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,midbrainSubarachnoid 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).Fiss
2、ures(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 sellaFTCesPdparietal lobe4th VFTMbCeF:frontal lobe Mb:midbrain T:temporal lobes:suprasellar cistern(碟鞍上腦池)Ce:cerebellumsTemporal lobeparietal lobeFQcMb3vTOF:fron
3、tal lobeSy:Sylvian fissureT:temporal lobeO:occipital lobeMb:midbrain3v:3rd ventriclelv:lateral ventricleCC:corpus callosum(genu)Qc:quadrigeminal cistern(四疊體腦池)SyCCparietal lobelvFPOSpCCF:frontal lobe CC:corpus callosumP:parietal lobeSp:splenium of CCO:occipital lobe lv:lateral ventricles:sulcusparie
4、tal lobelvssFPCiCSIfF:frontal lobe If:interhemisphericP:parietal lobe fissureCi:cingulumcs:central sulcusCS:centrum semiovalcsparietal lobepgctic: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 ganglialv:lateral ventricle,frontal horn3v:3rd ventricleqc:qu
5、adrigeminal cisternSy:Sylvian fissureqcsf3vlvsc:suprasellar cisternaq:aqueductth:temporal horn of lateral ventricle認識腦室及腦池 scaqthSyth3vlv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 hem
6、atoma(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.Scalp swellingEDH同側撞擊同側出血Counter-coup InjuryDura(硬腦膜)Subdural(硬腦膜下)Epidural(硬腦膜上)二.Extracerebral lesionsEpidural hematomaSubdural hematomaSubdural effusionAcute Epidural Hematoma
7、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，有未凝結的血塊EDH：紡垂型，高濃度血塊頭皮腫(箭)，撞擊處Acute Subdural H
8、ematomaSickle-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 fissureSDH：新月型(A.B)SDH可能在interhemispheric fissure內(C)。SDH也可在tentorium下(D)(不要誤為腦內出血)ABCDAcute Subdura
9、l HematomaChronic Subdural hematomaShape:Semilunar,Fusiform,Oval shapeDensity:HyperdenseIsodenseHypodenseMixed densityChronic Subdural HematomaT1WIT2WImethemoglobinHyperintense Subdural HematomaSubdural EffusionOccurred in aged patient or infantDeveloped several days later after a head injuryOften b
10、ilateralSpontaneously resorbedCraniotomy,V-P shunt,meningitis also may cause subdural effusionSubdural Effusion4 days later 10 days laterIntracerebral LesionsBrain 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 ContusionBrain edema mixe
11、d 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 ContusionPunctate hemorrhages and edemas in the subcortical white matter of left frontal lobe(A)and corpus callosum(B,C)ABCHead injury,GCS:3D
12、iffuse axonal injury(DAI)Traumatic SAHOften associates with other intracerebral or extracerebral lesionsCT findings:Linear high density in the subarachnoid spaces(sulci,fissures,cisterns)May cause hydrocephalusTraumatic SAH112345521.SDH2.EDH3.Contusion hemorrhage and edema4.IVH(外傷性腦室內出血)5.SAH(外傷性蜘蛛網
13、膜下腔出血)SAH：在腦溝、腦裂、腦池內 看到出血5Open 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&contusionhemorrhage86,5,16Post-craniotomy,the SDH disappeared,delayed hemorrhage;SAHin Rt.tentorium86,8,13Encephalomalaciachange
14、with mild hydrocephalusDecompression hemorrhagewith encephalomalacia change1st day4 months later-brain atrophy5th dayComa after head injury4 months later,semi-vegetate stageMultiple punctate hemorrhagesDiffuse axonal injury(DAI)caused brain atrophy86,9,10:Communicating hydrocephalus86,2,6:Traumatic SAH in the sulci,interhemispheric fissureSAH caused communicatinghydrocephalusTo Be Continued.
