1、關(guān)于腦疝分類及影像學(xué)表現(xiàn)圖解第一張，PPT共五十七頁，創(chuàng)作于2022年6月腦疝是指在顱內(nèi)壓增高的情況下，腦組織通過某些腦池向壓力相對較低的部位移位的結(jié)果，即腦組織由其原來正常的位置而進(jìn)入了一個(gè)異常的位置。第二張，PPT共五十七頁，創(chuàng)作于2022年6月腦疝的類型：a.大腦鐮疝 ： 一側(cè)大腦半球占位病變可使同側(cè)扣帶回經(jīng)大腦鐮下緣疝入對側(cè)，胼胝體受壓下移。 小腦幕切跡疝 b.前疝：也稱顳葉溝回疝，是顳葉溝回疝于腳間池及環(huán)池的前部；后疝：顳葉內(nèi)側(cè)部疝于四疊體池及環(huán)池的后部；f.小腦幕切跡上疝：后顱凹占位病變時(shí)，小腦上蚓部可向上疝入小腦幕切跡的四疊體池。c.中心疝：幕上壓力增高，致使大腦深部結(jié)構(gòu)及腦干縱

2、軸牽張移位。 d.顱外疝： 腦組織通過顱外缺損疝出。e.枕骨大孔疝 ： 后顱凹占位病變時(shí)，可致小腦扁桃體疝入枕骨大孔。g.蝶骨嵴疝：顱前凹和顱中凹的占位病變，由于病變部壓力相對高一些，則額眶回可越過蝶骨嵴進(jìn)入顱中凹，可顳葉前部擠向顱前凹。第三張，PPT共五十七頁，創(chuàng)作于2022年6月示意圖a) subfalcial (cingulate) herniation ;鐮下疝b) uncal herniation ; 鉤疝c) downward (central, transtentorial) herniation ; 下行性小腦幕疝d) external herniation ; 顱外疝e) t

3、onsillar herniation.扁桃體疝f) ascending transtentorial herniation (reversed tentorial)上行性小腦幕疝g) sphenoid herniation蝶骨嵴疝第四張，PPT共五十七頁，創(chuàng)作于2022年6月類型腦疝部位命名別名疝入腦組織命名1大腦鐮下疝扣帶回疝2小腦天幕疝 前疝 后疝小腦幕切跡疝、小腦幕下降疝腳間池疝環(huán)池疝，四疊體疝顳葉鉤回疝海馬回疝3小腦幕孔中心疝間腦 4小腦幕孔上疝小腦幕上疝 小腦蚓部疝 5枕骨大孔疝小腦扁桃體疝 第五張，PPT共五十七頁，創(chuàng)作于2022年6月示意圖第六張，PPT共五十七頁，創(chuàng)作于202

4、2年6月解剖關(guān)系第七張，PPT共五十七頁，創(chuàng)作于2022年6月解剖關(guān)系FQcMb3vTOSyCClvFPOSpCClvss第八張，PPT共五十七頁，創(chuàng)作于2022年6月解剖關(guān)系FTCesPd4th VFTMbCes第九張，PPT共五十七頁，創(chuàng)作于2022年6月The suprasellar cistern & the quadrigeminal cisternThe left and center images show the suprasellar cistern. Its anterior borders are formed by the frontal lobes (F). Its

5、lateral borders are formed 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 supras

6、ellar cistern has a 6-pointed 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 quadrigemina

7、l cistern space is compressed or obliterated. 第十張，PPT共五十七頁，創(chuàng)作于2022年6月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 anter

8、ior border 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

9、bottom. 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. 第十一張，PPT共五十七頁，創(chuàng)作于2022年6月鐮下疝臨床表現(xiàn)影像所見并發(fā)癥頭痛對側(cè)下肢無力同側(cè)額角截?cái)啻竽X鐮前份不對稱同側(cè)側(cè)腦室腔消失透

10、明隔移位因大腦前動脈卡壓到大腦鐮上引起同側(cè)ACA供血區(qū)梗塞伴有其他疝第十二張，PPT共五十七頁，創(chuàng)作于2022年6月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

11、shift is noted. There is central transtentorial and subfalcine herniation.第十三張，PPT共五十七頁，創(chuàng)作于2022年6月ACA供血區(qū)梗塞第十四張，PPT共五十七頁，創(chuàng)作于2022年6月Uncal herniation臨床表現(xiàn)影像所見并發(fā)癥同側(cè)瞳孔散大、眼動受限（動眼神經(jīng)受壓）對側(cè)偏癱（同側(cè)大腦腳受壓）有時(shí)顳葉疝壓跡會導(dǎo)致同側(cè)偏癱（對側(cè)大腦腳受壓。假定位體征）對側(cè)顳角增寬同側(cè)環(huán)池增寬同側(cè)橋前池增寬鉤回進(jìn)入鞍上池大腦后動脈受壓導(dǎo)致枕葉梗塞第十五張，PPT共五十七頁，創(chuàng)作于2022年6月鞍上池缺角第十六張，PPT共五十七頁，

12、創(chuàng)作于2022年6月冠狀位CT與MRI第十七張，PPT共五十七頁，創(chuàng)作于2022年6月海馬旁回褶皺第十八張，PPT共五十七頁，創(chuàng)作于2022年6月對側(cè)顳角增寬第十九張，PPT共五十七頁，創(chuàng)作于2022年6月同側(cè)橋前池增寬第二十張，PPT共五十七頁，創(chuàng)作于2022年6月同側(cè)環(huán)池增寬第二十一張，PPT共五十七頁，創(chuàng)作于2022年6月Uncal herniation第二十二張，PPT共五十七頁，創(chuàng)作于2022年6月Uncal herniationobliteration of the suprasellar cistern (red arrow) and the quadrigeminal cist

