2022年医学专题—指非外伤性脑实质内出血.pptVIP免费

(CerebralHemorrhage)定义(dìngyì)：指非外伤性脑实质内出血DepartmentofNeurology,The2ndaffiliatedhospital,KunmingMedicalcollege第一页，共六十页。Itmeansprimaryandnontraumaticintracerebralhemorrhage.第二页，共六十页。Halfofthepatientssufferfromhypertensioncombinedwitharteriolaratherosclerosis,itisthemostcommoncauseofthedisease.第三页，共六十页。高血压——小动脉：纤维素样坏死(huàisǐ)fibrinoidnecrosis、脂质透明变性hyalinefattychange、microaneurysm小动脉瘤、微夹层动脉瘤——渗出exudation、破裂rupture第四页，共六十页。脑内动脉：壁薄、中层(zhōngcéng)肌细胞及外膜结缔组织少、缺乏外弹力层——随年龄增长弯曲呈螺旋状——出血主要部位：深穿支penetratingarteries第五页，共六十页。一次出血(chūxiě)常在30min内停止第六页，共六十页。HypertensiveICH：基底节的内囊(nèinánɡ)区intercapsule、壳核putamen占70%，脑叶lobe、脑干brainstem、小脑齿状核区各占10%第七页，共六十页。HypertensiveICH：cerebralpenetratingarterymiliaryaneurysm第八页，共六十页。Swellingandcongestionofhemisphere第九页，共六十页。age：50~70yearsoldsex：moremalepatients第十页，共六十页。一般症状：中年以上发病。起病突然，第十一页，共六十页。：内囊(nèinán)ɡ“三偏征”第十二页，共六十页。基底节区的血液(xuèyè)供应豆纹动脉的破裂(pòliè)成因第十三页，共六十页。Thetwomostcommonsitesofhypertensivehemorrhagearetheputamen(figure1)andthalamus(figure2),whichareseparatedbytheposteriorlimboftheinternalcapsule.Ingeneral,putaminalhemorrhageleadstoamoreseveremotordeficit(hemiplegia)andthalamichemorrhagetoamoremarkedsensorydisturbance(hemianesthesia).第十四页，共六十页。Homonymoushemianopiamayoccurasatransientphenomenonafterthalamichemorrhageandisoftenapersistentfindinginputaminalhemorrhage.Inlargethalamichemorrhages,theeyesmaydeviatedownward,asinstaringatthetipofthenose,becauseofimpingementonthemidbraincenterforupwardgaze.第十五页，共六十页。Aphasiamayoccurifhemorrhageateithersiteexertspressureonthecorticallanguageareas.第十六页，共六十页。丘脑(qiūnǎo)出血thalamushemorrhage:第十七页，共六十页。Wi...