影像梗死部位推测责任供血血管

从影像梗死部位推测责任供血血管,北京天坛医院神经内科杜万良,大脑前动脉,大脑前动脉,前交通动脉穿支,irregularityandnarrowingofthesupracallosalbranchofthepericallosalartery,Narrowingofbothcavernouspartoftheinternalcarotidarteriesandbothmiddlecerebralarteries.Narrowingoftherightpericallosalartery,胼胝体压部梗死，应该属于大脑后的一个分支供血,heubner动脉,heubner动脉,heubner动脉,丘脑膝状体动脉,Anteriorthalamoperforatingartery前丘脑穿通动脉（应该也叫丘脑结节动脉或者丘脑极动脉）,丘脑穿通动脉,双侧丘脑穿通动脉,双侧丘脑穿通动脉thalamoperforatingartery,..7.9.丘脑膝状体动脉，12.为丘脑膝状体动脉和脉络膜后动脉分布区,15.丘脑膝状体动脉;16.丘脑结节动脉;18.双侧丘脑结节动脉;19.上：丘脑结节动脉，下：丘脑穿通动脉;20.脉络膜后动脉;21.丘脑穿通动脉,Schematicviewofthearterialsupplytothethalamus,Figure1.(A)Lateralview;(B)viewfromabove;(C,D)detailedrelationshipbetweenthearterialterritoriesandnuclearsubgroupswithinthethalamus.1=carotidartery;2=posteriorcommunicatingartery;3=basilarartery;4=thalamogeniculatearteries;5=tuberothalamicartery;6=posteriorchoroidalartery;7=paramedianpedicle;8=posteriorcerebralartery.Mainthalamicnucleiandtracts:CL=centrallateral;CM=centromedian;Co=commissural;Cp=commissuralposterior;DM=dorsomedian;MTT=mamillothalamictract;Pua=pulvinaranterior;Pum=pulvinarmedial;Pul=pulvinarlateral;Pf=parafascicularis;R=reticular;VA=ventralanterior;VLa=ventrallateralanterior;VLp=ventrallateralposterior;VPLa=ventroposterolateralanterior;VPLp=ventroposterolateralposterior;VPM=ventroposteromedian.,Figure2.(A)Diffusion-weightedMRIofaleftanteriorthalamicinfarctinvolvingtheanteriornucleiandmamillothalamictractina58-year-oldpatientwhopresentedwithperseverations,incoherentspeechwithintrusionofprevioustopics,anddistortedmemories.(B)Schematicrepresentation(seefigure1forlegend),Figure3.(A)T2-weightedMRIshowingabilateralparamedianstrokepredominantlyontheleftsideina39-yearoldwoman.Thispatientpresentedwithimproperbehaviorandinadequateanddisinhibitedcommentstoherhusband.Threehourslater,shecomplainedshewas“notabletocontrolhereyes,”thenrapidlybecamecomatose.Cognitivetests,performed3dayslater,showedpersistentlossofself-activationandsevereamnesia.(B)Schematicrepresentation(seefigure1forlegend).,Figure6.(A)T2-weightedMRIofaleftinferolateralthalamicinfarctintheterritoryofthethalamogeniculatearteriesina58-year-oldmanshowingexecutivedysfunctionwithverbalfluencydifficulties,pathologicresponseinhibition,andpathologicconceptualability,inadditiontoarightsensoryandataxichemisyndrome.(B)Schematicrepresentation(seefigure1forlegend).,Figure4.(A)T2-weightedMRIofaunilateralleftparamedianinfarctina54-year-oldmanwho,duringcoronaryangiography,presentedsuddenverticaldiplopiaandtransienthypersomnolence.Cognitivetests,performed2dayslater,wereentirelynormalexceptforlossofselfactivation.(B)Schematicrepresentation(seefigure1forlegend).,大脑后动脉,桥脑旁正中支,双侧小脑上动脉,小脑前下动脉,小脑前下动脉,小脑前下动脉,小脑后下动脉,小脑后下动脉,双侧小脑后下动脉,双侧小脑后下动脉,基底动脉旁正中支,脊髓前动脉和椎旁正中动脉,脊髓前动脉,脊髓前动脉,脊髓前动脉,stenosisofthevertebralarteries,脊髓前动脉,脊髓后动脉,更多,说明,Patients6and15representtheanteromedialgroup,Patient6hadasmalldeepinfarct,whereasPatient15hadasimilarlesionbutitextendedtothemedialsurface.MRangiographyofthispatientshowedocclusionoftheleftposteriorcerebralartery(arrow).Patient24,representingthecombinedgroup,hadaninfarctthatinvolvedboththeanteromedialandanterolateralareas.MRangiographyshowedstenosisintheP2portionoftheleftposteriorcerebralartery(arrow).Therightposteriorcerebralarterywasalsostenosed.Patient31,representingtheanterolateralgroup,showedaninfarctintheleftanterolateralarea.MRangiographydemonstratedstenosisintheP2portionoftheposteriorcerebralartery(arrow).Patient37,representingthelateralgroup,hadaninfarctinthelateralarea.Patient40hadbilateralinfarction.MRangiographyshowednonvisualizationofthebasilarartery(arrow).,说明,(Top)Patient1.T2-weightedMRIshowsdorsalinfarctsatthelowerponsandrostralmedullaryareas.Angiogramshowsocclusionoftheleftdistalvertebralartery(whitearrow)andretrogradefillingofthebasilararteryfromtheposteriorcommunicatingarteries(blackarrow).Therewasalsoanocclusionoftheproximalportionoftherightvertebralartery(notshownhere).(Middle)Patient10.Diffusion-weightedMRIshowsadorsalpontineinfarctionthatextendsventrally.MRangiogramshowsfocalstenosisoftherightsuperiorcerebellarartery(arrow).(Bottom)Patient16.T2-weightedMRIshowsd