《神经病学》脑血管疾病.pptx

第—节概述第—节概述?重点A脑血管病的概念:n?脑缺血III/病因/临床特征/诊断/治疗/预防?脑血管病：脑部血管源性疾病的总称。（A+V）IIIIII脑的动脉血液循环III?颈内动脉系统（前循环）?眼球/大脑半球前3/5部分?椎基底动脉系统（后循环）?大脑半球后2/5部分/丘脑/脊髓上部/脑干/小脑椎动脉Anterior communr-eating a.a Antericccerebrjh.RACAACAOhctory tractSuperbr chiismaticRMCA ?LMCAC^hthaimicPerfccated substanceLUCARTIC.Internal carotid a.Medal jnd lateral striate brar:bM斩?气LOAROAAnterior cerebrd aRecurrent。 (of Heubner)MddlecerebraU.LVARVAInfkrdibdLmTubercinereum-Stpracf^tic and pjrar^cntrkuhra.LICAfbstericr ccmmuniAnterior choredd a.CCARCC.Axteriwtothe tuber cinereumMamillary bodyRVApnLVAproMamilary* as. Rostericr thdamo-perforating a. Pccterbr cerebral a.Oculomotor nRSubALSubAPostericc perforating branchesSuperior cerebdhr a.Badly a.Fig. 11.12 Circle of WillsThe circle of Willis at the base of the brain as seen from belowSir Thomas Willis (1621-1675)AComAAComAPComAPComABlocked ica and collateral flowVAo o o o o0 5 0 52 11(廿余kns粧H玉嬰)@楓建桩200Hq^IOIs粧H玉理)板目燻0105 o1 1—50o002001o动脉压(mmHg)脑血液循环的特点III?侧枝循环丰富?解剖变异多?血管结构特殊性＞动脉管壁薄弱/中层平滑肌细胞少/外膜结缔组 织不发达?血流自动调节好（Bayliss效应）IIIIII?脑卒中(stroke):急性脑局部血液循环障碍 导致的迅即发生的脑功能缺损的临床事件。 (出血/缺血)Ill? 1995年脑血管疾病分类实用性?临床特征?定位症状和体征：病变血管供应脑部位IIIFig. 11.5 Territories and branches of the anterior cerebral, posterior cerebral, and middle cerebral arteries on the medial surface of the brain. I, anterior terrpor」artery: II, posterior temporal artery: III, posterior ocdpUi artety; IXT, cslcjrine artery:V\ pjrietoccdpttjl jrtery. For hbds l-V. see tot p. 427.大脑中动脉闭塞症状?皮层支A上干?运动性失语（主）?偏瘫/偏身感觉障碍?凝视障碍/空间忽视?感觉性失语/失读/失写（主）?对侧偏盲或上象限盲?失用等A下干Suspect posterior circulation stroke syndrome/ vertigo and imbalance/ diplopia or dysconjugate eye movement/ numbness around mouth/ eyes deviated towards (looking at) side of limb weakness/ facial droop or numbness on side opposite limb weakness or numbness/ bilateral weakness or numbness/ isolated homonymous hemianopsia or cortical blindness/ ptosis or partial Horner s syndrome/ nystagmus/ hearing loss/ dysphagia or loss of gag reflex/ ataxia or dysmetria wit