腦梗死的血管定位課件

腦梗死的血管定位腦梗死的血管定位內(nèi)容腦供血動脈解剖腦梗死的血管定位內(nèi)容腦供血動脈解剖人腦動脈解剖人腦動脈解剖腦動脈兩大體系頸內(nèi)動脈系：大腦前部＋部分間腦

椎基底動脈系：

大腦后部＋部分間腦＋腦干＋小腦小腦幕為界頂枕溝為界（3/2)腦動脈兩大體系頸內(nèi)動脈系：大腦前部＋部分間腦小腦幕為界頂枕溝腦動脈供血系統(tǒng)模式圖腦動脈供血系統(tǒng)模式圖腦的主要供血動脈。(A)腦腹側(cè)觀。方塊區(qū)域放大圖顯示W(wǎng)illis動脈環(huán)。(B)腦外側(cè)面觀和(C)中間矢狀面顯示大腦中/前/后動脈。(D)冠狀切面顯示大腦中動脈行程。腦的主要供血動脈。(A)腦腹側(cè)觀。方塊區(qū)域放大圖顯示W(wǎng)頸內(nèi)動脈系統(tǒng)MCA＋ACA＋脈絡(luò)叢前動脈頸內(nèi)動脈系統(tǒng)MCA＋ACA＋脈絡(luò)叢前動脈大腦中動脈（MCA）供血范圍MCAACAPCAMCA皮質(zhì)支供應(yīng)：半球外側(cè)面（額中回以下、中央前后回下3/4、頂下小葉、枕葉月狀溝或枕外側(cè)溝以前、顳下回上緣或上半以上的部分）；島葉；顳極內(nèi)外側(cè)；額葉眶面一部分。大腦中動脈（MCA）供血范圍MCAACAPCAMCA皮質(zhì)支供MCA中央支供應(yīng)：殼核、尾狀核、內(nèi)囊前肢、內(nèi)囊膝的背外側(cè)和內(nèi)囊后肢的背部區(qū)域。立體看，供應(yīng)內(nèi)囊上3/5MCA中央支供應(yīng)：殼核、尾狀核、內(nèi)囊前肢、內(nèi)囊膝的背外側(cè)和內(nèi)腦梗死的血管定位課件大腦中動脈（MCA）供血范圍大腦中動脈（MCA）供血范圍大腦前動脈（ACA）血液供應(yīng)ACA皮質(zhì)支供應(yīng)：半球內(nèi)側(cè)面為頂枕裂以前皮質(zhì)和胼胝體；在背外側(cè)面達額中回上緣或上半、額上回、中央前后回上1/4、頂上小葉及眶部內(nèi)側(cè)半等區(qū)域。ACA中央支供應(yīng)：部分額葉眶面皮質(zhì)、外囊、尾狀核和豆狀核前部、內(nèi)囊前肢和內(nèi)囊膝部和后肢前邊部分。大腦前動脈（ACA）血液供應(yīng)ACA皮質(zhì)支供應(yīng)：半球內(nèi)側(cè)面為頂腦梗死的血管定位課件脈絡(luò)叢前動脈：→側(cè)腦室下角的脈絡(luò)叢，并供應(yīng)外側(cè)膝狀體、內(nèi)囊后肢的后下部、大腦腳底的中1/3、蒼白球等，易形成血栓阻塞。脈絡(luò)膜前動脈的供血范圍左圖詳示：基底節(jié)區(qū)的血液供應(yīng)。脈絡(luò)叢前動脈：→側(cè)腦室下角的脈絡(luò)叢，并供應(yīng)外側(cè)膝狀體、內(nèi)囊后腦梗死的血管定位課件脈絡(luò)膜前動脈脈絡(luò)膜前動脈，1～4支，以3支最多，為一組較細小而恒定的血管，在后交通動脈起始遠側(cè)2mm處由頸內(nèi)動脈脈直接發(fā)出。該動脈在未穿入側(cè)腦室下腳之前，除發(fā)1～3個皮質(zhì)支外，還發(fā)出2～3個穿支，1支穿視神經(jīng)內(nèi)側(cè)至大腦腳，另兩支即為紋狀體內(nèi)囊動脈。此動脈主要營養(yǎng)尾狀核尾，行程長，管徑較小，易發(fā)生栓塞。脈絡(luò)膜前動脈脈絡(luò)膜前動脈，1～4支，以3支最多，為一組較細小D.AxialT2-weightedimage(2500/80)revealsthepresenceofaninhomogeneousmassintherightlateralventricle.Thelowsignalintensitysuggetsthepresenceofcalcificationandhemorrhage.E.Angiogramoftherightinternalcarotidarteryobtainedonday3demonstratesahypervascularmassfedfromtherightanteriorchoroidalartery(arrows).D.AxialT2-weightedimage(250WhichoneistheAnteriorChoroidalArtery?WhichoneistheAnteriorChor腦梗死的血管定位課件脈絡(luò)膜前動脈閉塞常引起三偏癥狀群，特點為偏身感覺障礙重于偏癱，而對側(cè)同向偏盲又重于偏身感覺障礙，有的尚有感覺過度、丘腦手、患肢水腫等。脈絡(luò)膜前動脈內(nèi)囊額狀斷面腦后片圖顯示各部位血液供應(yīng)來源。內(nèi)囊額狀斷面腦后片圖顯示各部位血液供應(yīng)來源。中央前回及中央后回的血液供應(yīng)圖中央前回及中央后回的血液供應(yīng)圖椎基底動脈系統(tǒng)VA＋BA椎基底動脈系統(tǒng)VA＋BA椎動脈（VA）①V1（骨外）段：向上進C6橫突孔。②V2（椎間孔段③V3（脊椎外）段：④V4（硬膜內(nèi)段）：過枕骨大孔，在腦橋及延髓交界處合成基底動脈。近側(cè)椎動脈段解剖（A側(cè)位；B前后位；C頦頂位）：骨外段（V1）橫突孔段（V2）椎外段（V3）4.硬膜內(nèi)段（V4）5.