Tải bản đầy đủ (.doc) (90 trang)

điện quang thần kinh phạm minh thông

Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (915.81 KB, 90 trang )

Điện quang thần kinh

I. Giải phẫu:
1.1 Giải phẫu nhu mô não
1.1.1. Giải phẫu thùy não:

!"#
$%&'()*#
+,-#
.
1.1.2.Các hạch nền(các nhân xám trung tâm)
/#,0123,-'(
4'5678'9:5;
<*(= 9*> ?@ A,B
;" C 06*5
;"'DE !=*56
,-'(5*5,-55'5
FD >G,-
FD5G,-5
1.1.3. Đồi thị5<6'C
Đồi thị:
"'(
"H
"
Vùng dới đồi
-I CJ#*,#
*5,-(4
K59,B L*> ?
,$*
/ C
Hypothalamus:


-K5,0,,-4
FC,0A41'6
A,M964N*N
OP>, LQA0%?9
*5R ? <'. .78 AP4$<
SCA2
1.1.4. Myelin hóa của não.
OE./KI*5?GTG#$#*5U3%*L
"7A$:$(VW
&@-1:$(XW
-Y Z
G54'Y 0TB6 9<C 9
Đặc điểm hình ảnh CHT của não:
%#
;FA[*3\69,?1-
X
OEX;X;/]
X;]^V;] !
_;]+^`;]a$
b;
X
V
_
`
b
c
OEV;/2
X;F^V;"'D
_;F5^`;d0
b;/#^c;dCJ

;/12*G*52@-e8
)%#@&@f74%
T*
1.2. HÖ thèng n·o thÊt.
1.2.1. Gi¶i phÉu:
/1'('(,.*5'(B*1_5EH61
'(*=g61'(@,0
;)T,-
;)T+G,-#
;)T$G,-
"1'B*1'B=
B)*#61'C
;"J
;",M
;"9
;"(9
;IBH CJ
"1'BB
;-'(*J4=
gK#%
;-#=g&&
;-*B44#B
1.2.2. C¸c biÕn thÓ cña v¸ch trong suèt:
"*#B
;OE,#T4
1'(g
;hij[,GU&6!@XbjGL
;"@<61-%Dk,
71;
"E1

;"9,B,-#4*#B6%'L21e%%@
*#B
;hijGU&6XbjGL
"GAH1
"*'<Tl#g
1.2.3. Gi¶i phÉu vïng tuyÕn tïng:
IJ-
;"#1_
;"H CJ
I@'EL49
;Xij*@Xi8 0
;bij*@GfVi
;I@@<0'%-49
;m-'EL4*@nXi
1.3. Gi¶i phÉu vïng tuyÕn yªn:
1.3.1. TuyÕn yªn:
9( o5 
V
OEX;_;OeB1
X;)T1'(^V;1'(
_;/l1'(^`;)Ta$
b;)T+^c;Kg^p;1'
h;",MJ1'^q;"(9
1'^Xi;/B)*#^XX;1`^
XV;BHr^X_6Kg&&
X`;'("`*5gK#%^Xb;"#(
Xc;0@,"`
;*9CBTN%&0Be(46'5
9,6s/O&,&^@-e(/O
;#CBT#51_6'5922*5I#,&##^L8

-eV
m-9 (/OY[,t
;u5_h ^@<XiGf>E6vXi@
;m-Vb
;9,B** C
;"#J
;8 >A%(BTB.=
1.3.2. BÓ trªn yªn :
IJ- ",-(5YB(
;/@E#b(,Y=0
;/@Ec9Y
5,0'( 
;/@ W#
;SJ6J
;/www6wI6I
;9(;
F<@<*J*5B(
?7B(g
1.3.3. Xoang hang
K52x57
''Z6'(@
;d?.6 B.
;/0%#Zww6wI6IX6IV*5Iw
/ f*52
;xY
;x*:
;x5H
;x'
;/2 (*5
;y' !

