精神病学脑血管病.pptVIP

脑血管疾病 七年制教学 定义 脑血管疾病（cerebrovascular disease)是指在脑血管壁病变的基础上发生的局限性或弥漫性脑功能障碍。 主要病因：高血压性脑动脉硬化和脑动脉粥样硬化。 椎基底动脉系统 椎动脉 基底动脉 大脑后动脉 脑血管病的危险因素和病因 （二）基本病因 1、血管壁病变 （1）高血压性脑细小动脉硬化； （2）脑动脉粥样硬化； （3）血管先天性发育异常和遗传性疾病； （4）各种感染和非感染性动、静脉炎； （5）中毒、代谢及全身性疾病 2、心脏病 3、其他 （三）促发因素 1、血流动力学因素 （1）血压过高或过低； （2）血容量改变； （3）心脏病 2、血液成份异常 （1）血粘度改变； （2）血小板数量或功能异常 （3）凝血或纤溶系统功能障碍 CLINICAL PRESENTATION  1、Cerebrovascular disease (CVD) includes all disorders in which an area of the brain is transiently affected by ischemia or bleeding； 2、sudden, severe headache，unexplained dizziness； 3、Internal Carotid Artery occlusion hemiplegia (paralysis of one side of the body) hemisensory deficit hemianopsia (blindness in 1/2 of the visual field) aphasia (if infarct is in the dominant hemisphere) Vertebrobasilar system  severe vertigo, nausea, vomiting, dysphagia, ipsilateral cerebellar ataxia diplopia, visual field loss, gaze palsies 3。bilateral paresthesias or paresis, and impaired consciousness Meningeal Irritation Sign nuchal rigidity Kernig sign Brudzinskis sign 短暂性脑缺血发作（transient ischemic attack,TIA) 脑动脉一过性供血不足引起短暂发作的局灶性脑功能障碍，即尚发生脑梗死的一过性缺血。每次发作出现的相应症状和体征一般持续数秒至数十分钟，24小时内完全恢复，但可反复发作。 病机：微栓塞、脑血管狭窄、痉挛或受压 血流动力学因素、血液成份改变 a. episodes of a temporary reduction in perfusion to a focal region of the brain causing a short-lived disturbance of function the patient experiences a temporary focal neurological deficit such as slurred speech, aphasia, amaurosis fugax (monocular blindness), or weakness or paralysis of a limb onset is rapid; usually onset is less than 5 minutes .duration usually 2-15 minutes; can last up to 24 hours; symptoms (vary depending on the CNS anatomy involved); 1、sensation of swelling or numbness of the hand, arm, or one side of the face or tongue 2、loss of strength in an arm, hand or leg 3、difficulties in speaking or reading no neuro