枕骨髁的大概位置椎動脈行程圖A：斜側(cè)位觀；圖B：前后位觀；圖C：俯觀。椎動脈（VA）椎動脈行程圖A：斜側(cè)位觀；圖B：前后位觀；圖C1.左椎動脈2.腦膜后動脈3.小腦后下動脈（PICA）4.基底動脈5.小腦前下動脈(AICA)6.腦橋外側(cè)支7.小腦上動脈（SCA）8.大腦后動脈9.小腦半球支大水平裂10.SCA的小腦半球分支11.小腦蚓上動脈椎基底動脈系統(tǒng)及其分支解剖（側(cè)位）：椎基底動脈系統(tǒng)及其分支解剖（側(cè)位）：椎基底動脈系統(tǒng)及其分支解剖（正位）：1.右椎動脈2.左椎動脈3.脊髓前動脈4.小腦后下動脈（PICA）5.基底動脈6.小腦前下動脈（AICA）7.腦橋外側(cè)支8.小腦上動脈（SCA）9.大腦后動脈10.后交通動脈11.頸內(nèi)動脈椎基底動脈系統(tǒng)及其分支解剖（正位）：1.右椎動脈腦梗死的血管定位課件大腦后動脈（PCA）血液供應(yīng)中央支：丘腦、下丘腦、底丘腦、膝狀體以及大部分中腦。此外，分支到側(cè)腦室及第三腦室脈絡(luò)叢。變異大。主要來自PCA（72.5-88.3%）；來自ICA（6.8-20.2%）；兩部分平均參加（4.3-11%）。大腦后動脈（PCA）血液供應(yīng)中央支：丘腦、下丘腦、底丘腦、膝PCA供血區(qū)模式圖皮質(zhì)支：半球底面和內(nèi)側(cè)面一部分（包括：海馬回、梭狀回、顳下回、舌回、窟窿回峽、楔葉、楔前葉后1/3及頂上小葉后部）PCA供血區(qū)模式圖皮質(zhì)支：半球底面和內(nèi)側(cè)面一部分（包括：海馬Bloodsupplyofthethreesubdivisionsofthebrainstem.Diagramofmajorsupply.Sectionsthroughdifferentlevelsofthebrainstemindicatingtheterritorysuppliedbyeachofthemajorbrainstemarteries.Bloodsupplyofthethreesubd腦橋的血液供應(yīng)特點橋腦的血供源自椎—基底動脈，橋腦基底外側(cè)和被蓋部由短旋動脈供應(yīng)；橋腦基底部內(nèi)側(cè)由基底動脈中央支供應(yīng)，旁正中支供應(yīng)橋腦被蓋部正中部分—腦室底部、外展神經(jīng)核、內(nèi)側(cè)縱束和網(wǎng)狀結(jié)構(gòu)；橋腦基底部和被蓋部最外側(cè)為長旋動脈供應(yīng)。由于外側(cè)區(qū)側(cè)支循環(huán)豐富，發(fā)生梗塞概率較低。而橋腦旁正中動脈、短旋動脈呈直角起自基底動脈，易受高血壓的影響而出現(xiàn)動脈粥樣硬化，易出現(xiàn)梗塞。腦橋的血液供應(yīng)特點橋腦的血供源自椎—基底動脈，橋腦基底外側(cè)和腦橋梗死的臨床特點貌似大腦半球病變的純運動性偏癱占橋腦梗塞的60.9%。這是因為錐體束位于橋腦基底部，基底部由基底動脈的旁正中深穿支供應(yīng)血流，該部位動脈易有動脈硬化性改變和透明變性，其近端閉塞時導(dǎo)致基底部正中梗塞，使未交叉的錐體束受損。PICA和SCA引起的梗塞通常僅累及小腦；而AICA（供應(yīng)腦橋外側(cè)被蓋部和小腦中腳）不同，它引起的梗塞灶多累及腦干和小腦中腳。腦橋梗死的臨床特點貌似大腦半球病變的純運動性偏癱占橋腦梗塞的橋腦梗塞時交叉性癱及顱神經(jīng)麻痹并不常見，因橋腦的顱神經(jīng)核多分部于被蓋部，由較豐富的長旋動脈及小腦上動脈供應(yīng)血流，后交通動脈、大腦后動脈和小腦上動脈有側(cè)枝循環(huán)，所以顱神經(jīng)可不受影響。腦橋梗死的臨床特點橋腦梗塞時交叉性癱及顱神經(jīng)麻痹并不常見，因橋腦的顱神經(jīng)核多分腦橋上/中部旁中線綜合征由基底動脈旁中央支血供障礙引起；病變對側(cè)中樞性舌癱＋對側(cè)中樞性上下肢癱瘓＋同側(cè)小腦性共濟失調(diào)Patientswithunilateralparamedianinfarctionstypicallypresentedapuremotorhemiparesisthatprogressedoverthefirst3daysandwasaccompaniedbydysarthriaandhomolateralataxia.腦橋上/中部旁中線綜合征由基底動脈旁中央支血供障礙引起；Pa橋腦上外側(cè)綜合征小腦上動脈閉塞引起；①眩暈、惡心、嘔吐、眼球震顫（前庭核損害）②兩眼向病灶側(cè)水平凝視不能（腦橋側(cè)視中樞損害）③同側(cè)肢體共濟失調(diào)（腦橋臂、結(jié)合臂、小腦齒狀核損害）；④同側(cè)Horner綜合征（下行交感神經(jīng)損害）⑤同側(cè)面部感覺障礙（三叉神經(jīng)感覺束損害）和對側(cè)痛覺、溫度覺障礙（脊髓丘腦束損害）；⑥對側(cè)下肢深感覺障礙（內(nèi)側(cè)丘系外側(cè)部分損害）⑦雙側(cè)聽力障礙，對側(cè)較重。橋腦上外側(cè)綜合征小腦上動脈閉塞引起；少見SCA綜合征出現(xiàn)病變對側(cè)感音性耳聾少見SCA綜合征出現(xiàn)病變對側(cè)感音性耳聾腦梗死的血管定位課件腦橋腹下部綜合征