1.4. HÖ thèng m¹ch m¸u
1.4.1. §éng m¹ch c¶nh ngoµid?.5@h-
d?,(
d?0(
d?z
d?[
d?+
d?*5
d?$
d?5
{d?5@
-
d?5H
d?5H
,|=g*
_
OEX;`;S.,Q*B(62
X;9(^V;,M^_;umwww^`;uwI
b;uIX^c;uIw^p;y'a^h;d?
.^q;0a'.B^Xi;"1www^
XX;SJ^XV;F<((^X_;/
%42x
X`;ya$a$^Xb;Ia C
Xc;uIV^Xp;u,9(
d?02B
/[626}*5Y
d?'%+6 ?
BY
{/ ?1,
5'C

T ?.
;'(
;5*B(
;/ ?Y
T ?.5
;d?5H
;d?5,|
;d?'*P
;/4 ?+
T ?#B
;d?5#
1.4.2. §éng m¹ch c¶nh trong: @` 
df%@'(6'Y 0T
5.6@@<( V`
d2$ 
;/@01-1(|,
;d?Px*5#H
;d?.Px
,&H*5
d2
;59(#
;'(
d2*5 ((
(2,@EH)6@b 
;/b5 (4.
2  7tT
!2$ B#
;/`B#BH  7*5

;/_ 2

BHBB#*5B
;/VB,0(
2
;/X,0B4 ?.
2
d(B( 57
;d?Y
;d((L%1
;d?#
;d?5;
`


OEX;b;)$ C ?.5
X;d,(^V;d0(^_;d?
az^`;d?[^b;d+^
c;d#^p;da$^h;
d?5
q;d.
OEX;c;)$ C ?.
X;d. f^V;579
(^`;dY^b;d#^c;d#
OEX;p;Oe ?#BA
E(
X;d#B^V;d5#^
_;d<#a^`;d<
aa^b;A^c;d2(0
^p;d<(^h;d
(^q;da
1.4.3. HÖ thèng ®éng m¹ch th©n nÒn.

d?#B5 0(4 ? Pqbj6bj
Lo,1 ? P21,R9,T= ?4H ?
 P*5 ?.;Vbj ?#B'(@9B
6Vbj ?#B9$'(,.;d?#BLg
4T/c 9/X6}@<'Y 0*5gT/`;
Chia ®o¹n vµ c¸c nh¸nh cña ®éng m¹ch sèng.
d*fP57
;/$
;/4#B
;d?5#
d#Z557
;d?4
;d?<#w/s
§éng m¹ch th©n nÒn.
;"<
;d?<(
;/ ?2(
;d?#;
1.4.4.§a gi¸c Willis: @ 4
Vbj6% 0 4Vbj
d?. (B(
dsX4 ?'(
d?
/ ?#
dX4 ?#
1.4.5. C¸c ®éng m¹ch n·o
§éng m¹ch n·o tríc: 5?>
4 ?.
d sX
;T(4 9g ?

;/'D<*H61,
0 *5,0'
;d?B sX
;d?=[o4O&'&
21,TsVbij6sX`bj6
1, 0 6'D6,-
'
dsV
;T ? 9g>
;d?=[o4O&'&
;/R
;"Y
">
;d?*A<
;d?*A
§éng m¹ch n·o gi÷a: 5>14
b
OEX;h;)$ C.,QeBdA
X;d#B^V;d?r#Ba^_;d?
<#a^`;dA^b;d<a
a^c;/2(0^p;d?#;
OEX;q;d?.a9t
X;FL(2a$ ^V;FL(BY^_;d
. 2a$ ^`;y,^
b;;d'<4d
a^c;d1*P
=R( CJ^p;dsXd
a^h;dsV^q;dXa
%&#*#4dH^XX;/ ?
'D*1,2^

