图解脑疝医学知识宣讲培训课件.ppt

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1、图解脑疝医学知识宣讲,图解脑疝医学知识宣讲,脑疝,是指在颅内压增高的情况下，脑组织通过某些脑池向压力相对较低的部位移位的结果，即脑组织由其原来正常的位置而进入了一个异常的位置。,图解脑疝医学知识宣讲,2,脑疝是指在颅内压增高的情况下，脑组织通过某些脑池向压力相对较,脑疝的类型：,a.大脑镰疝 ： 一侧大脑半球占位病变可使同侧扣带回经大脑镰下缘疝入对侧，胼胝体受压下移。 小脑幕切迹疝 b.前疝：也称颞叶沟回疝，是颞叶沟回疝于脚间池及环池的前部；后疝：颞叶内侧部疝于四叠体池及环池的后部；f.小脑幕切迹上疝：后颅凹占位病变时，小脑上蚓部可向上疝入小脑幕切迹的四叠体池。c.中心疝：幕上压力增高，致使大

2、脑深部结构及脑干纵轴牵张移位。 d.颅外疝： 脑组织通过颅外缺损疝出。e.枕骨大孔疝 ： 后颅凹占位病变时，可致小脑扁桃体疝入枕骨大孔。g.蝶骨嵴疝：颅前凹和颅中凹的占位病变，由于病变部压力相对高一些，则额眶回可越过蝶骨嵴进入颅中凹，可颞叶前部挤向颅前凹。,图解脑疝医学知识宣讲,3,脑疝的类型：a.大脑镰疝 ： 一侧大脑半球占位病变可使同侧扣,示意图,a) subfalcial (cingulate) herniation ;镰下疝b) uncal herniation ; 钩疝c) downward (central, transtentorial) herniation ; 下行性小脑幕疝

3、d) external herniation ; 颅外疝e) tonsillar herniation.扁桃体疝f) ascending transtentorial herniation (reversed tentorial)上行性小脑幕疝g) sphenoid herniation蝶骨嵴疝,图解脑疝医学知识宣讲,4,示意图a) subfalcial (cingulate) h,类型,图解脑疝医学知识宣讲,5,类型脑疝部位命名别名疝入脑组织命名1大脑镰下疝扣带回疝2,示意图,图解脑疝医学知识宣讲,6,示意图图解脑疝医学知识宣讲6,解剖关系,图解脑疝医学知识宣讲,7,解剖关系图解脑疝医学知识

4、宣讲7,解剖关系,图解脑疝医学知识宣讲,8,解剖关系FQcMb3vTOSyCClvFPOSpCClvss,解剖关系,图解脑疝医学知识宣讲,9,解剖关系FTCesPd4th VFTMbCes图解脑疝医学知,The suprasellar cistern & the quadrigeminal cistern,The left and center images show the suprasellar cistern. Its anterior borders are formed by the frontal lobes (F). Its lateral borders are formed

5、by the uncus (U) of the temporal lobes. The left image shows the 5-pointed star appearance of the suprasellar cistern where the posterior border is formed by the pons (Po). The black arrow points to the fourth ventricle. The center image shows a higher cut where the suprasellar cistern has a 6-point

6、ed star appearance since the posterior border is formed by the cerebral peduncles (P) which have a central cleft. The right image shows the quadrigeminal cistern (black arrow). Note the babys bottom appearance of its anterior border. When ICP is increased, the quadrigeminal cistern space is compress

7、ed or obliterated.,图解脑疝医学知识宣讲,10,The suprasellar cistern & the,The suprasellar cistern& the quadrigeminal cistern.,The midline sagittal MRI scan shows the levels of the axial diagrams. The quadrigeminal cistern is located above (anterior to) the Q in the highest cut shown (number 9). The anterior bo

8、rder of the quadrigeminal cistern is formed by the superior colliculi (c). Image 8 (lower cut) also shows the quadrigeminal cistern. In this case, its anterior border is formed by the inferior colliculi (c). This gives the anterior border of the quadrigeminal cistern the appearance of a babys bottom

9、. The quadrigeminal plate is comprised of the superior and inferior colliculi. The quadrigeminal cistern is posterior to this quadrigeminal plate, thus its anterior border may be formed by the inferior or superior colliculi.,图解脑疝医学知识宣讲,11,The suprasellar cistern& the,镰下疝,图解脑疝医学知识宣讲,12,镰下疝临床表现影像所见并发症

10、头痛同侧额角截断因大脑前动脉卡压,Subfalcine herniation (cingulate herniation)Transtentorial herniation,The suprasellar cistern (left image) is obliterated. The quadrigeminal cistern is very compressed and pushed posteriorly (center image). A subdural hematoma with a midline shift is noted. There is central transten

