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非增强CT显示左侧硬膜下血肿,脑组织推向右侧,脑室变窄。

These are two views of the same sagittal head CT scan without contrast demonstrating a large subdural hematoma with left to right shift and ventricular narrowing.

硬脑膜向上折起显示伸向大脑半球表面的桥静脉。外伤使其撕裂,特别是有明显脑萎缩的时候。

The dura has been reflected above to reveal the bridging veins that extend across to the superior aspect of the cerebral hemispheres. These can be torn with trauma, particularly if there is significant cerebral atrophy that exposes these veins even more.

双侧慢性硬膜下血肿。机化使血块呈现棕色到黑色之间。因为是静脉出血,硬膜下血肿比因动脉出血形成血块更慢,更隐匿,硬膜下血肿在低年龄群体和老年人更常见。

Here is a bilateral chronic subdural hematoma. The blood clots are brown to tan because of organization. Since the bleeding is venous, subdurals can form more slowly and insidiously than clots from arterial hemorrhages. Subdurals are most common in the very young and the elderly.

非增强CT显示双侧硬膜下血肿,可见右侧血肿更大。

This is a sagittal head CT scan without contrast demonstrating bilateral subdural hematomas, the right greater in size than the left.


Abbr Name of Artery Distribution
ACA Anterior Cerebral Artery Supplies most medial portions of frontal lobes and superior medial parietal lobes
AComA Anterior Communicating Artery Connects the anterior cerebral arteries at their closest juncture
ICA Internal Carotid Artery Ascends through base of skull to give rise to the anterior and middle cerebral arteries, and connect with posterior half of circle of Willis via posterior communicating artery
MCA Middle Cerebral Artery Trifurcates into temporal, frontal, and parietal branches that supply most of the parenchyma of these lobes
PComA Posterior Communicating Artery Connects the anterior circle of Willis with the posterior cerebral artery of vertebral-basilar circulation posteriorly
PCA Posterior Cerebral Artery Supplies the occipital lobe and the inferior portion of temporal lobe. A branch supplies the choroid plexus.
SCA Superior Cerebellar Artery Supplies the dorsal cerebellum, pons, and midbrain
BA Basilar Artery Formed by the junction of the two vertebral arteries, it terminates as a bifurcation into the posterior cerebral arteries
AICA Anterior Inferior Cerebellar Artery Supplies the inferior cerebellum and portions of pons and medulla
VA Vertebral Artery The vertebrals emerge from the posterior base of skull and merge to form the basilar artery
PICA Posterior Inferior Cerebellar Artery Supplies the posterior cerebellum, choroid plexus in 4th ventricle, and portions of medulla
ASA Anterior Spinal Artery Descends along the anterior (ventral) aspect of the spinal cord

大脑基底动脉环。图示一颅内小动脉瘤位于右颈内动脉末端分叉处。颅内小动脉瘤最常见的部位是前交通动脉和大脑前动脉及三支动脉(大脑中动脉、颈内动脉、后交通动脉)分叉处。在所有动脉瘤中椎基底动脉瘤发生率<10%。多重动脉瘤发生率大约在20%到30%之间。

ACA 大脑前动脉 AComA 前交通动脉
ICA 颈内动脉 MCA 大脑中动脉
PComA 后交通动脉 PCA 大脑后动脉
SCA 小脑上动脉 BA 基底动脉
VA 椎动脉 AICA 小脑下前动脉
PICA 小脑下后动脉 ASA 脊髓前动脉

The cerebral arterial circulation at the base of the brain is diagrammed here. A berry aneurysm is diagrammed at the final bifurcation of the right internal carotid artery. The most common locations for berry aneurysms are in the region of the anterior communicating and anterior cerebral, at the trifurcation of the middle cerebral, and at the bifurcation of internal carotid with posterior communicating. Vertebral-basilar aneurysms comprise <10% of cases. Multiple aneurysms occur in about 20 to 30% of cases.

在黑色卡片标出的白色箭头代表 Willis环上破裂的颅底小动脉瘤的部位。这是蛛网膜下腔出血的一介主要原因。

The white arrow on the black card marks the site of a ruptured berry aneurysm in the circle of Willis. This is a major cause for subarachnoid hemorrhage.

Willis环已被切开,可以看见 3 个颅底小动脉瘤。颅底小动脉瘤中多发性动脉瘤大约为20~30%。就出生时动脉壁缺陷这一点来看,多发性颅底小动脉瘤是先天性的,但实际上动脉瘤需要数年时间才能形成,因此颅底小动脉瘤破裂最可能在青年到中年发病。

The circle of Willis has been dissected, and three berry aneurysms are seen. Multiple aneurysms are seen in about 20-30% of cases of berry aneurysm. Such aneurysms are "congenital" in the sense that the defect in the arterial wall is present from birth, but the actual aneurysm takes years to develop, so that rupture is most likely to occur in young to middle age adults.

因动脉瘤破裂造成的蛛网膜下腔出血主要引发血管痉挛,其次才是团块损害。

The subarachnoid hemorrhage from a ruptured aneurysm is more of an irritant producing vasospasm than a mass lesion.

出血的另一个原因,特别对10~30岁的人,是血管畸形。这里看到的是位于左后顶骨区域的一团不规则,扭曲的血管。

Another cause for hemorrhage, particularly in persons aged 10 to 30, is a vascular malformation. Seen here is a mass of irregular, tortuous vessels over the left posterior parietal region.

血管造影显示颞区不规则扭曲的小血管团。

This angiogram demonstrates a tortuous collection of irregular small vessels in the temporal region of the brain.


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