XV;/g=B.dH
X_;/*34dH#
'.2a$#Z;
OEX;Xi;d.(a9(
X;y,d.^V;d5a
2(*5#Ta$C= CJ
1^_;;da^`;d=<
^b;;d*A<^c;"*3(4
dH^p;/g>,,-(45^
h;daLBg1,,-(##*
aL~/'L5BYg^q;/
*32B4dH^Xi;dY;
?.6@C 
dX Z
;T(4 9g4
 ?H
;"'(@ ?'D*'(6
1,'D6
?,0 6'
dZVTg6Vphj6_
XVj*5%&)*#
;/ .
d_ &%&)*#
'A[
'0 6@@
;"@(1,**5 !
;"@1,$
§éng m¹ch n·o sau:
dX
;T(4 9 ?#

 #
;/2(*5 CJ#
dV
;T# 9
;/ CJ
;d?#
/>*3
C¸c biÕn thÓ cña ®éng m¹ch n·o.
d?.
;/PC,4 ?
.*fB* ?#BA
d?.5
;d?5H T ?Y
; f>R4
dW#
;<#. ?#
;<#.%@sX
;d?#,'YCT
?.6
%1 ?#B%|,6
,Bo,<#.%@X
;S.#. ?#
1.4.6. C¸c vßng nèi cña ®éng m¹ch n·o.
"BH.*5.5
;/45* ?Y
;"[* ?Y
;/BG5 ?+60(65H
;/.5B*.P Be*5B* ?.
"BH.P*5 ?
c

OEX;XX;S.,Q W#
;/.5B* ?5H6=57B*
5 <B* ?*5H
;/.5B*5v ?A;
"BH ?
;"BH'(= ?
;d?.B* ?#=#
;d?.v ?nv#v
 ?A;
;/ ?B*=5;
1.5.Mµng n·o vµ hÖ thèng tÜnh m¹ch.
1.5.1. Mµng n·o:
+Mµng cøng:
556'Z[?,#Z6-*5'.2$#Z
57@AgC*5#Z5*A6A<6A
<6,B(;
57?*5'((*
{KA
;OEAG LH,'0
;G,-#?$G,-
;-'*53556,-#*5|+*5A<
;/@?#B2'(2Z(6Z62t
{KA<
;/@EA66,5*(A*5A
;--*53#562$ 6,-#-*52$+
;/72t*52'(
;FLHR
{u,,4B(
;IP9,1,354B(
;GH@g4,M9(

57(/KI*5?GT A8rZ8-e
+ Mµng mÒm
5e5#B',4
5
;K553A',4-*5'A[.
?%&
;F=BB*5*5*5(
%%W•'*5%5@<*%e;;;
5A8-e(|,?GT
;/@A5nX
;dLA
;1%(|
1.5.2. C¸c khoang mµng n·o.
{Khoang ngoµi mµng cøng:
IJ-5576H[?,#Z*5[557
K5%.6%>%@| +'@57%3[?,#Z
/@(=[€*6$%,Q>%'J1$
?*5x562x
+ Khoang díi mµng cøng:
p
IJ-H57*55e
K5%.6!@-J'(
K(=[€(}@$%1$xBH
x*3*52x;
+ Khoang díi nhÖn:
IJ-H5e*55
/7J46*eB1*5J%e4
K(=>9*/ ?,0='<
(}@$%1$;
1.5.3. HÖ thèng n·o thÊt.

+ N·o thÊt bªn:
/@1'(6E/
FC#T6$6+61
"B*1_,-=g
/7 B1*5B(|*1_
F9<'EL
;m-'(%'
;&?'(?,0
;"*#B&@G'561 %#6@<CGU
3^?#BLo,*"'(
;"G'L,-#*#BZ&<6%D**
#B
+ Lç Monro:
KgfEH•B"'(*"_
+ N·o thÊt 3.
"G LH,-"'(
/1J6,M*5((G,-#
"B*"'(=g6"`=B)*#
dB5G0"6B*"'(=g
1.5.4. C¸c bÓ n·o.
F< IJ- /5,0'(
C¸c bÓ n·o ë hè sau
F<4#B ",-4 / ?#B6 ?
4#*56myww
F<4# ",-#4 /d<#6
<6mwy6y6yw
F<0 "=0 d#BA6(44
d<#*5
('(6mIw
F<@0< "H2$

