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1、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 lobeCerebellumBasal ganglia,thalamusBrainstem,midbrain,Subarachnoid spaces(蜘蛛網膜下腔,CSF spaces),Ventricles(腦室)-lateral,3rd,4th ventriclesCisterns(腦池)-suprasellar,quadrigeminal cisterns(四疊體腦池)
2、.Fissures(腦裂)-Sylvian,interhemispheric fissuresSulci(腦溝),F:frontal lobe P:pons T:temporal lobes:suprasellar cistern(碟鞍上腦池)Ce:cerebellum d:dorsum sella,F,T,Ce,s,P,d,parietal lobe,4th V,F,T,Mb,Ce,F:frontal lobe Mb:midbrain T:temporal lobes:suprasellar cistern(碟鞍上腦池)Ce:cerebellum,s,Temporal lobe,pariet
3、al lobe,F,Qc,Mb,3v,T,O,F:frontal lobeSy:Sylvian fissureT:temporal lobeO:occipital lobeMb:midbrain3v:3rd ventriclelv:lateral ventricleCC:corpus callosum(genu)Qc:quadrigeminal cistern(四疊體腦池),Sy,CC,parietal lobe,lv,F,P,O,Sp,CC,F:frontal lobeCC:corpus callosumP:parietal lobeSp:splenium of CCO:occipital
4、lobe lv:lateral ventricles:sulcus,parietal lobe,lv,s,s,F,P,Ci,CS,If,F:frontal lobeIf:interhemisphericP:parietal lobe fissureCi:cingulumcs:central sulcusCS:centrum semioval,cs,parietal lobe,p,g,c,t,i,c:caudate nucleus尾狀核 p:putamen被核 g:globus pallidus 蒼白核 t:thalamus 視丘i:internal capsule 內囊,Basal gangl
5、ia,lv:lateral ventricle,frontal horn3v:3rd ventricleqc:quadrigeminal cisternSy:Sylvian fissure,sc:suprasellar cisternaq:aqueductth:temporal horn of lateral ventricle,認識腦室及腦池,Sy,th,3v,lv,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,Extracere
6、bral 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.,同側撞擊同側出血,Counter-coup Injury,Dura(硬腦膜),Subdural(硬腦膜下),Epidural(硬腦膜上),二.Extracerebral lesionsEpidural hematomaSubdural hematom
7、aSubdural effusion,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,血塊內含較灰區(箭)，代表正在出血中，有
8、未凝結的血塊,EDH：紡垂型，高濃度血塊頭皮腫(箭)，撞擊處,Acute Subdural Hematoma,Sickle-shape(鐮刀型)or new lunar shape(新月型)of hyperdense lesion over large portion of cerebral hemisphereThe hematoma may extending into the subdural space of tentorial region or interhemispheric fissure,SDH：新月型(A.B)SDH可能在interhemispheric fissure內(
9、C)。SDH也可在tentorium下(D)(不要誤為腦內出血),A,B,C,D,Acute Subdural Hematoma,Chronic Subdural hematoma,Shape:Semilunar,Fusiform,Oval shapeDensity:HyperdenseIsodenseHypodenseMixed density,Chronic Subdural Hematoma,T1WI,T2WI,methemoglobin,Hyperintense Subdural Hematoma,Subdural Effusion,Occurred in aged patient o
10、r infantDeveloped several days later after a head injuryOften bilateralSpontaneously resorbedCraniotomy,V-P shunt,meningitis also may cause subdural effusion,Subdural Effusion,4 days later 10 days later,Intracerebral Lesions,Brain contusion 腦挫傷(edema,hemorrhage.)Subarachnoid hemorrhage(SAH)蜘蛛網膜下腔出血I
11、ntraventricular 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 hematomaCircumscribed area of brain edema 局部腦水腫：很少見Diffuse brain edemaDiffuse axonal injury 廣泛神經軸受傷,Brain Contusion,Punctate hemorrhages and edemas in the subcortical white matt
12、er of left frontal lobe(A)and corpus callosum(B,C),A,B,C,Head injury,GCS:3Diffuse axonal injury(DAI),Traumatic SAH,Often associates with other intracerebral or extracerebral lesionsCT findings:Linear high density in the subarachnoid spaces(sulci,fissures,cisterns)May cause hydrocephalus,Traumatic SA
13、H,1,1,2,3,4,5,5,2,1.SDH2.EDH3.Contusion hemorrhage and edema4.IVH(外傷性腦室內出血)5.SAH(外傷性蜘蛛網膜下腔出血)SAH：在腦溝、腦裂、腦池內 看到出血,5,Open Cranial Injury,Skull fracture Pneumoencephalus,頭部外傷後遺症,廣泛腦萎縮(Diffuse brain atrophy)腦室積水(Hydrocephalus)腦組織軟化(Encephalomalacia),86,5,14Acute SDH&contusionhemorrhage,86,5,16Post-crani
14、otomy,the SDH disappeared,delayed hemorrhage;SAHin Rt.tentorium,86,8,13Encephalomalaciachange with mild hydrocephalus,Decompression hemorrhagewith encephalomalacia change,1st day,4 months later-brain atrophy,5th day,Coma after head injury4 months later,semi-vegetate stage,Multiple punctate hemorrhages,Diffuse axonal injury(DAI)caused brain atrophy,86,9,10:Communicating hydrocephalus,86,2,6:Traumatic SAH in the sulci,interhemispheric fissure,SAH caused communicatinghydrocephalus,To Be Continued.,
