脑卒中基本知识

脑卒中基本知识 cerebrovascular diseases,脑血管疾病Cerebrovascular Diseases， CVD,在脑血管病变或血流障碍基础上发生的局限性或弥漫性脑功能障碍 the cerebral diseases that are resulted from various cerebrovascular diseases,病因etiopathogenisis,高血压性脑动脉硬化(cerebral arteriosclerosis)脑动脉粥样硬化(cerebral atherosclerosis)心脏病(cardiac disease)先天性脑动脉病变(inborm arteriosis)脑动脉炎(cerebral arteritis)肿瘤(ambury)外伤(surgical trauma)血液病(hematologic disease),急性脑血管疾病分类classification of acute cerebrovascular diseases,短暂性脑缺血发作（transient ischemic attack TIA）颈动脉系统(internal carotid artery system) TIA椎基底动脉系统(basilar-vertebral artery system)TIA脑卒中（stroke, apoplexy, cerebrovascular accident）蛛网膜下腔出血（subarachnoid hemorrhage）脑出血（intracerebral hemorrhage, ICH）脑梗死 (cerebral infarction) 动脉血栓性脑梗死 (arterothrombotic cerebral infarction)脑栓塞(cerebral embolism)腔隙性脑梗死(lacunar infarction), 等,其他分类的脑血管疾病,椎基底动脉供血不足（Vertebrobasilar arterial insufficiency）脑血管性痴呆（cerebral vascular dementia）高血压脑病（hypertensive encephalopathy）颅内动脉瘤（intracranial aneurysm）颅内血管畸形（intracranial vascular malformation）脑动脉炎（cerebral arteritis）颅内静脉、静脉窦血栓形成（thrombosis of venous sinus）颅外段动、静脉疾病其他动脉疾病,颈内动脉系统internal carotid artery system,眼动脉(ophthalmic artery后交通动脉(posterior communicating artery)脉络前动脉(anterior choroidal artery)大脑前动脉(anterior cerebral artery)大脑中动脉(middle cerebral artery),椎-基底动脉系统vertebrobasilar circulation,椎动脉vertebral artery基底动脉basilar artery大脑后动脉posterior cerebral artery,脑的供血区域及临床表现,颈内动脉系统(internal carotid artery)又称前循环,供应额、颞、顶叶和基底核等大脑半球前3/5血流椎-基底动脉系统（basilar-vetebral artery)又称后循环，供应小脑、脑干、丘脑和枕、颞叶等大脑半球后2/5血液,脑动脉的细小分支,穿通支（perforating branch）间脑、纹状体、内囊、脑干基底部中线旁结构皮质支（cortical branch） 大脑半球皮质及皮质下白质与脑干的背外侧,脑底动脉环大脑中动脉近端基底动脉,脑动脉的侧支循环compensatory circulation,Willis环的构成双侧颈内动脉 internal carotic artey双侧大脑前动脉 anterior cerebral artey双侧大脑后动脉 posterior cerebral artery前交通动脉 anterior communicating artery双侧后交通动脉 posterior communicating artery,其他侧支循环,大脑前、中、后动脉皮质支在大脑表面彼此交通颈内、外动脉围绕眼耳、鼻、的深浅分支互相吻合大脑动脉皮质支与来自颈外动脉的脑膜动脉分支也存在丰富的侧支吻合分水岭脑梗死cerebral watershed infarction,脑的静脉(cerebral veins),大脑上静脉大脑中静脉大脑下静脉superior,middle,inferior cerebral veins,上矢状窦Superior sagittal sinus海绵窦sinus横窦Transverse sinus,大脑大静脉Great cerebral vein,直窦Straight sinus,颈内静脉Internal carotidvein,已状窦Sigmoid sinus,下矢状窦Inferior sagittal sinus,大脑镰静脉Falx cerebral vein,脑静脉的结构特点construction features of vena encephali,管腔大，管壁薄，缺乏弹力纤维无静脉瓣大多不与动脉伴行静脉窦由坚韧的硬脑膜围成，内衬一层内皮细胞,脑血流及其调节blood circulation regulation,脑血供丰富。在正常情况下，脑血流量（CBF）具有自动调节作用：CBF=（MAP-ICP）r4/（8L）。在缺血或缺氧的病理状态下，脑血管的自动调节机制紊乱，血管扩张或反应异常，脑水肿和颅内压升高，就会出现缺血区的充血和过度灌注或脑内盗血现象。,脑血管病的危险因素risk factor,高血压(hypertension)糖尿病(diabetes)心脏病(heart dieases)高脂血症(hyperlipemia)TIA 或脑卒中史(historic stroke)吸烟(smoking)和酗酒(heavy alcohol consumption)等不可干预的因素,基本病因etiopathogenisis,血管壁病变(dissepiment disorde