学术讨论—脑干损伤.ppt

神经神经(shnjng)解剖学解剖学脑干损伤脑干损伤lesions of the brain stem 第一页，共二十三页。第二页，共二十三页。第三页，共二十三页。第四页，共二十三页。第五页，共二十三页。第六页，共二十三页。第七页，共二十三页。第八页，共二十三页。第九页，共二十三页。第十页，共二十三页。第十一页，共二十三页。第十二页，共二十三页。第十三页，共二十三页。第十四页，共二十三页。第十五页，共二十三页。第十六页，共二十三页。Medial(basal)medullary syndrome usually involves the pyramid,part or all of the medial lemniscus,and nerve XII.If it is unilateral,it is also known as alternating hypoglossal hemiplegia(Fig 712);the term refers to the finding that the cranial nerve weakness is on the same side as the lesion,but the body paralysis is on the opposite side.Larger lesions can result in bilateral defects.The area involved is supplied by the anterior spinal artery or by medial branches of the vertebral artery.第十七页，共二十三页。Lateral medullary,or Wallenbergs,syndrome involves some(or all)of the following structures in the open medulla on the dorsolateral side(see Fig 712):inferior cerebellar peduncle,vestibular nuclei,fibers or nuclei of nerve IX or X,spinal nucleus and tract of V,spinothalamic tract,and sympathetic pathways.(Involvement of the sympathetic pathways may lead to Honers syndrome.)The affected area is supplied by branches of the vertebral artery or,most commonly,the posterior inferior cerebellar artery.An example is provided in Clinical Illustration 71.第十八页，共二十三页。Basal pontine syndromes can involve both the corticospinal tract and a cranial nerve(VI,VII,or V)in the affected region,depending on the extent and level of the lesion(Fig 713).The syndrome is called alternating abducens(VI),facial(V),or trigeminal hemiplegia(V).If the lesion is large,it may include the medial lemniscus.The vascular supply comes from the perforators,or pontine branches,of the anterior inferior cerebellar artery.第十九页，共二十三页。Dorsal pons syndrome affects nerve VI or VII or their respective nuclei,with or without involvement of the medial lemniscus,spinothalamic tract,or lateral lemniscus.The lateral gaze center is often involved(see Fig 87).At a more rostral level,nerve V and its nuclei may no longer be functioning.The affected area is supplied by various perforators(pontine branches)of the circumferential arteries.第二十页，共二十三页。Peduncular syndrome,also called alternating oculomotor hemiplegia and Webers syndrome in the basal midbrain,involves nerve III and portions of the cerebral peduncle(Fig 714).There is a nerve III palsy on the side of the lesion and a contralateral hemiparesis(because the lesion is above the pyramidal decussation).The arterial supply is by the posterior perforators and branches of the posterior cerebral artery.第二十一页，共二十三页。Benedikts syndrome,situated in the tegmentum of the midbrain,may damage the medial lemniscus,the red nucleus,and nerve III and its nucleus and associated tracts(see Fig 714).This area is supplied by perforators and branches of circumferential arteries.第二十二页，共二十三页。内容(nirng)总结神经(shnjng)解剖学第二十三页，共二十三页。