CNSTrauma竺可青2014-3-11Classificationofheadinjurybyclinicopathologicalcorrelation

根據臨床病理聯系的腦損傷分類Classificationofheadinjurybyneuroradiologicalandneuropathologicalfeatures根據神經放射學和神經病理學特點分類Classificationofheadinjurybymechanismofproduction根據產生機制分類Anarrestedgrowingfracturethatpresentedinawomanof38.Whenaskedaboutchildhoodinjuries,sherememberedthatshefallenoutofhercarriageasaveryyoungchild.A.PlainskullX-ray.B.Theexcisedportionofbone.顱骨骨折Fissuredfracture線性骨折Depressedfracture凹陷型骨折Penetratedfracture孔狀骨折Comminutedfracture粉碎性骨折Burstingfracture崩裂性骨折沖擊點傷和對沖傷

Mechanismofcerebralcontusion.Arrowsindicatepointofapplicationanddirectionofforce;blackareaindicateslocationofcontusion.Smallintracorticalcontusionsintypicalsitesatthebaseoffrontal(A)andtemporallobes(B).Oldcontusionsonthebaseofthefrontallobes.Extraduralhemorrhages.硬膜外出血EDH

A.Amanof60receivedablowbehindhisear.Bruisinginthetemporailsmuscleandthislinear,right-sidedtemporalfractureoverlayalargeextraduralhemorrhage,whichwasthecauseofhisdeath5hourslater.

B,Grossappearanceofabifrontalextraduralhematoma.

C.Aclassicalextraduralhematomasituatedintheparietotemporalregion.Acuteandsubacutesubduralhematomas硬膜下血腫.SDH

A.Acutesubduralhematoma;

B.Acutesubduralhematoma;C.Subacutesubduralhematoma.慢性硬膜下血腫（腦癱小兒）

外傷后大腦中動脈閉塞性血栓栓塞梗死

DAI彌漫性軸索損傷、腦白質彌漫性變化、剪切損傷、彌漫性腦深部損傷胼胝體以及腦干前段的局灶性出血病變彌漫性腦損傷4類DAI彌漫性缺血缺氧損傷腦水腫彌漫性血管損傷FrequencyofPrincipalmacroscopiclesionindiffuseaxonalinjuryandtheiranatomicaldistribution好發部位Twodays’survivalafterinjury.

Damagedaxonsareeasilyseenonroutinestains.Beta-APPdiagnosisaxonaldamage(2h)Histologyincaseswherediffusebraininjuryissuspected

診斷DAIPatternsandcausesofhypoxicischemicbraindamageaftertraumaticbraininjury

腦外傷后的彌漫性缺血缺氧性損傷原因及類型好發部位HippocampusCA1LaminarcorticalnecrosisInfrctioninthebounadryzonesofthemajorcerebralaeteries

彌漫性血管損傷車禍后腦外傷死亡，廣泛腦出血導致死亡反復腦損傷與癡呆

兒科腦損傷VascularPathologyDistributionofthebloodinthevariousformsofintracranialhemorrhages顱內出血原因Berryaneurysm

Diffusesubarachnoidhemorrhage動脈瘤出血部位

根據出血部位判斷動脈瘤位置Giantatheroscleroticaneurysms

A.Anteriorcerebralartery.B.Basilarartery高血壓與高血壓性腦血管病基底核出血Intracerebellarhemorrhage小腦出血

突然頭痛、眩暈、嘔吐；眼震；昏迷；枕骨大孔疝迅速死亡。Brainstemhemorrhage腦干出血

延髓、中腦罕見，腦橋多見；突然發病；眼部癥狀；呼吸障礙；感覺運動障礙；深昏迷；去腦強直；數小時或24小時內死亡。

腦葉出血、皮質下白質出血額葉：精神障礙，智能障礙，近記憶力、計算力、判斷力障礙，運動性失語。顳葉：破入蛛網膜下腔出現腦膜刺激癥，感覺性或命名性失語，精神癥狀。頂葉：下肢較上肢及顏面部重的偏癱及感覺障礙。枕葉：對側偏盲，皮質盲，瞳孔光反射存在。Vascularmalformations.

A.Medialfrontalcerebralarteriovenousaneurysm.

B.VeinofGalenaneurysm.腦血管畸形主要4種動靜脈血管畸形AVM靜脈血管畸形海綿狀血管畸形毛細血管擴張Multiplelobehemorrhagesinapatientwithleukemia白血病

貧血性梗死Hemorrhagicinfarcts出血性梗死注意出血病理動態變化過程