颅内压增高和脑疝模板.ppt

小脑幕切迹疝的临床表现clinical manifestation 颅内压增高症状加剧 意识障碍 瞳孔变化 锥体束征 生命体征改变 小脑幕切迹疝的治疗Treatment 早期明确诊断，病因处理 具体： 维持呼吸道的通畅 甘露醇的应用 病因处理--手术或姑息手术 脑室穿刺 枕骨大孔疝Transforamen Magna Herniation 病理生理 延髓受压 脑脊液循环障碍 疝出组织的变化 Tonsillar Herniation Posterior fossa space-occupying lesions tonsil of cerebellum displacement great occipital foramen compression medulla oblongata ,around cervical spinal nerves Respiration center in medulla oblongata 枕骨大孔疝的临床表现 枕下疼痛、项强或强迫头位 颅内压增高症状加剧 后组颅神经受累 生命体征改变 Clinical manifestation Respiratory changes Compressed respiration center Neck rigidity Compressed and pulled cervical spinal nerves Other vital sign changes Later stage mydriasis,apnea Treatment of Herniation Diagnosis clear and definite Osmotic diuretics mannitol Ventricular puncture ,v-p shunt Operation removal mass 枕骨大孔疝的处理 早期明确诊断、病因处理 Treatment of Herniation Diagnosis clear and definite Osmotic diuretics mannitol Ventricular puncture ,v-p shunt Operation removal mass 枕骨大孔疝与小脑幕切迹疝临床表现的比较 生命体征变化较早 瞳孔变化、意识障碍出现晚 本次课的思考题 颅内压增高的常见病因? 颅内压增高的治疗原则? 小脑幕切迹疝与枕骨大孔疝的主要表现、处理原则? 参考文献 1、王忠诚主编.王忠诚神经外科学. 2005,第二版.湖北科技出版社 2、 [美]Donald W. Marion原著;?只达石等主译.颅脑创伤学.?人民卫生出版社 3、江基尧主编.颅脑创伤临床救治指南.?2007 ,第三版. 第二军医大学出版社 * The upper brain stem is pushed downward into the posterior fossa and compressed from side to side by herniating tissue. * Pyramidal on facies ventralis of midbrain go down ,passing pons to facies ventralis of medulla oblongata ,cross to contralteral ,forming corticospinal tract. * We all know what center in medulla oblongata is ,it is the respiration center. Taking place respiratory changes in frequency,depth, rhythm,ultimately apnea(or respiratory arrest) * Because compressed tissue is respiration center ,result in respiratory changes * Intrav