（Millard-GublerSyndrome)同側(cè)外展N麻痹＋同側(cè)周圍性面癱對側(cè)中樞性舌癱一；對側(cè)肢體癱。也其它位置不同的突出癥狀可能出現(xiàn)小腦前下動脈阻塞引起。腦橋腹下部綜合征

（Millard-GublerSyndr腦梗死的血管定位課件腦橋基底內(nèi)側(cè)綜合征

（FovilleSyndrome)

病灶側(cè)周圍性面癱；兩眼向病灶側(cè)同向注視麻痹；病灶對側(cè)偏癱；基底動脈旁正中支閉塞引起。腦橋基底內(nèi)側(cè)綜合征

（FovilleSyndrome)

病小腦后下動脈綜合征

（Wallenbergsyndrome)現(xiàn)證實10％由PICA引起，75％由一側(cè)椎動脈閉塞引起。余下由基底動脈閉塞引起。小腦后下動脈綜合征

（Wallenbergsyndrome腦梗死的血管定位課件延髓內(nèi)側(cè)綜合征

（Dejerine綜合征）

椎動脈及其分支或基底動脈后部血管阻塞，引起延髓錐體發(fā)生梗死時產(chǎn)生同側(cè)舌肌麻痹（XII腦神經(jīng)損害）和萎縮，對側(cè)上下肢中樞性癱瘓以及觸覺、位置覺、振動覺減退或喪失。延髓內(nèi)側(cè)綜合征