$*5<60
*5A<
d<6@<@
 (6mI6Iww6
Iwww
F<(< SHA<*5 <(6
h
?6'0<
*5B*'<4#
G,-(
?(
BÓ ®¸y ( hay bÓ trªn
yªn)
F<=B "HB dA6(4
d2(*5 CJ*5d
#6mwww
F<J'<
((
",-(B( dBd.6
21,d*5
H6d56
#&6mJ6/
<N*N6"_;
C¸c bÓ ë gian n·o
F<'= "=6B
*'<((6=
0*5'<4
#
d?#6A6
?<(6

0%wI6x
;
F<4# "#9*5
4#6B*'<
=*5'<
<(;
96,0#"'6
?#6
S&*5A#&
C¸c bÓ trªn bªn
F<)*& "H] .*52
$#Z6B*'<(
(
d?H*5
4@6x6
4dH
/%e
*P#Z
O'('0 d?x*3

‚&ƒ&&&#&ƒ
1.5.5. Níc n·o tñy.
{/$<@%.Xbi
{"4 o#%.bii„5
hbj B6=Z1"_
Xbj51=
{K4J4%._0„5L#7 >,4
"4 T"'(#"_=g6#"`=B)*#
T"`4=g'(*5# <*5'<B#6LN
!?o13*5BH4;

) @,0""(0(A*5'<((6'<=
B6%e'0 
?,0"" 2B%5e4
{'B4
q
)$ CJ4;
Vij"
bij%e
_ij%e4
{O1,|""
0"" o1,|=N45e215
2Z(*52'(
?,0=51
?,0=5
?,0=eB'0%*54#B;
II. BÖnh lý m¹ch m¸u.
2.1.Ch¶y m¸u trong n·o:(intracranial Hemorhage)
K5?! J[,11,7*A e=0%;
/|,Y,*-*5?GT@ ?1+ 65%2k 0
 <+ ,'e*C*51$#Z;
2.1.1.BiÓu hiÖn trªn CLVT:
 {S 1,-n_5
8rZhiXii…O#*`ibi…O
8rZ,&{&'@@
m8rZ9&1,nh„
Oe7%B
{S '1,_X`5
86 C.rZ#*
@,&&'T**5
Oe7%B.

{S -vV0
S.rZ
2.1.2. BiÓu hiÖn trªn céng hëng tõ.
/1f7@7@-1T-%
JT6>T61>T6#YT;05E('*5
2('*5&2(' <26#YG†&ww;mO'%3
e05E<@'EL%l1 6O''J'91 ;u1e
(?GT?*55,0T-4@*5%N4f$;
DÊu hiÖu céng hëng tõ cña ch¶y m¸u trong n·o
S 
5,0
@#
)‡
'e
IJ- T- F<e(/O
X V S&
B1,*5L 2O' O9
{O/
9
'5
"J
T
C 8 .
/1,-
XV5
u2OF ml2 9
'5
>T C S. +.
F1,#
_p5

&O' 2@6
5'9
1
9
'5
>T 8 S. 1.
F1,?
X`0
&O' (4
O/
"59
'5
>T 8 8 S.
- O&#&
†&
-|#Y "59
'5
T-
#Y
S. IA
.
.
2.1.3 Nguyªn nh©n cña ch¶y m¸u trong n·o:
"(L[,1589,
Xi
…
/1$
uJ ?x
E
Fe‡ 

Fe‡'?,
"C.
Fe‡%
2.1.3.1.Ch¶y m¸u do cao huyÕt ¸p:
L21eG*2(z4 ?H*5
?A;?*5*J-*5%-4%B|5(o'e
[ˆ;
Tiªn lîng xÊu:
;mB|
;/.G
;/.@*51
VÞ trÝ
;OA9hij,&v#
;/0Xij
;/1Ybj
;<bj
§Æc ®iÓm h×nh ¶nh.
;IJ- [4.9,GA
;Oe7%B*5,@<*J
;Fe#B#@E%B|(  <Bg1:(/KI*5
|,?GT;
2.1.3.2. Ch¶y m¸u trong u
/.@<'e‡*A 'eY6B
B [.R,;/. A1re.
9bXij
C¸c lo¹i U hay ch¶y m¸u:
;…9(
;S'#&6#&%'e@
;~&&
;…5&,&&

