CVD 浙大英文课件

深穿支动脉为出血的主要部位，豆纹动脉是脑出血最好发部位，其外侧支称为出血动脉The mainly hemorrhagic sites are the perforating branches of middle cerebral artery, the most common sites of ICH are lenticulostriate arteries, lateral branches of those are called hemorrhagic arteries.基底节区Basal ganglia 70%脑叶Cerebral lobe 10%脑干Brain stem 10%小脑齿状核区Cerebellar dentate nucleus 10%粟粒状动脉瘤:大脑中动脉深穿支豆纹动脉>基底动脉脑桥支>大脑后动脉丘脑支>小脑上动脉分支>顶枕交界区和颞叶分支Granulous aneurysm : the lenticulostriate arteries > branches of the basilar artery supplying the pons > thalamic branches of the posterior cerebral arteries > branches of the superior cerebellar arteries > some arteries supplying the junctional zone between parietal and occipital lobe and branches of temporal lobe临床表现clinical manifestations (1)年龄50-70岁，男>女Age 50-70 years. The incidence is higher in men than in women冬春季多发Mostly occurrs in winter and spring.多有高血压史Usually with hypertension.活动或情绪激动时发生Occurrs when activities or emotional excitement.数分钟至数小时症状达高峰Neurologic deficits may progress over minutes to hours.全脑症状：头痛、呕吐、意识改变Global cerebral symptom: headache, vomiting, alterd consciousness临床表现clinical manifestions (2)1. 基底节区出血（内囊区出血）占70%，其中壳核（内囊外侧型）60%，丘脑（内囊内侧型）10%。

The most common site of hemorrhage is basal ganglia, which occurs in 70% of patients. It consists of putamen (lateral of the internal capsule) and thalamus (medial of the internal capsule) . (1)壳核出血：三偏，双眼向病灶对侧同向凝视不能，主侧半球有失语。

(1) Putaminal hemorrhage: hemiplegia, hemisensory deficit, hemiopia, impairment of syntropic gaze to the contralateral lesion, aphasia with dominant hemisphere临床表现clinical manifestions (3)(2)丘脑出血：丘脑膝状动脉和丘脑穿通动脉。

三偏，上下肢程度相近，深浅感觉障碍，特征性眼征，意识障碍，中线症状，锥体外系症状，丘脑性失语，精神症状。

(2)Thalamic hemorrhage: the thalamic genual artery and the long penetrating thalamic artery. hemiplegia, hemisensory deficit, hemiopia, hemiplegia affecting the arm and leg to a roughlyequal extent, impairment of superficial and deep sensation, marked ocular sign, impairment of consciousness, symptoms of the median line, the extrapyramidal symptoms, the thalamic aphasia, mentalsymptoms.临床表现clinical manifestions (4)(3)尾状核头部出血：少见。

脑膜刺激征，无明显瘫痪，头痛，呕吐，颈强，Kernig征(+)，可有对侧中枢性面、舌瘫(3)Hemorhage in the head of the caudate nucleus: seldom. meningeal irritation sign, unobvious paralysis, headache, vomiting, neck stiffness, positive Kernig’s sign, the facial and hypoglossal paralysis caused by contralateral upper unit opathy.临床表现clinical manifestions(5)2.脑桥出血:10%，多位于脑桥基底与被盖部之间。

2. Pontine hemorrhage: 10%, mostly occurs between the basal pons and the tegmen.大量出血(>5ml)：常破入四脑室。

昏迷，针尖样瞳孔，呕吐，中枢性高热，中枢性呼吸困难，眼球浮动，四肢瘫，去大脑强直发作，多在48小时内死亡。

Massive hemorrhage(>5ml): usually ruptures into the fourth ventricle. Coma, pinpoint pupils, vomiting, central fever, central dyspnea, impairment of horizontal eye movements, quadriplegia, decerebrate rigidity, usually leads to death within 48 hours.临床表现clinical manifestions (6)小量出血：交叉性瘫，共济失调性偏瘫，双眼向病灶侧凝视或核间性眼肌麻痹。

Small hemorrhage: crossed paralysis, ataxic-hemiplegia, both eyes gaze to the ipsilateral lesion or internuclear ophthalmoplegia.3.中脑出血：罕见．Hemorrhage in diencephalon: seldom.轻症：一侧或双侧动眼神经不全瘫痪，Weber综合征Mild case: unilateral or bilateral oculomotor nerve partial paralysis, Weber’s syndrome.重症：深昏迷，四肢弛缓性瘫，迅速死亡Severe case: deep coma, flaccid quadriplegia, rapidly go to death临床表现clinical manifestions (7)4.小脑出血：10%，小脑齿状核动脉多发。

发病初期有眩晕，呕吐，枕部头痛，平衡障碍，无肢体瘫痪。

4.Cerebellar hemorrhage: 10%, usually occurs in the artery supplying dentate nucleus.The symptoms including vertigo, vomiting, occipital headache and disorders of equilibrium, but not quadriplegia appear at onset of bleeding.临床表现clinical manifestions (8)轻症：一侧肢体笨拙，行动不稳，共济失调，眼震，无瘫痪。

Mild case: clumsiness of unilateral body, unstable movement, ataxia, nystagmus, no paralysis.重症：双眼向病灶对侧凝视，吞咽发声困难，锥体束征，一侧瞳孔缩小，光反应迟钝，脑干受压表现，甚至枕大孔疝。

Severe case: both eyes gaze at the contralateral lesion, difficulty in swallowing and dysphonia, pyramidal sign, constriction of unilateral pupil , bluntness in response to light, signs of brainstem compression, even foramen magnum herniation.临床表现clinical manifestations (9)5.脑叶出血：10%，以顶叶最常见。

头痛，呕吐，脑膜刺激征，局灶症状，抽搐较多见。

5.Lobar hemorrhage:10%, the most common site is parietal lobe. Headache, vomiting, Meningeal irritation sign, focal brain sign, sizure额叶：偏瘫，Broca失语，摸索。

Frontal lobe: hemiplegia, broca’s aphasia, crocidismus.临床表现clinical manifestations (10)颞叶：Wernicke失语，精神症状。

Temporal lobe: Wernicke’s aphasia, mental symptoms.枕叶：视野缺损。