外科学课件整理-颅内压增高和脑疝-2.pptVIP

脑疝的分类 按部位及疝出内容 小脑幕切迹疝 (颞叶钩回疝) [Transtentorial herniation] 枕骨大孔疝 (小脑扁桃体疝) [Tonsillar herniation] 大脑镰下疝 (扣带回疝) [Inferior cerebral falx herniation] 小脑幕上疝 (小脑蚓疝) (a)大脑镰下疝 （扣带回疝） (b)小脑幕裂孔疝 （颞叶沟回疝） (c)枕骨大孔疝 （小脑扁桃体疝） Transtentorial herniation Supratentorial mass— making pressure difference— cerebral tissue(temporal lobe –uncus/hippocampal)—displacement—tentorial incisure—compression—upper brain stem(midbrain) ,around cranial nerve (oculomotor),artery(posterior cerebral a.) 小脑幕切迹疝Transtentorial Herniation 病理生理变化 动眼神经损害 脑干受压变化 脑脊液循环障碍 疝出组织变化 枕叶梗死 Clinical Manifestation Severe headache and vomiting Disturbance of consciousness (compressed reticular formation of midbrain) Ipsilateral platycoria (compressed oculomotor nerve) Contralateral palsy (compressed pyramidal system) Change in vital sign (BP,heart rate,respiration) 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 * 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 * Intravenously administered hypertonic solutions reduce brain bulk rapidly. It can fall in intracranial pressure temporarily (transiently), a space occupying mass must be ruled out as quickly as possible in all patient with suspected intracranial hypertension. * Intravenously administered hypertonic solutions reduce brain bulk rapidly. It can fall in intracranial pressure temporarily (transiently), a space