53例小脑挫伤的形态学观察

目的观察53例原发性小脑挫伤的形态学改变。方法全部小脑标本在表面检查后分别进行矢状、水平切面观察。结果①表面局部散在出血21例,弥漫性出血15例,出血伴局部叶片挫伤28例,切面见8例导水管周围、13例第四脑室壁、6例小脑扁桃体上部与9例蚓小结表面有散在点状出血;②表面未见出血但有局部肿胀17例;局部肿胀致小脑中线移位5例。矢状与水平切面:山顶肿胀向上移位4例,直达胼胝体压部6例;山顶并中央小叶向上向前移位挤压上、下丘致导水管狭窄4例;闭塞10例;中央小叶并蚓小结肿胀向前移位11例,均致导水管闭塞与第四脑室狭窄。中央小叶并小脑扁桃体上部肿胀6例,造成导水管闭塞与第四脑室腔狭窄。小脑扁桃体上部与蚓小结肿胀向脑桥第四脑室移位12例。结论小脑受力可使应力部位肿胀,移位,造成导水管闭塞或第四脑室狭窄,甚至与脑干背侧相互挤压致伤。这是脑干损伤与继发脑肿胀原因之一。

A morphological study on cerebellum contusion in 53 cases

Objective To investigate the morphological changes of primary cerebellum contusion in 53 cases.Methods Cerebellum specimens were observed both in sagittal section and horizontal section.Results ①Sporadic focal subarachnoid hemorrhages were detected in 21 cases and diffuse hemorrhage in 15 cases. Hemorrhage with focal laminal destruction was noted in 28 cases.In sections sporadic hemorrhage could be seen around aqueductus cerebri in 8 cases,under ventriculus quartus wall in 13 cases,on the top of tonsilla cerebelli in 6 cases and nodulus surface in 9 cases.②Local swelling could be seen without hemorrhage in 17 cases.Cerebellum midline was shifted by local swelling in 5 cases.4 cases showed culmen swelling and shifting upwards,and 6 cases shifting to splenium corporis callosi.Aqueductus cerebri stenosis was found in 4 cases and occlusion in 10 cases,which was caused by culmen and lobulus centralis shifted ahead and upside.Central lobule and nodulus were found of swelling and shifting ahead in 11 cases,or swelling of central lobule and cerebellar tonsil in 6 cases,which led to obliteration of aqueductus cerebri and stenosis of ventriculus quartus.12 cases showed tumefection in top of tonsilla cerebelli and nodulus shifting towards pontine ventriculus quartus.Conclusion Impact to the cerebellum may cause local swelling and displacement,and leads to occlusion of aqueductus cerebri and stenosis of ventriculus quartus,or even extrusion on back of the brainstem,which may be one of the mechanisms resulting in brainstem lesion and secondary cerebellar swelling.