18.图解脑疝要点.pptVIP

Durette hemorrhage Kernohan’s notch颞叶疝压迹 Uncal herniation When mass effects within or adjacent to the temporal lobe occur, the medial portion of the temporal lobe (uncus) is forced medially and downward over the tentorium. There is ipsilateral pupillary dilation. The uncus is pushed medially into the suprasellar cistern. There is bilateral uncal herniation. The suprasellar cistern is obliterated. early uncal herniation The right uncus is pushing into the suprasellar cistern; early right uncal herniation. 中心疝 临床表现 影像所见 并发症 意识改变 呼吸模式改变 去皮层、去脑 小瞳孔 因脉络膜前动脉受压引起苍白球和视束梗塞 中心疝 Superior vermian herniation ( ascending transtentorial herniation ) 由于后颅凹的占位效应，小脑蚓和小脑半球通过小脑幕切迹向上移动 临床表现 影像所见 并发症 恶心 呕吐 意识障碍 中脑外观呈陀螺状 双侧环池变窄 四叠体池充满 因小脑上动脉受压引起梗塞 Galen静脉移位 脑积水 意识障碍迅速出现，并可能死亡 陀螺状外观 双侧环池变窄 四叠体池充满 不露齿的微笑 皱眉 第一天的四叠体池和环池 第二天，四叠体池和环池消失 脑积水 ascending transtentorial herniation 枕大孔疝 临床表现 影像所见 并发症 双侧上肢感觉减退 意识障碍 轴位像见到小脑扁桃体位于齿状突水平 矢状位见到小脑扁桃体低于枕大孔5mm（成人）或7mm（儿童） 小脑扁桃体出血性坏死 意识障碍和死亡 枕大孔疝 Tonsillar herniation In tonsillar herniation (rare), a mass effect in the posterior fossa causes the cerebellar tonsils to herniate inferiorly through the foramen magnum compressing the medulla and upper cervical spinal cord. Conscious patients complain of neck pain and vomiting. They may have nystagmus, pupillary dilatation, bradycardia, hypertension and respiratory depression. Early tonsillar herniation is difficult to recognize in an unconscious patient. It may not be evident on CT scan since axial views cannot see the pathology well. It is best seen on sagittal MRI. Clinically changes in vital signs may be the only clinical clue in an unconscious patient. Tonsillar herniation a male patient in his 30s who died of brain stem herniation after completing a marathon. The CT shows (A) loss of the rostral cerebral sulci suggesting increase in ICP, (B) and (C) a large hydrocephalus with widening of both temporal horns. The grey matter can still be differentiated from the white matter, but all sulci are lost. Th