11、torial and subfalcine herniation.,图解脑疝医学知识宣讲,13,Subfalcine herniation (cingula,ACA供血区梗塞,图解脑疝医学知识宣讲,14,ACA供血区梗塞图解脑疝医学知识宣讲14,Uncal herniation,图解脑疝医学知识宣讲,15,Uncal herniation临床表现影像所见并发症同侧瞳,鞍上池缺角,图解脑疝医学知识宣讲,16,鞍上池缺角图解脑疝医学知识宣讲16,冠状位CT与MRI,图解脑疝医学知识宣讲,17,冠状位CT与MRI图解脑疝医学知识宣讲17,海马旁回褶皱,图解脑疝医学知识宣讲,18,海马旁回褶皱图解脑疝

12、医学知识宣讲18,对侧颞角增宽,图解脑疝医学知识宣讲,19,对侧颞角增宽图解脑疝医学知识宣讲19,同侧桥前池增宽,图解脑疝医学知识宣讲,20,同侧桥前池增宽图解脑疝医学知识宣讲20,同侧环池增宽,图解脑疝医学知识宣讲,21,同侧环池增宽图解脑疝医学知识宣讲21,Uncal herniation,图解脑疝医学知识宣讲,22,Uncal herniation图解脑疝医学知识宣讲22,Uncal herniation,obliteration of the suprasellar cistern (red arrow) and the quadrigeminal cistern (green arr

13、ow),图解脑疝医学知识宣讲,23,Uncal herniationobliteration o,Uncal herniation,The ipsilateral ventricle, sulci, fissures are compressed and obliterated, isappeared.,obliteration of the suprasellar cistern(s) and quadrigeminal cistern(q),图解脑疝医学知识宣讲,24,Uncal herniationThe ipsilatera,Uncal herniation,Acute infarct

14、ion1st day,Acute infarction 4th day,图解脑疝医学知识宣讲,25,Uncal herniationAcute infarcti,Uncal herniation,Before surgery, a big GBM in the left temporal lobe with uncal herniation.After surgery, the GBM was removed, the suprasellar cistern and quadrigeminal cisterns are normal.,图解脑疝医学知识宣讲,26,Uncal herniatio

15、nBefore surgery,Uncal herniation,Acute infarction of right posterior artery (PCA), this is a complication of uncal/transtentorial herniation, because the PCA was compressed by brain herniation.,图解脑疝医学知识宣讲,27,Uncal herniationAcute infarcti,双侧大脑后动脉梗塞,图解脑疝医学知识宣讲,28,双侧大脑后动脉梗塞图解脑疝医学知识宣讲28,双侧大脑后动脉梗塞,图解脑疝医

16、学知识宣讲,29,双侧大脑后动脉梗塞图解脑疝医学知识宣讲29,Durette hemorrhage,图解脑疝医学知识宣讲,30,Durette hemorrhage 图解脑疝医学知识宣讲3,Durette hemorrhage,图解脑疝医学知识宣讲,31,Durette hemorrhage图解脑疝医学知识宣讲31,Kernohans notch颞叶疝压迹,图解脑疝医学知识宣讲,32,Kernohans notch颞叶疝压迹图解脑疝医学知识宣,Uncal herniation,When mass effects within or adjacent to the temporal lobe o

17、ccur, the medial portion of the temporal lobe (uncus) is forced medially and downward over the tentorium. There is ipsilateral pupillary dilation. The uncus is pushed medially into the suprasellar cistern. There is bilateral uncal herniation. The suprasellar cistern is obliterated.,图解脑疝医学知识宣讲,33,Unc

18、al herniationWhen mass effe,early uncal herniation,The right uncus is pushing into the suprasellar cistern; early right uncal herniation.,图解脑疝医学知识宣讲,34,early uncal herniation The rig,中心疝,图解脑疝医学知识宣讲,35,中心疝临床表现影像所见并发症意识改变因脉络膜前动脉受压引起苍,中心疝,图解脑疝医学知识宣讲,36,中心疝图解脑疝医学知识宣讲36,Superior vermian herniation ( asce

19、nding transtentorial herniation ),由于后颅凹的占位效应，小脑蚓和小脑半球通过小脑幕切迹向上移动,图解脑疝医学知识宣讲,37,Superior vermian herniation (,陀螺状外观,图解脑疝医学知识宣讲,38,陀螺状外观图解脑疝医学知识宣讲38,双侧环池变窄,图解脑疝医学知识宣讲,39,双侧环池变窄图解脑疝医学知识宣讲39,四叠体池充满,图解脑疝医学知识宣讲,40,四叠体池充满图解脑疝医学知识宣讲40,不露齿的微笑,图解脑疝医学知识宣讲,41,不露齿的微笑图解脑疝医学知识宣讲41,皱眉,图解脑疝医学知识宣讲,42,皱眉图解脑疝医学知识宣讲42,图