（Dejerine綜合征）

椎動脈及其分支或Magneticresonanceimageofthefluidattenuatedinversionrecoverysequencefortheaxial(left)andT2weightedcoronal(right)sections.Thereisawelldemarcatedunilateralmedialmedullaryinfarctjustbelowthepontomedullaryjunction.Therightsideofeachimagecorrespondstotheleftsideofthebrain.Magnetic大腦動脈血管供血分區(qū)CT解剖(圖文)大腦動脈血管供血分區(qū)CT解剖(圖文)MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支PCA終末支脈胳膜前動脈MCA終末支ACA終末支PCA終末支脈胳膜前動脈MCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支PCA穿支及PCoAMCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支MCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支PCA穿支及PCoAMCA穿支MCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支MCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支PCA穿支及PCoAMCA穿支MCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支MCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支PCA穿支及PCoAMCA穿支MCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支MCA終末支ACA終末支ACA終末支ACA終末支腦梗死的血管定位課件腦梗死的血管定位課件腦梗死的血管定位課件腦的供血模式圖腦的供血模式圖腦梗死的血管定位課件腦梗死的血管定位課件腦梗死的血管定位課件腦梗死的血管定位課件左枕葉梗死。（PCA終末支）左枕葉梗死。（PCA終末支）Figure1:(a)NormalinitialCTofthepatient;(b)ThecranialCTtwodaysaftertheincidentshowssignalchangesconsistentwithsimultaneousinfarctsintherightMCAandPCAareas;(c)InthedigitalsubtractionangiographyoftherightICA,PCAisseentooriginatefromtherightICAthroughPCoAi.e.fetaltypePCAFigure1:(a)NormalinitialCPICAOntheleftCT-imagesofaleft-sidedPICA-infarction.Noticetheposteriorextention.Theinfarctionwastheresultofadissection(bluearrow).PICAOntheleftCT-imagesofaleft-sidedPICA-infarction.Inunilateralinfarctsthereisalwaysasharpdelineationinthemidlinebecausethesuperiorvermianbranchesdonotcrossthemidline,buthaveasagittalcourse.Thissharpdelineationmaynotbeevidentuntilthelatephaseofinfarction.Intheearlyphase,edemamaycrossthemidlineandcreatediagnosticdifficulties.Infarctionsatpontinelevelareusuallyparamedianandsharplydefinedbecausethebranchesofthebasilarareryhaveasagittalcourseanddonotcrossthemidline.Bilateralinfarctsarerarelyobservedbecausethesepatientsdonotsurvivelongenoughtobestudied,butsometimessmallbilateralinfarctscanbeseen.OntheleftCT-imagesofalefSCAOntheleftCT-imagesofacerebellarinfarctionintheregionofthesuperiorcerebellararteryandalsointhebrainstemintheterritoryofthePCA.Noticethelimitationtothemidline.SCAACA：?A1segment:fromorigintoanteriorcommunicatingarteryandgivesrisetomediallenticulostriatearteries(inferiorpartsoftheheadofthecaudateandtheanteriorlimboftheinternalcapsule).?A2segment:fromanteriorcommunicatingarterytobifurcationofpericallosalandcallosomarginalarteries.?A3segment:majorbranches(medialportionsoffrontallobes,superiormedialpartofparietallobes,anteriorpartofthecorpuscallosum).ACA：AnteriorchoroidalarteryTheterritoryoftheanteriorchoroidalarteryencompassespartofthehippocampus,theposteriorlimboftheinternalcapsuleandextendsupwardstoanarealateraltotheposteriorpartofthecellamedia.ThewholeareaisrarelyinvolvedinAChAinfarcts.Ontheleftanuncommoninfarctioninthehippocampalregion.PartoftheterritoryoftheanteriorchoroidalarteryandthePCAareinvolved.AnteriorchoroidalarteryMiddlecerebralarteryTheMCAhascorticalbranchesanddeeppenetratingbranches,whicharecalledthelaterallenticulo-striatearteries.Theterritoryofthelaterallenticulo-striateperforatingarteriesoftheMCAisindicatedwithadifferentcolorfromtherestoftheterritoryoftheMCAbecauseitisawell-definedareasuppliedbypenetratingbranches,whichmaybeinvolvedorsparedininfarctsseparatelyfromthemaincorticalterritoryoftheMCA.OntheleftaT2W-imageofapatientwithaninfarctionintheterritoryofthemiddlecerebralartery(MCA).Noticethatthelaterallenticulo-striateperforatingarteriesoftheMCAarealsoinvolved(orangearrow).MiddlecerebralarteryOntheleftimagesofahemorrhagicinfarctionintheareaofthedeepperforatinglenticulostriatebranchesoftheMCA.OntheleftimagesofahemorrOntheleftenhancedCT-imagesofapatientwithaninfarctionintheterritoryofthemiddlecerebralartery(MCA).Thereisextensivegyralenhancement(luxuryperfusion).Sometimesthisluxuryperfusionmayleadtoconfusionwithtumoralenhancement.OntheleftenhancedCT-imagesPosteriorcerebralartery(PCA)DeeporproximalPCAstrokescauseischemiainthethalamusand/ormidbrain,aswellasinthecortex.SuperficialordistalPCAinfarctionsinvolveonlycorticalstructures(4).Ontheleftapatientwithacutevisionlossintherighthalfofthevisualfield.TheCTdemonstratesaninfarctioninthecontralateralvisualcortex,i.eleftoccipitallobe.Posteriorcerebralartery(PCATherearetwopatternsofborderzoneinfarcts:1.CorticalborderzoneinfarctionsInfarctionsofthecortexandadjacentsubcorticalwhitematterlocatedattheborderzoneofACA/MCAandMCA/PCA2.InternalborderzoneinfarctionsInfarctionsofthedeepwhitematterofthecentrumsemiovaleandcoronaradiataattheborderzonebetweenlenticulostriateperforatorsandthedeeppenetratingcorticalbranchesoftheMCAorattheborderzoneofdeepwhitematterbranchesoftheMCAandtheACA.TherearetwopatternsofbordOntheleftthreeconsecutiveCT-imagesofapatientwithanocclusionoftherightinternalcarotidartery.Thehypoperfusionintherighthemisphereresultedinmultipleinternalborderzoneinfarctions.Thispatternofdeepwatershedinfarctionisquitecommonandshouldurgeyoutoexaminethecarotids.OntheleftthreeconsecutiveOntheleftimagesofapatientwhohassmallinfarctionsintherighthemisphereinthedeepborderzone(bluearrowheads)andalsointhecorticalborderzonebetweentheMCA-andPCA-territory(yellowarrows).Thereisabnormalsignalintherightcarotid(redarrow)asaresultofocclusion.Inpatientswithabnormalitiesthatmayindicateborderzoneinfarcts,alwaysstudytheimagesofthecarotidarterytolookforabnormalsignal.OntheleftimagesofapatienOntheleftanotherexampleofsmallinfarctionsinthedeepborderzoneandinthecorticalborderzonebetweentheMCA-andPCA-territoryinthelefthemisphere.OntheleftanotherexampleofOntheleftanexampleofinfarctionsinthedeepborderzoneandinthecorticalborderzonebetweentheACA-andMCA-territory.Theabnormalsignalintensityintherightcarotidistheresultofanocclusion.Thiscombinationoffindingsissocommon,thatonceyouknowthepattern,youwillseeitmanytimes.Ontheleftanexampleofinfa脈絡(luò)膜前動脈供血區(qū)梗死脈絡(luò)膜前動脈供血區(qū)梗死A9-year-oldpreviouslyhealthygirlwasadmittedtotheEmergencyRoomwithaneight-hourhistoryofsuddenonsetofsevereheadache.Thepainwaspulsatileandbilateralandnotaccompaniedbyothersymptoms.Thereisnohistoryofmigraine,epilepsyorstroke.Parentsreportedthatsoonaftertheonsetoftheheadachethepatientbecamedrowsyforaboutonehour.Notriggerfactorwasidentified.Ontheneurologicalexamination,thepatientwasalertandwellorientedwithnootherabnormalitiesbutmildnuchalrigidity.Computedtomographyofthebrainrevealedhemorrhageintherightlateralventricle(Fig1)andgadolinium-enhancedmagneticresonanceimagingstudyofthebraindisclosedaheterogeneouslesioninthemesialportionoftherighttemporallobe,aboveandinsidethetemporalhornofthelateralventricle.Thelesionextendeduntilthesubependimaryareaofthetrigonooftherightventricle.ThelesionwashypointenseonT1andT2-weightedimagesandenhancedwiththecontrast.OtherhyperintenseT1andT2-weightedimageslesionswereseenintherightlateralventriclesuggestingbleeding.Magneticresonanceangiographyandcerebralangiographydisclosedanarteriovenousmalformationinpartofthechoroidplexus,suppliedbytheanteriorchoroidalartery(Figs2and3).TheAVMwasclassifiedaccordingtoSpetzlergradingsystemasgrade3(deepvenousdrainage:1;eloquencearea:0andsize:2).A9-year-oldpreviouslyhealthLacunesmaybeconfusedwithotheremptyspaces,suchasenlargedperivascularVirchow-Robinspaces(VRS).TheVRSareextensionsofthesubarachnoidspacethataccompanyvesselsenteringthebrainparenchyma.WideningofVRSoftenfirstoccursaroundpenetratingarteriesinthesubstantiaperforataandcanbeseenontransverseMRIslicesaroundtheanteriorcommisure,eveninyoungsubjects(5).OntheleftCT-andMR-imagesattheleveloftheanteriorcommisure(bluearrows).OntheCTthereisahypodenseareaintherighthemisphere,whichfollowsthesignalintensityofCSFonT2W-andFLAIR-images,whichistypicalforwidenedVRS.Lacunesmaybeconfusedwitho腦梗死的血管定位課件PRES

