ct及mri断面解剖.pptVIP

腦 部---- (1) 腦部的正常CT及MRI解剖 腦部解剖構造---Brain Parenchyma(腦實質) Cerebrum : frontal lobe, temporal lobe, parietal lobe, occipital lobe Cerebellum Basal ganglia, thalamus Brainstem, midbrain Subarachnoid spaces (蜘蛛網膜下腔, CSF spaces) Ventricles (腦室)--- lateral, 3rd, 4th ventricles Cisterns (腦池)--- suprasellar, quadrigeminal cisterns (四疊體腦池)…. Fissures (腦裂)--- Sylvian, interhemispheric fissures… Sulci (腦溝) 頭 部 外 傷 Classification of Head Injury 腦外病灶 ( Extracerebral Lesions ) 腦內病灶 ( Intracerebral Lesions ) 其他傷害 頭部外傷的後遺症 Extracerebral Lesions Epidural hematoma （硬腦膜上腔血腫） Subdural hematoma ( 硬腦膜下腔血腫 ) Subdural effusion( 硬腦膜下積水 ） Counter-coup Injury The lesion is in the opposite side of impact site 30% incidence. Acute Epidural Hematoma Fusiform (紡綞狀) or biconvex (雙凸狀) hyperdense lesion 腫塊效應強，可造成herniation(疝脫） The hematoma still contains uncoagulated blood, or still has active bleeding. Round , stream-like filling defects may be seen in the hematoma. 需緊急處理 Acute Epidural Hematoma Acute Subdural Hematoma Sickle-shape (鐮刀型) or new lunar shape (新月型) of hyperdense lesion over large portion of cerebral hemisphere The hematoma may extending into the subdural space of tentorial region or interhemispheric fissure Acute Subdural Hematoma Chronic Subdural hematoma Shape: Semilunar, Fusiform, Oval shape Density: Hyperdense Isodense Hypodense Mixed density Chronic Subdural Hematoma Hyperintense Subdural Hematoma Subdural Effusion Occurred in aged patient or infant Developed several days later after a head injury Often bilateral Spontaneously resorbed Craniotomy, V-P shunt, meningitis also may cause subdural effusion Subdural Effusion Intracerebral Lesions Brain contusion 腦挫傷(edema, hemorrhage..) Subarachnoid hemorrhage (SAH)蜘蛛網膜下腔出血 Intraventricular hemorrhage (IVH) 腦室內出血 Brain Contusion Brain edema mixed with multiple small hemorrhages 腦水腫合併出血 ：最常見 Solitary hematoma Circumscribed area of brain edema 局部腦水腫：很少見 Diffuse brain edema Diffuse axonal injury 廣泛神經軸受傷 Brain Contusion H