitte frontal girusların arasındaki koyu BOS yarıklarını bulun ve iki hemisferde benzer derinlikteki sulkusları gözle eşleyin.
Kan içeren konveksite sulkusu. Sulkus lümeni içinde çevre korteksten daha parlak ince çizginin ardışık kesitlerde sürüp sürmediğini izleyin.
Kanama altındaki korteks. Kan çizgisinin hemen altındaki girus dokusunda yama tarzı yoğunluk artışı veya şişme olup olmadığını ayırt edin.
Bazal sisternler ve ventriküller. Aynı BT'nin daha alt kesitlerinde suprasellar ve interpedinküler sisternlere, Sylvian fissüre ve ventrikül içlerine göz gezdirerek yüzeyel odağın gerçekten izole kaldığını sınayın.
Kalvaryum ve komşu ekstraaksiyel alan. Kemik penceresinde yakın kalvaryumda kırık arayın; komşu ekstraaksiyel koleksiyon veya ikinci kontüzyon varsa izole tanımını yeniden düşünün.

Faz ve pencere

Kontrastsız tanısal: Akut kan, frontal veya parietal konveksitenin kortikal sulkuslarında BOS'tan daha yüksek atenüasyonlu ince çizgi ya da küçük odak olarak görünür. İzole patern için kan yüzeyel sulkuslarla sınırlı olmalı; bazal sisternlerde, ventriküllerde veya komşu parankimde ayrı kan odağı bulunmaması aranır. Kontrast gerekmez.

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

BT bulguları

Sulkal hiperdensite — konveksite girusunda bir veya birkaç sulkus boyunca BOS boşluğunu dolduran ince akut kan çizgisi.
Yüzeyel konveksite dağılımı — frontal veya parietal kortikal sulkuslarda sınırlı kan; bazal sistern yoğunluğu eşlik etmez.
Kontüzyon eşlik etmemesi — sulkus kanının hemen altında parankim içi odak, çevresel ödem veya doku ezilmesi görülmez.
Ekstraaksiyel koleksiyon eşlik etmemesi — aynı düzeyde konkav lentiform epidural ya da hilal biçimli subdural kan birikimi bulunmaz.
Kafa kemiği yaralanması — ince kemik penceresinde doğrusal kırık görülebilir; varlığı travmatik kaynağı destekler fakat olmaması yüzeyel kanamayı dışlamaz.
Kanama yayılımı — Sylvian fissür, interhemisferik fissür ve bazal sisternler boyunca uzanım olup olmadığı anevrizmal patern ayrımına yardım eder.
Kitle etkisinin yokluğu — küçük izole sulkal kanamada komşu giruslarda belirgin bası veya ventrikül deformasyonu beklenmez.

Normalde

Yüksek konveksite kesitlerinde frontal ve parietal sulkuslar ince, simetrik, BOS dansitesinde aralıklar olarak izlenir; içlerinde parlak çizgisel materyal bulunmaz. Sağ ve sol konveksite sulkuslarını ve komşu girusların gri-beyaz ayrımını karşılaştırın; Sylvian fissür ile bazal sisternlerin açıklığını daha alt kesitlerde değerlendirin.

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

Anevrizmal subaraknoid kanama: bazal sistern, suprasellar alan veya Sylvian fissürlerde yoğun kan görülebilir; kanama tek bir yüzeyel konveksite sulkusuyla sınırlı olmayabilir.
Kortikal venöz tromboza bağlı sulkal kanama: sulkal kanla birlikte sinüs/kortikal ven hiperdensitesi veya arter dışı ödemli parankim bulunabilir.
Reversibl serebral vazokonstriksiyon sendromu: konveksite subaraknoid kanaması yapabilir; travma öyküsü tek başına açıklayıcı olmayabilir ve arteriyel görüntülemede segmental daralmalar araştırılır.
Amiloid ilişkili konveksite kanaması: özellikle ileri yaşta tekrarlayan yüzeyel kanama odakları görülebilir; kafa travması ve akut kırık-kontüzyon bulguları yokluğu ayırıcıdır.
Hemokonsantrasyon veya yalancı sulkal hiperdensite: yaygın yüksek kan dansitesi ve beyin ödemi sulkusları olduğundan parlak gösterebilir; sulkus içinde net lokal kan çizgisi ve çevre anatomiyi doğrula.

Tuzaklar

Tek bir ince hiperdens sulkus çizgisi hareket, parsiyel hacim veya kalın kesit etkisi olabilir; komşu kesitlerde devamlılığını ve koronal rekonstrüksiyonu kontrol et.
Konveksite kanamasını otomatik olarak travmaya bağlama; bazal sistern/Sylvian dağılımı, damar bulguları ve klinik zamanlamayla spontan nedenleri ayır.
Sadece belirgin kontüzyona odaklanıp küçük sulkal kanı kaçırma; konveksite sulkusları ile interhemisferik fissürü kesit kesit izle.
Travmatik subaraknoid kanama sıklıkla diğer intrakraniyal lezyonlarla birlikte görülür; aynı incelemede intrakraniyal kanama veya parankim kontüzyonunun eşlik etme ihtimali değerlendirilmelidir.

Kendini dene

Düşme sonrası BT'de yalnızca frontal konveksite sulkusunda ince kan var; bazal sisternler açık. En olası tanı hangisidir?
Cevabı göster
Travmatik sulkal kanama. Travma sonrası yüzeyel sulkusla sınırlı kan, başka odak olmadan izole travmatik sulkal kanama paternidir. Anevrizmal kanama daha çok sisternal/Sylvian dağılım gösterir; venöz tromboz damar dolum kusuru aratır; subdural kan beyin yüzeyinde ekstraaksiyel hilal oluşturur.
Konveksite sulkusunda kanla birlikte parasagittal ödem ve yoğun kortikal ven görülüyor. En olası alternatif nedir?
Cevabı göster
Kortikal ven trombozu. Yoğun ven ve arter sınırlarını aşan ödem venöz çıkış tıkanıklığına işaret eder. Epidural hematom kemik ile dura arasında; putaminal kanama derin parankimde bulunur; hidrosefali ventrikül genişlemesi yapar.

İlgili konular

Kaynaklar

Bu sayfadaki 39 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 2 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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