Vai tr ca Skull Radiography trong chn

thng u cp:
Nt

s
Tn thng xuyn thu

nh gi nhanh v xuyn thu ca d vt cn

quang

Cc chiu th thng kho st

S

thng
S nghing
Towne

Tin li
Ph

bin, thi gian chp nhanh, tng hp vi cc

thit b y khoa.
Nhy vi cc tn thng xng, xut huyt cp

Hn ch
t

nhy i vi cc tn thng nh khng phi xut

huyt c bit gn xng, tn thng trc lan ta,
ph no sm

Tin li
Nhy

i vi tn thng trc lan ta, xc nh tui

ca mu
Cc tn thng mch mu

Hn ch
Kh,

xng
Thi gian ghi hnh di, khng tng hp vi vi thit
b y khoa

CA SO NHU MO-CA
SO XNG

WL 100HU, WC 40-50HU

WL 2000-3000HU, WC 500-700HU

Xng trn
Khp vnh
Xng nh

Khp dc gia

Rnh trung tm: dng mc, di nht, khng phn nhnh, rnh
trn trn khng ct qua hi trc tr.tm, rnh sau tr.tm ch
i, hi trc tr.tm dy hn sau tr.tm.

Trung tm bn bu dc

Xng chm

Khp Lambdoid

Khp vnh

Xng thi
dng

Khp Lambdoid

1
2

3
5

1-xoang trn. 2-xoang sng. 3-xoang bm. 4-cnh ln xng bm. 5-xng thi dng. 6-xng
chm

2
3
4
5

1-xng mi. 2-cung g m. 3-li cu xng hm di. 4-kh bo chm. 5-xng chm

 Teo

v no (Cortical atrophy)
Nhuyn no (Encephalomalacia)
T kh ni s (Pneumocephalus)
Nang mng nhn (Leptomeningeal cyst formation)
Tn thng thn kinh s (Cranial nerve lesions)
i thi nht (Diabetes insipidus (pituitary injury))
No ng thu (Hydrocephalus (communicating or
obstructive))

Trong trc
Nhu m
no

Ngoi trc

Mng
mm

Mng
nhn

Xut huyt
khoang di
nhn

Mng
cng

Hp s

T mu ngoi
mng cng

T mu di
mng cng

M CT (HU)

Vi (1000HU)
M mm
Nc (0)
M (-60 HU)
Kh (-1000 HU)

CC T DiN T M
Gim m (Hypodense)
ng m (Isodense)
Tng m (Hyperdense).

Chn thng s no
m cao/ Xut huyt no
m thp/ Ph dp no

M mm
Nn

quan st u tin
Xc nh v tr va chm (coup site)

Tn thng phn mm hp s

Xng

Gy dng ng

Gy ln

Thng gp nht
scout image
Thng lin quan vi tn thng nhu m no ngay pha di

Gy xng nn s: c th tn thng

ng mch cnh trong

Xoang ngang, xoang sigma
Cc dy thn kinh s
Tai gia, tai trong

Bc tch (Dissection)
Gi phnh (Pseudoaneurysm)
R ng tnh mch (Arteriovenous
fistula)

1% to 4% bnh nhn CTSN

Ngun gc mu

85%

t ng mch

Thng ngay di ch nt s (90%)

Hnh nh:
m

cao
Hai mt li
Khng vt qua cc khp s
Vt qua c cc np mng cng (lim i
no, lu tiu no)

10% to 20% bnh nhn CTSN

Do t cc tnh mch cu ni.
Thng thy v tr i bn (contrecoup site)
Hu ht trn lu:
Hai

bn cu
Dc lu tiu no
Dc lim no

3 giai on:
G/

cp (<1 tun)

Hnh lim, chim gn na bn cu

m cao
Vt qua c cc khp s
Khng vt qua c cc np mng cng.

3 giai on:
G/

cp (<1 tun)

Trng hp ng - gim m :

Thiu mu

m hn hp
ang chy mu
Chy mu li/SDH mn trc .

3 giai on:
G/

bn cp (1-3 tun)

m gim t t
Phase ng m nhu m no kh pht hin/
noncontrast CT

Dch chuyn vo trong ca ranh gii cht trng cht

xm (dy v no)
Hiu ng khi: y ng gia, p no tht cng bn,
xa rnh no

3 giai on:
G/

mn (>3 tun)

Hnh lim
m thp, ng nht
m hn hp: chy mu li
C th to thnh cc ngn c m khc nhau
do dnh to cc mng.

11% bnh nhn CTSN

Do rch cc mch mu nh ca mng nhn, mng mm
Lan t xut huyt trong no tht
Lan t tn thng dp/t mu trong nhu m no

V tr:
B

gian cung no
B nn
Rnh Sylvian
Rnh no

CT
Tng

m cc khe, rnh no

2,8% bnh nhn CTSN

Rch cc tnh mch di mng no tht
Lan t khi mu t trong nhu m no, t xut huyt
khoang di nhn
Tn thng xuyn thu
Thng kt hp vi SAH v dp no

Do dp vo mt trong hp s, lim-lu no
Thi dng trn cnh ng gia
Dng tn thng

Dp ph no: gim m
Nu km xut huyt no: tng m

Dp no

Dp no km xut huyt

Do nhiu nguyn nhn

Hnh nh:

Xa

cc rnh no, b no, no tht

Mt ranh gii cht trng-cht xm

Thng hnh nh CT bnh thng hoc biu

hin cc nt chy mu nh, ri rc
V tr thng gp: vng ranh gii cht trng-cht
xm bn cu, th chai, cung no sau bn
MRI c gi tr trong chn on

Tn thng trc lan ta

Thot v di lim
Thot v xuyn lu
Hng

xung
Hng ln

Thot v hnh nhn tiu no

Thot v di lim no

-Mm mc
hi cnh hi
thot v qua
lu
tiu
xung di

ca
m
khe
no

+Xa b trn yn
+Rng b gc
cu tiu no
cng bn.

Ti liu tham kho

1/ Alisa D. Gean and Nancy J. Fischbein. Head Trauma.
Neuroimag Clin N Am 2010; 20: 527556.
2/ Tarek A. Hijaz, Enzo A. Cento & Matthew T. Walker.
Imaging of Head Trauma. Radiol Clin N Am 2011; 49:
81103.
3/ Philip L. Johnson, Donald A. Eckard, David P. Chason,
Marci A. Brecheisen, Solomon Batnitzky. Imaging of
acquired cerebral herniations. Neuroimag Clin N Am
2002; 12: 217228
4/ G.M. Giannatempo, T. Scarabino, A. Simeone, A. Casillo,
A. Maggialetti, M. Armillotta. CT in Head Injuries.
Emergency Neuroradiology 2006; 137-162