;…'E
;u8
;…'E0%(,*&"&‚&‰"‚
ChÈn ®o¸n ph©n biÖt
/.5- /.
mB d$.6@<,7,
(/O
7,
IA&#& O55 m55
"1B -%1?L
|,
"1615*%
.
9< 9<.0 /P,A*5e7%B
XX
IJ- d$ ? /@<Af
2.1.3.3. Ph×nh m¹ch n·o
C¸c lo¹i ph×nh m¹ch.
EENhij
.N,E9<N,E@
;E1$
;EM1_j
;E
;EoP.
;E'e‡K,#' 3eB6%#6#.2$$
EE
E'@
{Ph×nh h×nh tói.
EENL[,Gg,4 ?;d5?,ER#R6
N,E@,5?*5;

"(Lf$@'+#v1$6M
66'e‡;/@%.Vj#B,<6AN
,EVij6Vbj,E%fCvVb
?#B'e‡58reY'e
;Fe> GL
;/PB ?
;K#.2$$
;FeB1N&ƒ6‚&#u#
;F@ ?R,;
d[ <E.
Trªn chôp m¹ch:
;)BoN,EVijAN
;IJ-qijGe.
;m-N,E
;K(= 9 ?N,E
;/BN,E1:%6%-
Trªn céng hëng tõ m¹ch.
;L,Bo,*/OL
;u <,ef$GHL@9B$
;d?1,*N,En`
;/0,.2& < B9*EN,E(
E.4He
F974N,E
BiÕn chøng vì tói ph×nh:
;/.%e
;|
;71
Co th¾t m¹ch.
;y1e`b5#*zN,E
;K5(C7,

;K5(-l*7
HiÖu øng khèi:
XV
;d 0
;Ke0%
Tử vong_ij
Chảy máu tái phát
;bij.c 0
;bijl*
m@AN,EE@?#B [ <@<+ N,E.
;IJ-4*.%e|
=N,E.
;N,E15N,E@$.1
;N,E@'L% A15N,E@%.8.
;d%@<1B5P
;/YGN,E.
+Phình khổng lồ:
K5N,E%-vVb;K#5@e7%B6@<@e0%6@
<.
Đặc điểm hình ảnh:
;/@%B6'(@1#4@
;u1e11<5P**A
9%BG*
;/@*A*@G*
;/@*PB2$@G551B#%
9%BY5'?
;S[P0042$ (6(
+ Phình mạch do nhiễm trùng( nấm)
Nguyên nhân:
;I(?6(-hij

;I(5Xij
;I(YxMXij
Đặc điểm hình ảnh:
;1-%,e(/KI
;IJ-L[,G**5A
;"1AB.=2=N,E
;/|,58%RZ
+ Phình hình thoi( xơ vữa)
E52$*H6849Ge#BA6L,Bo,* ?*5
5
Đặc điểm hình ảnh:
.d?A56D*5
; 0@,4A@<1:*5"'
;E@<'J9%B
/8rZ
/OXW8-e
Biến chứng:
;"C9%B
;Oe7%B
+ Phình bóc tách.
X_
&:9<4'@ ?E%B|5( *5@<
NB,E
"(1$v'evR,
IJ-/.v ?#B
Đặc điểm hình ảnh
;mB1B5PZ& ?
;/O109 < f$
;d%|, < -2f$
*J-'@63;;;

