医学孤立性大脑凸面蛛网膜下腔出血的病因课件.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,孤立性大脑凸面蛛网膜下腔出血的病因,病因,Vascular Malformations,Similarly,cavernomas are rarely described as a cause of SAH.,However,superficial and leptomeningeal cavernomas may be the source of cSAH.,RCVS,RCVS,Vasculitides,Vasculitides,Infectious Origin,Cortical SAH may be seen after rupture of infectious aneurysms(caused by infective endocarditis,meningitis,or rarely crypto-genically)(Fig 5).Headache is diffuse and vague,rather than the,typical,excruciating,极痛苦,headache of noninfectious aneurysmal SAH.Usually,there are also general symptoms(eg,anorexia,weight loss,malaise,or fever),In infective endocarditis,MR imaging,might show associated lesions(ischemic,microbleeds,brain abscesses).DSA might be used for the diagnosis of distal arterial lesions and for therapeutic purposes.,Infectious Origin,Infectious Origin,Infectious Origin,Moyamoya,According to a recent classification,patients with well recognized associated conditions(eg,sickle cell disease,，,neurofibromatosis type 1,cranial therapeutic irradiation,and Down syndrome)are considered as having a Moyamoya syndrome,while patients with no known associated risk factors are said to have Moyamoya disease,Moyamoya,High-Grade Stenosis,Fig 6.Pial vasodilation,.A,Axial GRE T2 image shows a left frontal sulcal SAH(black arrowhead),possibly located in the“watershed”territory between the anterior and the middle cerebralarteries.,B,Axial maximum-intensity-projection reconstruction of CTA shows an asymmetry of the distal arteries,in favor of left pial vasodilation.,C,Frontal projection of 3D angiographyof the left carotid artery reveals a severe stenosis at the origin of the M2 branch(white arrowhead).,Fig.1 A CT demonstrates a left inferior temporal SAH.,B This is confirmed on MRI.,C Several areas of restricted diffusion are seen in the left MCA region.,D Angiography demonstrates tight bilateral internal carotid stenoses,posterior reversible encephalopathy syndrome,cerebral amyloid angiopathy,cerebral amyloid angiopathy,A,Axial brain CT scan shows a subtle left rolandic hyperattenuation favoring minimal SAH(white arrowhead).,B and C,Axial GRE T2 images show left temporal lobar,hemorrhage,multiple microbleeds,and cortical hemosiderosis.,D,Axial FLAIR image obtained after 7 months shows a new asymptomatic SAH in a left parietal sulcus(white arrowhead),which was previously normal(see B),谢谢！,