脑疝ppt课件
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• A subfalcine herniation, the most common cerebral herniation pattern, is characterised by displacement of the brain (typically the cingulate gyrus) beneath the free edge of the falx cerebri due to raised intracranial pressure.
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cause
• Any intra-cranial mass can have this effect, including: -intracranial haemorrhage -cerebral swelling -tumours -cerebral abscess
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Subfalcine herniation
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Radiographic features
• CT
• The easiest method of evaluating for subfalcine shift is a straight line drawn in the expected location of the septum pellucidum from the posterior most aspects to the falx on axial images. Shift of the septum pellucidum from this midline can be measured in millimeters and compared over time to determine any change.
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Descending
• Descending transalar herniation occurs as a result of frontal lobe mass effect. There is posterior and inferior displacement of the posterior aspect of the frontal lobe orbital surface over the sphenoid wing. Small herniations involve only the orbital gyri while larger herniations may include the gyrus rectus.
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Type
• subfalcine herniation • transalar herniation
-downward -upward • transtentorial herniation（小脑幕裂孔疝）
-downward (uncal herniation)
-upward (ascending transtentorial herniation) • tonsillar herniation小脑扁桃体疝
• Asymmetry at the anterior falx with a widened CSF spaces on the contralateral anterior falx. There may be ipsilateral lateral ventricle compression with contralateral lateral ventricular dilation.
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• MRI
• Findings are best visualized on coronal MR imaging. Unilateral mass effect from pathology in the frontal, parietal or temporal region, such as intracranial haemorrhage or tumour, causes displacement of the brain away from the mass.
Morning Conference
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Cerebral herniation
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• Cerebral herniation (also referred to as acquired intracranial herniation) refers to shift of cerebral tissue from its normal location, into an adjacent space .
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Complications
• contralateral hydrocephalus (due to obstruction of the foramen of Monro)
• anterior cerebral artery territory infarct (due to compression of ACA branches).
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Transalar herniation
• Transalar herniation describes herniation of brain matter in and around the middle cranial fossa and can be ascending or descending. Compression of structures against the sphenoid bone results in symptoms.
• ACA infarction occurs as the cingulate sulcus extends under the falx dragging the ipsilateral anterior cerebral artery with it. If this becomes compressed against the falx occlusion can lead to a distal anterior cerebral artery infarction and thus the clinical symptom of contralateral leg weakness.
精选ppt
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cause
• Any intra-cranial mass can have this effect, including: -intracranial haemorrhage -cerebral swelling -tumours -cerebral abscess
精选ppt
5
Subfalcine herniation
精选ppt
6
Radiographic features
• CT
• The easiest method of evaluating for subfalcine shift is a straight line drawn in the expected location of the septum pellucidum from the posterior most aspects to the falx on axial images. Shift of the septum pellucidum from this midline can be measured in millimeters and compared over time to determine any change.
精选ppt
10
Descending
• Descending transalar herniation occurs as a result of frontal lobe mass effect. There is posterior and inferior displacement of the posterior aspect of the frontal lobe orbital surface over the sphenoid wing. Small herniations involve only the orbital gyri while larger herniations may include the gyrus rectus.
精选ppt
3
Type
• subfalcine herniation • transalar herniation
-downward -upward • transtentorial herniation（小脑幕裂孔疝）
-downward (uncal herniation)
-upward (ascending transtentorial herniation) • tonsillar herniation小脑扁桃体疝
• Asymmetry at the anterior falx with a widened CSF spaces on the contralateral anterior falx. There may be ipsilateral lateral ventricle compression with contralateral lateral ventricular dilation.
精选ppt
7
• MRI
• Findings are best visualized on coronal MR imaging. Unilateral mass effect from pathology in the frontal, parietal or temporal region, such as intracranial haemorrhage or tumour, causes displacement of the brain away from the mass.
Morning Conference
精选ppt
1
Cerebral herniation
精选ppt
2
• Cerebral herniation (also referred to as acquired intracranial herniation) refers to shift of cerebral tissue from its normal location, into an adjacent space .
精选ppt
8
Complications
• contralateral hydrocephalus (due to obstruction of the foramen of Monro)
• anterior cerebral artery territory infarct (due to compression of ACA branches).
精选ppt
9
Transalar herniation
• Transalar herniation describes herniation of brain matter in and around the middle cranial fossa and can be ascending or descending. Compression of structures against the sphenoid bone results in symptoms.
• ACA infarction occurs as the cingulate sulcus extends under the falx dragging the ipsilateral anterior cerebral artery with it. If this becomes compressed against the falx occlusion can lead to a distal anterior cerebral artery infarction and thus the clinical symptom of contralateral leg weakness.