2013继续教育-脑梗死影像学诊断规范201303版.ppt

* * * * 这 * * * is a physiological phenomenon based on reversible depression of functions anatomically or functionally connected to the damaged area，might explain the neuropsychological and functional neuroimaging changes observed over the first few months after the vascular incident. Crossed cerebellar diaschisis (CCD) is a depression of neuronal metabolism and activity manifested as reduced blood flow in the cerebellar hemisphere contralateral to a supratentorial infarct, and is believed to be caused by an interruption of the corticopontocerebellar fibers. As a result of decreased afferent input, there is a decline in synaptic cerebellar Purkinje cell function, coupled with a decrease in cerebellar perfusion. 皮质脑桥小脑纤维的中断 * * * * * On the far left a FLAIR image demonstrating high signal in the left thalamus.When you look closely and you may have to enlarge the image to appreciate this, there is also high signal in the basal ganglia on the right.These bilateral findings should raise the suspicion of deep cerebral venous thrombosis.A sagittal CT reconstruction demonstrates a filling defect in the straight sinus and the vein of Galen (arrows). * In some cases of venous thrombosis the imaging findings can resolve completely.On the left a patient with a subcortical area of high signal intensity.The first impression was that this could be a low grade glioma.On a follow up scan the abnormalities had resolved completely.In retrospect a dense vessel sign was seen in one of the cortical veins and the diagnosis of venous thrombosis was made.The high signal intensity can be attributed to vasogenic edema due to the high venous pressure that resulted from the thrombosis * * * * * 2、脑静脉性梗死 （cerebral venous infarction，CVI）  CVI通常出现在受阻的皮层浅静脉和(或) 大脑深静脉引流区 (3-8%),可伴有或不伴有静脉窦的受累 脑静脉系统有广泛的侧支循环， 其在静脉闭塞初期对血液回流起到代偿作用，当侧支循环失代偿，CVI 才可能发生 ，故 CVI 的发展过程较动脉性脑梗死缓慢 静脉性脑梗死的病理生理 静脉性梗死：当静脉发生血栓时，由于压力升高---血管源性水肿—产生梗死---细胞性水肿---继而再产生血管性水肿【与动脉性梗死的