20、解脑疝医学知识宣讲培训课件,第二天，四叠体池和环池消失,图解脑疝医学知识宣讲,44,第二天，四叠体池和环池消失图解脑疝医学知识宣讲44,脑积水,图解脑疝医学知识宣讲,45,脑积水图解脑疝医学知识宣讲45,ascending transtentorial herniation,图解脑疝医学知识宣讲,46,ascending transtentorial herni,枕大孔疝,图解脑疝医学知识宣讲,47,枕大孔疝临床表现影像所见并发症双侧上肢感觉减退轴位像见到小脑,枕大孔疝,图解脑疝医学知识宣讲,48,枕大孔疝图解脑疝医学知识宣讲48,Tonsillar herniation,In tonsill

21、ar herniation (rare), a mass effect in the posterior fossa causes the cerebellar tonsils to herniate inferiorly through the foramen magnum compressing the medulla and upper cervical spinal cord. Conscious patients complain of neck pain and vomiting. They may have nystagmus, pupillary dilatation, bra

22、dycardia, hypertension and respiratory depression. Early tonsillar herniation is difficult to recognize in an unconscious patient. It may not be evident on CT scan since axial views cannot see the pathology well. It is best seen on sagittal MRI. Clinically changes in vital signs may be the only clin

23、ical clue in an unconscious patient.,图解脑疝医学知识宣讲,49,Tonsillar herniation In tonsil,Tonsillar herniation,图解脑疝医学知识宣讲,50,Tonsillar herniation图解脑疝医学知识宣讲,a male patient in his 30s who died of brain stem herniation after completing a marathon.,The CT shows (A) loss of the rostral cerebral sulci suggesting

24、increase in ICP, (B) and (C) a large hydrocephalus with widening of both temporal horns. The grey matter can still be differentiated from the white matter, but all sulci are lost. This suggests that the brain oedema is of relative recent onset and massive tissue ischaemia has not yet occurred. (D) C

25、ompression of the fourth ventricle with dilatation of the third ventricle and the caudal aspect of both temporal horns. This is observed with considerable brain oedema and obstructive hydrocephalus. (E) Herniation of the medulla and pons into the foramen magnum. (F) The tonsils are located at the le

26、vel of the dens which is a good indicator for foramen magnum herniation.,图解脑疝医学知识宣讲,51,a male patient in his 30s who,(A) The disc shows florid hemorrhages with relatively little swelling, indicating a rapid, dramatic increase in CSF pressure. Progressive changes of optic disc oedema are seen in a pa

27、tient with an intracranial tumour who declined treatment (B-D). (B) Early nerve fiber dilatation is seen particularly superiorly, inferiorly and nasally. (C) This increases and venous engorgement develops. (D) Temporal nerve fiber dilatation and swelling of the disc increases and hemorrhages appear.

28、 (E) In gross chronic disc oedema the normal retinal vasculature is masked and dilated superficial capillaries are observed. (F) In atrophic optic disc oedema nerve fibers are eventually destroyed and the optic disc without viable nerve fibers does not swell. This patient had longstanding benign int

29、racranial hypertension. Retinochoroidal venous collaterals are present (black arrowhead).,图解脑疝医学知识宣讲,52,(A) The disc shows florid hemo,颅外疝,图解脑疝医学知识宣讲,53,颅外疝图解脑疝医学知识宣讲53,核磁选择,1. Subfalcine herniation. This is best seen on coronal MR images.2. Descending transtentorial herniation (uncal herniation, hi

30、ppocampal herniation). best seen on coronal images, but the compression of the brainstem is best observed on axial T2-WI.3. Ascending transtentorial herniation. The sagittal imaging plane is preferred.4. Cerebellar tonsillar herniation. Sagittal and coronal imaging planes are preferred.,图解脑疝医学知识宣讲,54,核磁选择1. Subfalcine herniation.,图解脑疝医学知识宣讲,55,图解脑疝医学知识宣讲55,图解脑疝医学知识宣讲,56,图解脑疝医学知识宣讲56,小结,占位效应引起的脑组织移位影像上识别脑疝的关键是看脑池的变化,图解脑疝医学知识宣讲,57,小结占位效应引起的脑组织移位图解脑疝医学知识宣讲57,