从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大脑前动脉大脑前动脉前交通动脉穿支irregularityandnarrowingofthesupracallosalbranchofthepericallosalarteryNarrowingofbothcavernouspartoftheinternalcarotidarteriesandbothmiddlecerebralarteries.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.2.3.5.6.7.9.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-weightedMRIshowsdorsalisthmuslesionthatextendstothemidbrainarea.MRangiogramshowsfocalstenosisoftherightposteriorcerebralartery(arrow).Numbersindicatepatients’numbers.LesionsresponsibleforinternuclearophthalmoplegiaaremarkedasR.更多精彩……