PRESisshortforPosteriorReversibleEncephalopathySyndrome.ItisalsoknownasreversibleposteriorLeukoencephalopathysyndrome[RPLS].Itclassicallyconsistsofpotentiallyreversiblevasogenicedemaintheposteriorcirculationterritories,butanteriorcirculationstructurescanalsobeinvolved(6).Manycauseshavebeendescribedincludinghypertension,eclampsiaandpreeclampsia,immunosuppressivemedicationssuchascyclosporine.Themechanismisnotentirelyunderstoodbutisthoughttoberelatedtoahyperperfusionstate,withblood-brain-barrierbreakthrough,extravasationoffluidpotentiallycontainingbloodormacromolecules,andresultingcorticalorsubcorticaledema.ThetypicalimagingfindingsofPRESaremostapparentashyperintensityonFLAIRimagesintheparietooccipitalandposteriorfrontalcorticalandsubcorticalwhitematter;lesscommonly,thebrainstem,basalganglia,andcerebellumareinvolved.Ontheleftimagesofapatientwithreversibleneurologicalsymptoms.Theabnormalitiesareseenbothintheposteriorcirculationaswellasinthebasalganglia.Continue.

PRESDiagnosis:MELASDiagnosis:MELAS謝謝2010.06.22謝謝2010.06.22后面內(nèi)容直接刪除就行資料可以編輯修改使用資料可以編輯修改使用后面內(nèi)容直接刪除就行主要經(jīng)營：網(wǎng)絡(luò)軟件設(shè)計、圖文設(shè)計制作、發(fā)布廣告等公司秉著以優(yōu)質(zhì)的服務(wù)對待每一位客戶，做到讓客戶滿意！主要經(jīng)營：網(wǎng)絡(luò)軟件設(shè)計、圖文設(shè)計制作、發(fā)布廣告等致力于數(shù)據(jù)挖掘，合同簡歷、論文寫作、PPT設(shè)計、計劃書、策劃案、學(xué)習(xí)課件、各類模板等方方面面，打造全網(wǎng)一站式需求致力于數(shù)據(jù)挖掘，合同簡歷、論文寫作、PPT設(shè)計、計劃書、策劃感謝您的觀看和下載Theusercandemonstrateonaprojectororcomputer,orprintthepresentationandmakeitintoafilmtobeusedinawiderfield感謝您的觀看和下載Theusercandemonstr腦梗死的血管定位腦梗死的血管定位內(nèi)容腦供血動脈解剖腦梗死的血管定位內(nèi)容腦供血動脈解剖人腦動脈解剖人腦動脈解剖腦動脈兩大體系頸內(nèi)動脈系：大腦前部＋部分間腦

