MINORHEADINJURYamp;MEDIALTEMPORALDAMAGE：轻微头部损伤amp;课件.ppt

1、Deepak Agrawal,MBBS,MS,MCh.Fellow,Pediatric Neurosurgery BC Childrens Hospital,UBC.LEARNING OBJECTIVES.Imaging Brain function using SPECTAll India Institute of Medical Sciences,New Delhi.Imaging Brain function using SPECT.Imaging Brain function using SPECT.Imaging Brain function using SPECT.Imaging

2、Brain function using SPECT.Imaging Brain function using SPECT.Imaging Brain function using SPECT.Imaging Brain function using SPECT.Imaging Brain function using SPECT.Imaging Brain function using SPECT.Imaging Brain function using SPECT.Imaging Brain function using SPECT.Imaging Brain function using

3、 SPECT.Imaging Brain function using SPECT.Imaging Brain function using SPECT.SPECT in TRAUMA.Imaging Brain function using SPECT.Deepak Agrawal,Naveen K*,C S Bal*,A K Mahapatra Departments of Neurosurgery and*Nuclear medicine,All India Institute of Medical Sciences,New Delhi.WHY MEDIAL TEMPORAL LOBE?

4、Hippocampus is especially vulnerable to insults such as ischemia,hypoxia,and seizuresExtent of hippocampal damage can be correlated with severity of memory impairmentRempel-Clower NL,Zola SM,Squire LR,Amaral DG.Three cases of enduring memory impairment after bilateral damage limited to the hippocamp

5、al formation.J Neurosci 1996;16:5233-5255.criteria published by the members of the Mild Traumatic brain injury Interdisciplinary Special Interest Group(BISIG)Kay T,Harrington DE,et al.Definition of mild traumatic brain injury.J Head Trauma Rehabil 1993;8:86.30 Children with minor head injuryNormal C

6、T head&Post concussion Syndrome(PCS)SPECT scan(within 72 hrs)Medial temporal hypoperfusion(n=14)(“MTH”)No Medial temporal hypoperfusion(n=16)(“control”)3 months laterRepeat SPECT&clinical evaluation(PPCS)3 months laterRepeat SPECT&clinical evaluation(PPCS).BaselineAt 3 months.12/14(86%)children deve

7、loped PPCS in the MTH group,compared to 2/16(12.5%)children in the control groupP=0.0003RESULTSPersistent post concussion syndrome(PPCS).criteria published by the Mild Traumatic brain injury Interdisciplinary Special Interest Group(BISIG)Kay T,Harrington DE,et al.Definition of mild traumatic brain i

8、njury.J Head Trauma Rehabil 1993;8:86.STUDY DESIGN20 PATIENTSWITH POSTCONCUSSION SYNDROME&ABNORMAL SPECTPIRACETAM GROUPCONTROL GROUP10 PATIENTS800 mg PIRACETAM(Cerecetam)TDS x 6 WEEKSCLINICAL EVALUATION&REPEAT SPECT AT 6 WEEKS10 PATIENTSNO PIRACETAMCLINICAL EVALUATION&REPEAT SPECT AT 6 WEEKS.Imaging

9、 Brain function using SPECT.SPECT In vertebrobasilar insufficiency.SPECT In vertebrobasilar insufficiency.SPECT In vertebrobasilar insufficiency.Chronic low grade micro-traumaRepeated flex/extn of vesselIntimal damageThrombosisEmbolisationSPECT In vertebrobasilar insufficiency.SPECT In vertebrobasil

10、ar insufficiency.SPECT In vertebrobasilar insufficiency.SPECT In vertebrobasilar insufficiency.SPECT In vertebrobasilar insufficiency.19 PATIENTS WITH IRREDUCIBLE AADClinical assessment&Brain SPECT on admissionCONTROL GROUP(7 PTS)VBI GROUP(12 PTS)Transoral Odontoidectomy+Posterior FusionTransoral Od

11、ontoidectomy+Posterior FusionRpt SPECT at 4 weeksRpt SPECT at 4 weeksSPECT In vertebrobasilar insufficiencyAAD:Atlanto-axial dislocation.SPECT In vertebrobasilar insufficiency.SPECT In vertebrobasilar insufficiency.SPECT In vertebrobasilar insufficiency.SPECT In vertebrobasilar insufficiency.SPECT In vertebrobasilar insufficiency.SPECT In vertebrobasilar insufficiency.SPECT In vertebrobasilar insufficiencyBaselineAt 1 month postop.SPECT In vertebrobasilar insufficiency.SPECT In vertebrobasilar insufficiency.SPECT In vertebrobasilar insufficiency.SPECT In vertebrobasilar insufficiency.