Subdural hematom ve koleksiyonlar

Özet

Subdural hematom, çocukta travma sonrası, doğum çevresinde veya nadir diğer nedenlerle, dura ile araknoid arasındaki potansiyel boşlukta oluşan bir kanama koleksiyonudur. Kontrastsız BT akut kanı ve eşlik eden kitle etkisini hızla gösterir; küçük, izodens ya da BOS'la karışmış koleksiyonlar belirsiz kalabilir. Konveksiteye ek olarak falx, tentoryum ve posterior fossanın taranması gerekir. İnce koleksiyonun veya kitle etkisi ile herniasyon bulgularının gözden kaçırılması, klinik kötüleşme riskini olduğundan düşük gösterebilir; yoğunluktan (densiteden) tek başına travmanın zamanını belirlemek mümkün değildir.

Faz ve pencere

Kontrastsız tanısal

Akut kan çoğunlukla iç kalvaryuma yaslanan hilal biçimli yüksek atenüasyonlu tabaka oluşturur; kronik sıvı daha düşük dansiteli olabilir, ancak anemi, BOS karışımı ve yeniden kanama yoğunluğu değiştirebilir. Kontrast fazı rutin subdural kanama saptama amacı taşımaz.

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

BT bulguları

• Konveksite hilali — iç kalvaryum ile beyin yüzeyi arasındaki, iç sınırı konkav olan ekstraaksiyel koleksiyon.
• Falx boyunca kan — interhemisferik fissürde ince yüksek dansiteli tabaka; parasagittal kesitlerde daha belirgin olabilir.
• Tentoryal hematom — tentoryum yaprağını izleyen asimetrik kalınlaşma veya lineer yüksek atenüasyon.
• Posterior fossa uzanımı — serebellar hemisfer çevresi ya da tentoryal yaprak altında koleksiyon; dördüncü ventrikül ve beyin sapına bası aranır.
• Karma dansiteli koleksiyon — pıhtılaşmamış kan, BOS karışımı veya yeniden kanama gibi farklı nedenlerle oluşabilir; tek başına tekrarlayan travmayı kanıtlamaz.
• Kitle etkisi — komşu sulkuslarda silinme, ventrikül basısı, orta hat kayması veya bazal sisternalarda daralma.
• İki taraflı ince koleksiyon — karşılıklı konveksite boyunca düşük hacimli kan ya da sıvı; simetrik görünüm patolojiyi dışlamaz.

Normalde

Normal ekstraaksiyel aralıkta konveksite ile iç tabula arasında hilal biçimli yumuşak doku dansitesi bulunmaz; falx ve tentoryum ince, düzgün ve iki taraflı dengelidir. Eş düzeyde sağ-sol hemisfer aralıklarını, sulkus açıklığını, lateral ventrikül kalibrasyonunu ve posterior fossadaki dördüncü ventrikül çevresini karşılaştırın.

Ayırıcı tanı

Epidural hematom

daha çok bikonveks şekillidir, sutürleri geçmez ve komşu kafatası kırığına sıkça eşlik eder.

Subdural higroma

BOS'a yakın dansitede koleksiyon; küçük kan karışımı BT'de ayırt edilemeyebilir ve MRI daha iyi karakterize eder.

Subaraknoid kanama

ekstraaksiyel hilal yerine kortikal sulkusları, fissürleri veya bazal sisternleri doldurur.

Benign genişlemiş subaraknoid boşluk

özellikle süt çocuğunda damarlar genişleyen sıvı aralığının içinde serbestçe seyreder; patolojik subdural koleksiyonda ise kortikal damarlar beyin yüzeyine doğru itilmiş olabilir.

Dural kalınlaşma veya kitle

yaygın plaka biçimli yumuşak doku olabilir; akut kanın tipik hilal dağılımı ve travma işaretleri yoktur.

Tuzaklar

• Hipodens koleksiyonu kesin kronik, hiperdens koleksiyonu kesin yeni kabul etme; hematokrit, karışım ve yeniden kanama dansiteyi etkiler.
• İnce falx veya tentoryum kanını normal dural yoğunluk sanma; iki tarafın eş düzeyini ve ardışık kesitlerde kalınlık farkını karşılaştır.
• Bebekte geniş BOS aralığını subdural sıvı diye adlandırma; kortikal damarların BOS aralığı içindeki konumunu ve beyin yüzeyine göre yerini izle.
• Bir koleksiyonun görünümünden istismar ya da travmanın zamanını tek başına çıkarsama; klinik öykü ve tamamlayıcı incelemeler gerekir.

Kendini dene

1. Konveksite boyunca hilal biçimli yüksek dansiteli koleksiyon kafa sütürlerini aşarak orta hatta (falx cerebri yanına) ulaşmaktadır. Bu koleksiyon hangi anatomik aralıktadır?

   • Dura ile araknoid arasındaki subdural aralık
   • Kafatası kemiği ile dura mater arasındaki epidural aralık
   • Kortikal sulkusları dolduran subaraknoid boşluk
   • Beyin parankimi içi
   Cevabı göster

   Dura ile araknoid arasındaki subdural aralık. Subdural kanama, dura mater ile araknoid membran arasındaki potansiyel boşlukta birikir; bridging venlerin kopması sonucu oluşur ve kafa sütürlerini aşabilir. Subaraknoid kanama sulkusları doldururken, parankim içi kanlama beyin dokusu içindedir.

2. BENİGN GENİŞLEMİŞ SUBARAKNOİD BOŞLUKLAR (BESS) tanısı alan süt çocuklarında tipik olarak gözlenen klinik ve radyolojik özellik aşağıdakilerden hangisidir?

   • Makrosefali ve genellikle spesifik travma öyküsünün bulunmaması
   • Keskin sınırlı bikonveks epidural hematom görüntüsü
   • Diffüz subaraknoid kanama ile birlikte meningeal tutulum
   • Yaygın kalvarial fraktürler ve şiddetli kafa travması öyküsü
   Cevabı göster

   Makrosefali ve genellikle spesifik travma öyküsünün bulunmaması. BESS, süt çocukluğunda genişlemiş subaraknoid boşluklarla karakterize olup genellikle makrosefali ile ilişkilidir ve spesifik travma öyküsü olmaksızın spontan subdural koleksiyonlarla birlikte görülebilir.

Bu konunun yer aldığı turlar

• Çocukta acil BT

İlgili konular

• Minör künt kafa travması ve PECARN bağlamı
• Şüpheli fiziksel istismarda kafa içi yaralanma
• Hidrosefali ve ventrikülomegali

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 11 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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