椎基底動脈系：

大腦后部＋部分間腦＋腦干＋小腦小腦幕為界頂枕溝為界（3/2)腦動脈兩大體系頸內(nèi)動脈系：大腦前部＋部分間腦小腦幕為界頂枕溝腦動脈供血系統(tǒng)模式圖腦動脈供血系統(tǒng)模式圖腦的主要供血動脈。(A)腦腹側(cè)觀。方塊區(qū)域放大圖顯示W(wǎng)illis動脈環(huán)。(B)腦外側(cè)面觀和(C)中間矢狀面顯示大腦中/前/后動脈。(D)冠狀切面顯示大腦中動脈行程。腦的主要供血動脈。(A)腦腹側(cè)觀。方塊區(qū)域放大圖顯示W(wǎng)頸內(nèi)動脈系統(tǒng)MCA＋ACA＋脈絡(luò)叢前動脈頸內(nèi)動脈系統(tǒng)MCA＋ACA＋脈絡(luò)叢前動脈大腦中動脈（MCA）供血范圍MCAACAPCAMCA皮質(zhì)支供應(yīng)：半球外側(cè)面（額中回以下、中央前后回下3/4、頂下小葉、枕葉月狀溝或枕外側(cè)溝以前、顳下回上緣或上半以上的部分）；島葉；顳極內(nèi)外側(cè)；額葉眶面一部分。大腦中動脈（MCA）供血范圍MCAACAPCAMCA皮質(zhì)支供MCA中央支供應(yīng)：殼核、尾狀核、內(nèi)囊前肢、內(nèi)囊膝的背外側(cè)和內(nèi)囊后肢的背部區(qū)域。立體看，供應(yīng)內(nèi)囊上3/5MCA中央支供應(yīng)：殼核、尾狀核、內(nèi)囊前肢、內(nèi)囊膝的背外側(cè)和內(nèi)腦梗死的血管定位課件大腦中動脈（MCA）供血范圍大腦中動脈（MCA）供血范圍大腦前動脈（ACA）血液供應(yīng)ACA皮質(zhì)支供應(yīng)：半球內(nèi)側(cè)面為頂枕裂以前皮質(zhì)和胼胝體；在背外側(cè)面達額中回上緣或上半、額上回、中央前后回上1/4、頂上小葉及眶部內(nèi)側(cè)半等區(qū)域。ACA中央支供應(yīng)：部分額葉眶面皮質(zhì)、外囊、尾狀核和豆狀核前部、內(nèi)囊前肢和內(nèi)囊膝部和后肢前邊部分。大腦前動脈（ACA）血液供應(yīng)ACA皮質(zhì)支供應(yīng)：半球內(nèi)側(cè)面為頂腦梗死的血管定位課件脈絡(luò)叢前動脈：→側(cè)腦室下角的脈絡(luò)叢，并供應(yīng)外側(cè)膝狀體、內(nèi)囊后肢的后下部、大腦腳底的中1/3、蒼白球等，易形成血栓阻塞。脈絡(luò)膜前動脈的供血范圍左圖詳示：基底節(jié)區(qū)的血液供應(yīng)。脈絡(luò)叢前動脈：→側(cè)腦室下角的脈絡(luò)叢，并供應(yīng)外側(cè)膝狀體、內(nèi)囊后腦梗死的血管定位課件脈絡(luò)膜前動脈脈絡(luò)膜前動脈，1～4支，以3支最多，為一組較細小而恒定的血管，在后交通動脈起始遠側(cè)2mm處由頸內(nèi)動脈脈直接發(fā)出。該動脈在未穿入側(cè)腦室下腳之前，除發(fā)1～3個皮質(zhì)支外，還發(fā)出2～3個穿支，1支穿視神經(jīng)內(nèi)側(cè)至大腦腳，另兩支即為紋狀體內(nèi)囊動脈。此動脈主要營養(yǎng)尾狀核尾，行程長，管徑較小，易發(fā)生栓塞。脈絡(luò)膜前動脈脈絡(luò)膜前動脈，1～4支，以3支最多，為一組較細小D.AxialT2-weightedimage(2500/80)revealsthepresenceofaninhomogeneousmassintherightlateralventricle.Thelowsignalintensitysuggetsthepresenceofcalcificationandhemorrhage.E.Angiogramoftherightinternalcarotidarteryobtainedonday3demonstratesahypervascularmassfedfromtherightanteriorchoroidalartery(arrows).D.AxialT2-weightedimage(250WhichoneistheAnteriorChoroidalArtery?WhichoneistheAnteriorChor腦梗死的血管定位課件脈絡(luò)膜前動脈閉塞常引起三偏癥狀群，特點為偏身感覺障礙重于偏癱，而對側(cè)同向偏盲又重于偏身感覺障礙，有的尚有感覺過度、丘腦手、患肢水腫等。脈絡(luò)膜前動脈內(nèi)囊額狀斷面腦后片圖顯示各部位血液供應(yīng)來源。內(nèi)囊額狀斷面腦后片圖顯示各部位血液供應(yīng)來源。中央前回及中央后回的血液供應(yīng)圖中央前回及中央后回的血液供應(yīng)圖椎基底動脈系統(tǒng)VA＋BA椎基底動脈系統(tǒng)VA＋BA椎動脈（VA）①V1（骨外）段：向上進C6橫突孔。②V2（椎間孔段③V3（脊椎外）段：④V4（硬膜內(nèi)段）：過枕骨大孔，在腦橋及延髓交界處合成基底動脈。近側(cè)椎動脈段解剖（A側(cè)位；B前后位；C頦頂位）：骨外段（V1）橫突孔段（V2）椎外段（V3）4.硬膜內(nèi)段（V4）5.枕骨髁的大概位置椎動脈行程圖A：斜側(cè)位觀；圖B：前后位觀；圖C：俯觀。椎動脈（VA）椎動脈行程圖A：斜側(cè)位觀；圖B：前后位觀；圖C1.左椎動脈2.腦膜后動脈3.小腦后下動脈（PICA）4.基底動脈5.小腦前下動脈(AICA)6.腦橋外側(cè)支7.小腦上動脈（SCA）8.大腦后動脈9.小腦半球支大水平裂10.SCA的小腦半球分支11.小腦蚓上動脈椎基底動脈系統(tǒng)及其分支解剖（側(cè)位）：椎基底動脈系統(tǒng)及其分支解剖（側(cè)位）：椎基底動脈系統(tǒng)及其分支解剖（正位）：1.右椎動脈2.左椎動脈3.脊髓前動脈4.小腦后下動脈（PICA）5.基底動脈6.小腦前下動脈（AICA）7.腦橋外側(cè)支8.小腦上動脈（SCA）9.大腦后動脈10.后交通動脈11.頸內(nèi)動脈椎基底動脈系統(tǒng)及其分支解剖（正位）：1.右椎動脈腦梗死的血管定位課件大腦后動脈（PCA）血液供應(yīng)中央支：丘腦、下丘腦、底丘腦、膝狀體以及大部分中腦。此外，分支到側(cè)腦室及第三腦室脈絡(luò)叢。變異大。主要來自PCA（72.5-88.3%）；來自ICA（6.8-20.2%）；兩部分平均參加（4.3-11%）。大腦后動脈（PCA）血液供應(yīng)中央支：丘腦、下丘腦、底丘腦、膝PCA供血區(qū)模式圖皮質(zhì)支：半球底面和內(nèi)側(cè)面一部分（包括：海馬回、梭狀回、顳下回、舌回、窟窿回峽、楔葉、楔前葉后1/3及頂上小葉后部）PCA供血區(qū)模式圖皮質(zhì)支：半球底面和內(nèi)側(cè)面一部分（包括：海馬Bloodsupplyofthethreesubdivisionsofthebrainstem.Diagramofmajorsupply.Sectionsthroughdifferentlevelsofthebrainstemindicatingtheterritorysuppliedbyeachofthemajorbrainstemarteries.Bloodsupplyofthethreesubd腦橋的血液供應(yīng)特點橋腦的血供源自椎—基底動脈，橋腦基底外側(cè)和被蓋部由短旋動脈供應(yīng)；橋腦基底部內(nèi)側(cè)由基底動脈中央支供應(yīng)，旁正中支供應(yīng)橋腦被蓋部正中部分—腦室底部、外展神經(jīng)核、內(nèi)側(cè)縱束和網(wǎng)狀結(jié)構(gòu)；橋腦基底部和被蓋部最外側(cè)為長旋動脈供應(yīng)。由于外側(cè)區(qū)側(cè)支循環(huán)豐富，發(fā)生梗塞概率較低。而橋腦旁正中動脈、短旋動脈呈直角起自基底動脈，易受高血壓的影響而出現(xiàn)動脈粥樣硬化，易出現(xiàn)梗塞。腦橋的血液供應(yīng)特點橋腦的血供源自椎—基底動脈，橋腦基底外側(cè)和腦橋梗死的臨床特點貌似大腦半球病變的純運動性偏癱占橋腦梗塞的60.9%。這是因為錐體束位于橋腦基底部，基底部由基底動脈的旁正中深穿支供應(yīng)血流，該部位動脈易有動脈硬化性改變和透明變性，其近端閉塞時導(dǎo)致基底部正中梗塞，使未交叉的錐體束受損。PICA和SCA引起的梗塞通常僅累及小腦；而AICA（供應(yīng)腦橋外側(cè)被蓋部和小腦中腳）不同，它引起的梗塞灶多累及腦干和小腦中腳。腦橋梗死的臨床特點貌似大腦半球病變的純運動性偏癱占橋腦梗塞的橋腦梗塞時交叉性癱及顱神經(jīng)麻痹并不常見，因橋腦的顱神經(jīng)核多分部于被蓋部，由較豐富的長旋動脈及小腦上動脈供應(yīng)血流，后交通動脈、大腦后動脈和小腦上動脈有側(cè)枝循環(huán)，所以顱神經(jīng)可不受影響。腦橋梗死的臨床特點橋腦梗塞時交叉性癱及顱神經(jīng)麻痹并不常見，因橋腦的顱神經(jīng)核多分腦橋上/中部旁中線綜合征由基底動脈旁中央支血供障礙引起；病變對側(cè)中樞性舌癱＋對側(cè)中樞性上下肢癱瘓＋同側(cè)小腦性共濟失調(diào)Patientswithunilateralparamedianinfarctionstypicallypresentedapuremotorhemiparesisthatprogressedoverthefirst3daysandwasaccompaniedbydysarthriaandhomolateralataxia.腦橋上/中部旁中線綜合征由基底動脈旁中央支血供障礙引起；Pa橋腦上外側(cè)綜合征小腦上動脈閉塞引起；①眩暈、惡心、嘔吐、眼球震顫（前庭核損害）②兩眼向病灶側(cè)水平凝視不能（腦橋側(cè)視中樞損害）③同側(cè)肢體共濟失調(diào)（腦橋臂、結(jié)合臂、小腦齒狀核損害）；④同側(cè)Horner綜合征（下行交感神經(jīng)損害）⑤同側(cè)面部感覺障礙（三叉神經(jīng)感覺束損害）和對側(cè)痛覺、溫度覺障礙（脊髓丘腦束損害）；⑥對側(cè)下肢深感覺障礙（內(nèi)側(cè)丘系外側(cè)部分損害）⑦雙側(cè)聽力障礙，對側(cè)較重。橋腦上外側(cè)綜合征小腦上動脈閉塞引起；少見SCA綜合征出現(xiàn)病變對側(cè)感音性耳聾少見SCA綜合征出現(xiàn)病變對側(cè)感音性耳聾腦梗死的血管定位課件腦橋腹下部綜合征

