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 lobe Cerebellum Basal ganglia, thalamus Brainstem, midbrain,Subarachnoid spaces (蜘蛛網膜下腔, CSF spaces),Ventricles (腦室)- lateral, 3rd, 4th ventricles Cisterns (腦池)- suprasellar, quadrigeminal cisterns (四疊體腦池). Fissures (腦裂)- Sylvian, interhemispheric fissures Sulci (腦溝),F: frontal lobe P: pons T: temporal lobe s: 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 lobe s: suprasellar cistern (碟鞍上腦池) Ce: cerebellum,s,Temporal lobe,parietal lobe,F,Qc,Mb,3v,T,O,F: frontal lobe Sy: Sylvian fissure T: temporal lobe O: occipital lobe Mb: midbrain 3v: 3rd ventricle lv: lateral ventricle CC: corpus callosum (genu) Qc: quadrigeminal cistern (四疊體腦池),Sy,CC,parietal lobe,lv,F,P,O,Sp,CC,F: frontal lobe CC: corpus callosum P: parietal lobe Sp: splenium of CC O:occipital lobe lv: lateral ventricle s: sulcus,parietal lobe,lv,s,s,F,P,Ci,CS,If,F: frontal lobe If: interhemispheric P: parietal lobe fissure Ci: cingulum cs: central sulcus CS: 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 ganglia,lv: lateral ventricle, frontal horn 3v: 3rd ventricle qc: quadrigeminal cistern Sy: Sylvian fissure,sc: suprasellar cistern aq: aqueduct th: 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,Extracerebral 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 site30% 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 lesions Epidural hematoma Subdural hematoma Subdural 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 hemisphere The hematoma may extending into the subdural space of tentorial region or interhemispheric fissure,SDH：新月型(A.B) SDH可能在interhemisphericfissure內(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 shape Density: Hyperdense Isodense Hypodense Mixed density,Chronic Subdural Hematoma,T1WI,T2WI,methemoglobin,Hyperintense Subdural Hematoma,Subdural Effusion,Occurred in aged patient or infant Developed several days later after a head injury Often bilateral Spontaneously resorbed Craniotomy, 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 Intraventricular 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 hematoma Circumscribed area of brain edema 局部腦水腫：很少見 Diffuse brain edema Diffuse axonal injury 廣泛神經軸受傷,Brain Contusion,Punctate hemorrhages and edemas in the subcortical white matter of left frontal lobe (A) and corpus callosum (B,C),A,B,C,Head injury, GCS:3 Diffuse axonal injury (DAI),Traumatic SAH,Often associates with other intracerebral or extracerebral lesions CT findings:Linear high density in the subarachnoid spaces (sulci, fissures, cisterns) May cause hydrocephalus,Traumatic SAH,1,1,2,3,4,5,5,2,1. SDH 2. EDH 3. Contusion hemorrhageand edema 4. 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 fracturePneumoencephalus,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 ),86,5,14 Acute SDH & contusion hemorrhage,86,5,16 Post-craniotomy, the SDH disappeared, delayed hemorrhage; SAH in Rt. tentorium,86,8,13 Encephalomalacia change with mild hydrocephalus,Decompression hemorrhage with encephalomalacia change,1st day,4 months later-brain atrophy,5th day,Coma after head injury 4 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 communicating hydrocephalus,To Be Continued.,