13、ern (green arrow)第二十三張，PPT共五十七頁，創(chuàng)作于2022年6月Uncal herniationThe ipsilateral ventricle, sulci, fissures are compressed and obliterated, isappeared.obliteration of the suprasellar cistern(s) and quadrigeminal cistern(q)第二十四張，PPT共五十七頁，創(chuàng)作于2022年6月Uncal herniationAcute infarction1st dayAcute infarction 4th

14、daysq第二十五張，PPT共五十七頁，創(chuàng)作于2022年6月Uncal herniationBefore 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.第二十六張，PPT共五十七頁，創(chuàng)作于2022年6月Uncal herniationAcute infarction of right posterior arter

15、y (PCA), this is a complication of uncal/transtentorial herniation, because the PCA was compressed by brain herniation.第二十七張，PPT共五十七頁，創(chuàng)作于2022年6月雙側(cè)大腦后動脈梗塞第二十八張，PPT共五十七頁，創(chuàng)作于2022年6月雙側(cè)大腦后動脈梗塞第二十九張，PPT共五十七頁，創(chuàng)作于2022年6月Durette hemorrhage 第三十張，PPT共五十七頁，創(chuàng)作于2022年6月Durette hemorrhage第三十一張，PPT共五十七頁，創(chuàng)作于2022年6月Ke

16、rnohans notch顳葉疝壓跡第三十二張，PPT共五十七頁，創(chuàng)作于2022年6月Uncal herniationWhen mass effects within or adjacent to the temporal lobe occur, 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 t

17、he suprasellar cistern. There is bilateral uncal herniation. The suprasellar cistern is obliterated.第三十三張，PPT共五十七頁，創(chuàng)作于2022年6月early uncal herniation The right uncus is pushing into the suprasellar cistern; early right uncal herniation. 第三十四張，PPT共五十七頁，創(chuàng)作于2022年6月中心疝臨床表現(xiàn)影像所見并發(fā)癥意識改變呼吸模式改變?nèi)テ印⑷ツX小瞳孔因脈絡(luò)膜前動脈

18、受壓引起蒼白球和視束梗塞第三十五張，PPT共五十七頁，創(chuàng)作于2022年6月中心疝第三十六張，PPT共五十七頁，創(chuàng)作于2022年6月Superior vermian herniation ( ascending transtentorial herniation )由于后顱凹的占位效應(yīng)，小腦蚓和小腦半球通過小腦幕切跡向上移動臨床表現(xiàn)影像所見并發(fā)癥惡心嘔吐意識障礙中腦外觀呈陀螺狀雙側(cè)環(huán)池變窄四疊體池充滿因小腦上動脈受壓引起梗塞Galen靜脈移位腦積水意識障礙迅速出現(xiàn)，并可能死亡第三十七張，PPT共五十七頁，創(chuàng)作于2022年6月陀螺狀外觀第三十八張，PPT共五十七頁，創(chuàng)作于2022年6月雙側(cè)環(huán)池變窄

19、第三十九張，PPT共五十七頁，創(chuàng)作于2022年6月四疊體池充滿第四十張，PPT共五十七頁，創(chuàng)作于2022年6月不露齒的微笑第四十一張，PPT共五十七頁，創(chuàng)作于2022年6月皺眉第四十二張，PPT共五十七頁，創(chuàng)作于2022年6月第一天的四疊體池和環(huán)池第四十三張，PPT共五十七頁，創(chuàng)作于2022年6月第二天，四疊體池和環(huán)池消失第四十四張，PPT共五十七頁，創(chuàng)作于2022年6月腦積水第四十五張，PPT共五十七頁，創(chuàng)作于2022年6月ascending transtentorial herniation第四十六張，PPT共五十七頁，創(chuàng)作于2022年6月枕大孔疝臨床表現(xiàn)影像所見并發(fā)癥雙側(cè)上肢感覺減退意識

20、障礙軸位像見到小腦扁桃體位于齒狀突水平矢狀位見到小腦扁桃體低于枕大孔5mm（成人）或7mm（兒童）小腦扁桃體出血性壞死意識障礙和死亡第四十七張，PPT共五十七頁，創(chuàng)作于2022年6月枕大孔疝第四十八張，PPT共五十七頁，創(chuàng)作于2022年6月Tonsillar herniation In tonsillar herniation (rare), a mass effect in the posterior fossa causes the cerebellar tonsils to herniate inferiorly through the foramen magnum compressin

21、g the medulla and upper cervical spinal cord. Conscious patients complain of neck pain and vomiting. They may have nystagmus, pupillary dilatation, bradycardia, hypertension and respiratory depression. Early tonsillar herniation is difficult to recognize in an unconscious patient. It may not be evid

22、ent 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 clinical clue in an unconscious patient.第四十九張，PPT共五十七頁，創(chuàng)作于2022年6月Tonsillar herniation第五十張，PPT共五十七頁，創(chuàng)作于2022年6月a male patient in his 30s who died of brain

23、stem herniation after completing a marathon. The CT shows (A) loss of the rostral cerebral sulci suggesting 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 suggest

24、s that the brain oedema is of relative recent onset and massive tissue ischaemia has not yet occurred. (D) Compression 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 hydrocep

25、halus. (E) Herniation of the medulla and pons into the foramen magnum. (F) The tonsils are located at the level of the dens which is a good indicator for foramen magnum herniation.第五十一張，PPT共五十七頁，創(chuàng)作于2022年6月(A) The disc shows florid hemorrhages with relatively little swelling, indicating a rapid, dram

26、atic increase in CSF pressure. Progressive changes of optic disc oedema are seen in a patient 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. (E) In gross chronic disc oedema the normal retinal vasculature is masked and di