脑血管定位诊断.ppt

丘脑供血病例讨论患者女性，73岁。突发右侧肢体无力3小时3小时前突发右侧肢体无力，言语不清，无恶心、呕吐，无肢体抽搐、二便失禁，无视物旋转，急呼120送至我院急诊，血压200/110mmhg，心电图提示房颤查体：神清，混合性失语，右侧肢体肌力4级，NIHSS4分，拟收入神经内科监护室进行溶栓治疗，在入院过程中，患者症状好转，无失语，肌力5-级北京天坛医院BeijingTiantanHospitalpericallosalLateralposterioranteriorFigure2-35.DrawingsshowingthemostcommonCTlocationsofinfarctsintheanteriorcirculationinpatientswithICAocclusions;infarctsareshownbyhatchedgray:(A)wedge-shapedMCAinfarct;(B)entireMCAterritory;(C)superiordivisionMCA;(D)inferiordivisionMCA;(E)ACA;(F)ACAandMCA;(G)striatocapsularinfarct;(H)wedge-shaped,anteriorwatershedinfarct;(I)wedge-shaped,posteriorwatershedinfarct;(J)anteriorandposteriorwatershedinfarcts;(K)linearinternalwatershedinfarct;(L)oval-shaped,deepwatershedinfarct;(M)smallwhite-matterwatershedinfarct.(AdaptedfromRingelsteinE,ZeumerH,AngelouD:Thepathogenesisofstrokesfrominternalcarotidarteryocclusion.Stroke1983;14:867-875.)Figure2-36.Drawingsshowingthemostcommoninfarctpatternsinpatientswithembolicstrokes.(AdaptedfromRingelsteinEB,KoschorkeS,HollingA,etal:Computedtomographicpatternofprovenembolicbraininfarctions.AnnNeurol1989;26:759-765.)PosteriorinferiorAnteriorinferiorAnteriorspinalparamedianLateralposteriorchoroidalThalamogeniculateInferiorramusMedialposteriorinferolateralpericallosalA33-year-oldmanpresentedtotheemergencyroomafteramassiveobjectfellontohisheadandneck.Anacuteepiduralhematomaontheleftsidewasidentifiedandevacuated.Onsubsequentphysicalexamination,thepatientwasstuporousandhadflaccidhemiplegiaontherightsideandadilatedleftpupilthatwasnotresponsivetolightstimulation.Diffusion-weightedmagneticresonanceimagingshowedextensiveinfarctionsoftheleft,middle,andbilateralanteriorcerebralarteryterritories(PanelA).Inaddition,hyperintenselesions(PanelB)wereobservedinthebilatera