（Millard-GublerSyndrome)同側(cè)外展N麻痹＋同側(cè)周圍性面癱對側(cè)中樞性舌癱一；對側(cè)肢體癱。也其它位置不同的突出癥狀可能出現(xiàn)小腦前下動脈阻塞引起。腦橋腹下部綜合征

（Millard-GublerSyndr腦梗死的血管定位課件腦橋基底內(nèi)側(cè)綜合征

（FovilleSyndrome)

病灶側(cè)周圍性面癱；兩眼向病灶側(cè)同向注視麻痹；病灶對側(cè)偏癱；基底動脈旁正中支閉塞引起。腦橋基底內(nèi)側(cè)綜合征

（FovilleSyndrome)

病小腦后下動脈綜合征

（Wallenbergsyndrome)現(xiàn)證實10％由PICA引起，75％由一側(cè)椎動脈閉塞引起。余下由基底動脈閉塞引起。小腦后下動脈綜合征

（Wallenbergsyndrome腦梗死的血管定位課件延髓內(nèi)側(cè)綜合征

（Dejerine綜合征）

椎動脈及其分支或基底動脈后部血管阻塞，引起延髓錐體發(fā)生梗死時產(chǎn)生同側(cè)舌肌麻痹（XII腦神經(jīng)損害）和萎縮，對側(cè)上下肢中樞性癱瘓以及觸覺、位置覺、振動覺減退或喪失。延髓內(nèi)側(cè)綜合征

