脑疝图解课件.pptVIP

鞍上池缺角 * 冠状位CT与MRI * 海马旁回褶皱 * 对侧颞角增宽 * 同侧桥前池增宽 * 同侧环池增宽 * Uncal herniation * Uncal herniation obliteration of the suprasellar cistern (red arrow) and the quadrigeminal cistern (green arrow) * Uncal herniation The ipsilateral ventricle, sulci, fissures are compressed and obliterated, isappeared. obliteration of the suprasellar cistern(s) and quadrigeminal cistern(q) * Uncal herniation Acute infarction 1st day Acute infarction 4th day s q * Uncal herniation Before surgery, a big GBM in the left temporal lobe with uncal herniation. After surgery, the GBM was removed, the suprasellar cistern and quadrigeminal cisterns are normal. * Uncal herniation Acute infarction of right posterior artery (PCA), this is a complication of uncal/transtentorial herniation, because the PCA was compressed by brain herniation. * 双侧大脑后动脉梗塞 * 双侧大脑后动脉梗塞 * Durette hemorrhage * 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 * PART * 图解脑疝 * 脑疝 是指在颅内压增高的情况下，脑组织通过某些脑池向压力相对较低的部位移位的结果，即脑组织由其原来正常的位置而进入了一个异常的位置。 * 脑疝的类型： a.大脑镰疝 ： 一侧大脑半球占位病变可使同侧扣带回经大脑镰下缘疝入对侧，胼胝体受压下移。 小脑幕切迹疝 b.前疝：也称颞叶沟回疝，是颞叶沟回疝于脚间池及环池的前部；②后疝：颞叶内侧部疝于四叠体池及环池的后部；f.小脑幕切迹上疝：后颅凹占位病变时，小脑上蚓部可向上疝入小脑幕切迹的四叠体池。 c.中心疝：幕上压力增高，致使大脑深部结构及脑干纵轴牵张移位。 d.颅外疝： 脑组织通过颅外缺损疝出。 e.枕骨大孔疝 ： 后颅凹占位病变时，可致小脑扁桃体疝入枕骨大孔。