脑血管定位诊断 北京天坛医院神经内科 脑血管病治疗中心监护室 杨中华 供血模式图 大脑前动脉 前交通动脉穿支 双箭头 病例讨论 患者女性，73岁。突发右侧肢体无力3小时??患者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  第一天 第二天 第四天 heubner动脉 视神经和视交叉 大脑中动脉 脉络膜前动脉 脉络膜前 脉络膜前 丘脑供血 丘脑穿通 双侧丘脑穿通动脉 丘脑结节动脉 丘脑结节动脉或者丘脑极动脉 丘脑膝状体动脉 丘脑及纹状体静脉 试一试 试一试 中脑的供血 桥脑的供血 旁正中支 大脑后动脉 胼胝体压部梗死，应该属于大脑后的一个分支供血 小脑上动脉 双侧小脑上动脉 双侧小脑上动脉 小脑前下动脉 小脑后下动脉 双侧小脑后下动脉 双侧小脑后下动脉 Nodular infarction  有些人认为与一侧椎动脉发育不全有关 脊髓前动脉椎旁正中动脉   脊髓前动脉 脊髓后动脉 病例讨论 16岁女性，既往体健。引体向上时突发头颈部疼痛，当天出现右侧偏瘫 脉络膜前还是后交通动脉 谢谢 资料来自于叩诊锤论坛 http://max.book118.com/forum/view.asp?id=4867 * 北 京 天 坛 医 院 Beijing Tiantan Hospital * 北 京 天 坛 医 院 Beijing Tiantan Hospital --------从梗死部位推测供血血管           病例分享 * 北 京 天 坛 医 院 Beijing Tiantan Hospital * * Figure 2-35. Drawings showing the most common CT locations of infarcts in the anterior circulation in patients with ICA occlusions; infarcts are shown by hatched gray: (A) wedge-shaped MCA infarct; (B) entire MCA territory; (C) superior division MCA; (D) inferior division MCA; (E) ACA; (F) ACA and MCA; (G) striatocapsular infarct; (H) wedge-shaped, anterior watershed infarct; (I) wedge-shaped, posterior watershed infarct; (J) anterior and posterior watershed infarcts; (K) linear internal watershed infarct; (L) oval-shaped, deep watershed infarct; (M) small white-matter watershed infarct. (Adapted from Ringelstein E, Zeumer H, Angelou D: The pathogenesis of strokes from internal carotid artery occlusion. Stroke 1983;14:867-875.) Figure 2-36. Drawings showing the most common infarct patterns in patients with embolic strokes. (Adapted from Ringelstein EB, Koschorke S, Holling A, et al: Computed tomographic pattern of proven embolic brain infarctions. Ann Neurol 1989;26:759-765.) Figure 6-12. Common patterns of infarction with MCA occlusion: (A) normal cerebral hemisphere in coronal section, (B) occlusion of the upper trunk of the MCA, (C) occlusion of the lower trunk of the MCA, (D) infarct of the deep basal ganglia, (E) wedge infarct in the pial territory, and (F) whole MCA occlusion. max.book118.com.max.book118.com.9.丘脑膝状体动脉，12.为丘脑膝状体动脉和脉络膜后动脉分布区  15.丘脑膝状体动脉16.丘脑结节动脉18.双侧丘脑结节动脉19.上：丘脑结节动脉，下：丘脑穿通动脉20.脉络膜后动脉21.丘脑穿通动脉 Figure 1. MR-FLAIR sequence showing right PCA infarction (A to C) with involvement of cortical, TGA (B) (arrowhead), and PChA (C) (arrowhead) territory.MRA with occlusion of P2 segment of right PCA (D) (arrowhead).B图箭头属于丘脑膝状体动脉供血区C图箭头属于脉络膜后外动脉供血区（这个部位的梗死往往容易误诊为前循环梗死）D图MRA显示右侧大脑后动脉P2段闭塞  A图提示大脑脚受累，说明这个部位为大脑后动脉供血（容易忽视）B图箭头属于丘脑膝状体动脉供血区C图箭头属于脉络膜后外动脉供血区（这个部位的梗死往往容易误诊为前循环梗死）D图提示右侧大脑后动脉P1段闭塞  Figure 3. DWI showing restricted diffusion caused by left PCA infarction (A to C) with involvement of TGA (B) (arrowhead) and PChA (C) (arrowhead) territory. MRA with occlusion of P1 segment of left PCA (D) (arrowhead).B图箭头属于丘脑膝状体动脉供血区C图箭头属于脉络膜后外动脉供血区（这个部位的梗死往往容易误诊为前循环梗死）D图提示左侧大脑后动脉P1段闭塞  C图箭头属于丘脑膝状体动脉供血区E图MRA提示右侧PCA闭塞 Fig. 2. Pre- (a) and post-operative cerebral angiogram of carotid artery demonstrating vasospasm at supraclinoid carotid

脑血管定位诊断.ppt