（Dejerine綜合征）

椎動脈及其分支或Magneticresonanceimageofthefluidattenuatedinversionrecoverysequencefortheaxial(left)andT2weightedcoronal(right)sections.Thereisawelldemarcatedunilateralmedialmedullaryinfarctjustbelowthepontomedullaryjunction.Therightsideofeachimagecorrespondstotheleftsideofthebrain.Magnetic大腦動脈血管供血分區(qū)CT解剖(圖文)大腦動脈血管供血分區(qū)CT解剖(圖文)MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支PCA終末支脈胳膜前動脈MCA終末支ACA終末支PCA終末支脈胳膜前動脈MCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支PCA穿支及PCoAMCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支MCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支PCA穿支及PCoAMCA穿支MCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支MCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支PCA穿支及PCoAMCA穿支MCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支MCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支PCA穿支及PCoAMCA穿支MCA終末支ACA終末支PCA終末支脈胳膜前動脈ACA穿支MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支PCA終末支MCA終末支ACA終末支MCA終末支ACA終末支ACA終末支ACA終末支腦梗死的血管定位課件腦梗死的血管定位課件腦梗死的血管定位課件腦的供血模式圖腦的供血模式圖腦梗死的血管定位課件腦梗死的血管定位課件腦梗死的血管定位課件腦梗死的血管定位課件左枕葉梗死。（PCA終末支）左枕葉梗死。（PCA終末支）Figure1:(a)NormalinitialCTofthepatient;(b)ThecranialCTtwodaysaftertheincidentshowssignalchangesconsistentwithsimultaneousinfarctsintherightMCAandPCAareas;(c)InthedigitalsubtractionangiographyoftherightICA,PCAisseentooriginatefromtherightICAthroughPCoAi.e.fetaltypePCAFigure1:(a)NormalinitialCPICAOntheleftCT-imagesofaleft-sidedPICA-infarction.Noticetheposteriorextention.Theinfarctionwastheresultofadissection(bluearrow).PICAOntheleftCT-imagesofaleft-sidedPICA-infarction.Inunilateralinfarctsthereisalwaysasharpdelineationinthemidlinebecausethesuperiorvermianbranchesdonotcrossthemidline,buthaveasagittalcourse.Thissharpdelineationmaynotbeevidentuntilthelatephaseofinfarction.Intheearlyphase,edemamaycrossthemidlineandcreatediagnosticdifficulties.Infarctionsatpontinelevelareusuallyparamedianandsharplydefinedbecausethebranchesofthebasilarareryhaveasagittalcourseanddonotcrossthemidline.Bilateralinfarctsarerarelyobservedbecausethesepatientsdonotsurvivelongenoughtobestudied,butsometimessmallbilateralinfarctscanbeseen.OntheleftCT-imagesofalefSCAOntheleftCT-imagesofacerebellarinfarctionintheregionofthesuperiorcerebellararteryandalsointhebrainstemintheterritoryofthePCA.Noticethelimitationtothemidline.SCAACA：?A1segment:fromorigintoanteriorcommunicatingarteryandgivesrisetomediallenticulostriatearteries(inferiorpartsoftheheadofthecaudateandtheanteriorlimboftheinternalcapsule).?A2segment:fromanteriorcommunicatingarterytobifurcationofpericallosalandcallosomarginalarteries.?A3segment:majorbranches(medialportionsoffrontallobes,superiormedialpartofparietallobes,anteriorpartofthecorpuscallosum).ACA：AnteriorchoroidalarteryTheterritoryoftheanteriorchoroidalarteryencompassespartofthehippocampus,theposteriorlimboftheinternalcapsuleandextendsupwardstoanarealateraltotheposteriorpartofthecellamedia.ThewholeareaisrarelyinvolvedinAChAinfarcts.Ontheleftanuncommoninfarctioninthehippocampalregion.PartoftheterritoryoftheanteriorchoroidalarteryandthePCAareinvolved.AnteriorchoroidalarteryMiddlecerebralarteryTheMCAhascorticalbranchesanddeeppenetratingbranches,whicharecalledthelaterallenticulo-striatearteries.Theterritoryofthelaterallenticulo-striateperforatingarteriesoftheMCAisindicatedwithadifferentcolorfromtherestoftheterritoryoftheMCAbecauseitisawell-definedareasuppliedbypenetratingbranches,whichmaybeinvolvedorsparedininfarctsseparatelyfromthemaincorticalterritoryoftheMCA.OntheleftaT2W-imageofapatientwithaninfarctionintheterritoryofthemiddlecerebralartery(MCA).Noticethatthelaterallenticulo-striateperforatingarteriesoftheMCAarealsoinvolved(orangearrow).MiddlecerebralarteryOntheleftimagesofahemorrhagicinfarctionintheareaofthedeepperforatinglenticulostriatebranchesoftheMCA.OntheleftimagesofahemorrOntheleftenhancedCT-imagesofapatientwithaninfarctionintheterritoryofthemiddlecerebralartery(MCA).Thereisextensivegyralenhancement(luxuryperfusion).Sometimesthisluxuryperfusionmayleadtoconfusionwithtumoralenhancement.OntheleftenhancedCT-imagesPosteriorcerebralartery(PCA)DeeporproximalPCAstrokescauseischemiainthethalamusand/ormidbrain,aswellasinthecortex.SuperficialordistalPCAinfarctionsinvolveonlycorticalstructures(4).Ontheleftapatientwithacutevisionlossintherighthalfofthevisualfield.TheCTdemonstratesaninfarctioninthecontralateralvisualcortex,i.eleftoccipitallobe.Posteriorcerebralartery(PCATherearetwopatternsofborderzoneinfarcts:1.CorticalborderzoneinfarctionsInfarctionsofthecortexandadjacentsubcorticalwhitematterlocatedattheborderzoneofACA/MCAandMCA/PCA2.InternalborderzoneinfarctionsInfarctionsofthedeepwhitematterofthecentrumsemiovaleandcoronaradiataattheborderzonebetweenlenticulostriateperforatorsandthedeeppenetratingcorticalbranchesoftheMCAorattheborderzoneofdeepwhitematterbranchesoftheMCAandtheACA.TherearetwopatternsofbordOntheleftthreeconsecutiveCT-imagesofapatientwithanocclusionoftherightinternalcarotidartery.Thehypoperfusionintherighthemisphereresultedinmultipleinternalborderzoneinfarctions.Thispatternofdeepwatershedinfarctionisquitecommonandshouldurgeyoutoexaminethecarotids.OntheleftthreeconsecutiveOntheleftimagesofapatientwhohassmallinfarctionsintherighthemisphereinthedeepborderzone(bluearrowheads)andalsointhecorticalborderzonebetweentheMCA-andPCA-territory(yellowarrows).Thereisabnormalsignalintherightcarotid(redarrow)asaresultofocclusion.Inpatientswithabnormalitiesthatmayindicateborderzoneinfarcts,alwaysstudytheimagesofthecarotidarterytolookforabnormalsignal.OntheleftimagesofapatienOntheleftanotherexampleofsmallinfarctionsinthedeepborderzoneandinthecorticalborderzonebetweentheMCA-andPCA-territoryinthelefthemisphere.OntheleftanotherexampleofOntheleftanexampleofinfarctionsinthedeepborderzoneandinthecorticalborderzonebetweentheACA-andMCA-territory.Theabnormalsignalintensityintherightcarotidistheresultofanocclusion.Thiscombinationoffindingsissocommon,thatonceyouknowthepattern,youwillseeitmanytimes.Ontheleftanexampleofinfa脈絡(luò)膜前動脈供血區(qū)梗死脈絡(luò)膜前動脈供血區(qū)梗死A9-year-oldpreviouslyhealthygirlwasadmittedtotheEmergencyRoomwithaneight-hourhistoryofsuddenonsetofsevereheadach