2.2. Chảy máu màng não.
21e%e*5 %1
/Y#.5(-l*#.5

2.2.1.Nguyên nhân chảy máu màng não:
L[,15,Eqij
/1$
uJ ?x
B
K54%B|69,
Y,.1B
uJ ?x4
2.2.2.Biến chứng
/.74| '-Yg1*(5
e
/Y*55#.@<C7,;
/7M#YG55 &(VW#YY ZG57
,#.
2.3. Dị dạng mạch não
Các loại dị dạng mạch não:
/@`J
uJ ?x
;uJ
;uJ ?x57*5P#
;Bo,HJ5*557
S,&#
uJx%<2*&#
uJx
;x'1L
;uJxS&

;FNx;
2.3.1. Dị dạng thông động tĩnh mạch não
2.3.1.1 Dị dạng thông động tĩnh mạch trong não (AVMs)
-Định nghĩa: uJ Zx5'1L4 ?*5x6
%@LBH ?*5x6fLVi`i
Giải phẫu bệnh:
;Tổn thơng bẩm sinh có bốn thành phần:
X/ ?
X`
V/@'5e
_/@fJ#
;/< ?@53B*
;"B*<x3
;m@L
;m@f70% ef
;/@N,EfJcij
.Tổ chức não lân cận:
Xu-4.
V/*@z
_&6@<@9
-Phân loại:
;9hij.6#BA^
'e'+#
;I579Xij ?.51,
;Bo,.Xij
;hihbjG'0 ^XbjVijGB#
Tuổi xuất hiện bệnh.
;"AGfVi`i
;Vbj@.GfXb
;hiqij21ee7Gfbi

-Lâm sàng:
;bij'<e'.
v/.6165
,Bo,
vrel*TXiXpj
vY'e*'<e9|0%Xij
;m.Vbj'<e'$ ?%
;m.Vbj'<e,Bo,6*51e%
Nguy cơ chảy máu:
."$.58T_`j6@--}
;/7 ?f$&),&&
X/5b ?TXc6R*5 < B*%-Xn_^V_
c^_vc^.G 92=i%.G^X@.
G^xQi!Qx^XQ*5x#^
*78G*A78X^*-78i
VFeG ?X5B1
_d?cL%P! J,Q>
;8$.%
Xf$11
V/@,Bo,*,EB6f6
02
_/@Q*5xx#
`O,YxQ
;S.$.%
XmBJ@AT*3
*5ABT*35
V/@AxQ,Bo,
Xb
-Đặc điểm hình ảnh:
;/?GT5B1 <,ef$6|, o95'9,

& < -1f$*5@%9 AJ-o,
;8.-ePxQ?*5
oP.61:(|,?GT
;mBJ9g%e7%BTLo,@.
*5,;
;!21e%@.@YxC
;/@%9o,*,EXij
;"'(L@&eo,*59
;I@[,Vbj
;/@<@M.(?GT B*.}
Biến chứng.
;/.
;/>
;"$.%.v_j8
2.3.1.2. Thông động tĩnh mạch màng cứng
-Giải phẫu bệnh và nguyên nhân.
;/5'eJY,.
;/T575e7%,.5A
;OeBQ*52576x*3.
;O,Bo,oY62x
-Vị trí:
;OG*A2'(*52#[,1
;/*J-%y6A#Z6A<
-Tỷ lệ, tuổi giới:
;/9%.XiXbjJ
;/9cjJ ?x(A*5_bjA
;S%,'eH^'<e#5f`ici
-Lâm sàng: f?*J-f$
;"&@f6 0% [e*26
#

;KCY6.JR*2
;Ke0%
;xQ*5*3x#@<.
6>69|0%;
-Đặc điểm hình ảnh:
X/|,
;?A ?T7 fR9,*52x
;/ ?[, ?+6 ?5H65
9(
;O,Y2x@<[,
;y9,R*5|, B9#5
Loại 1 ?x57Q*52x6
@P.2A'<e#55-
Loại 2: ?x57Q*52x
@xQoA6.*5*3
.Xij68,R?#ZVij
Xc
Loại 3: ?x57@QR9,*5x
*3%6.,`ij
K` ?x57@QR9,*5x
*3*xvb6.cbj
Lo,
Kb ?x57*Q*5x
=46'e4[,bijLo,
V/|,Y,*-
;L'EL
;/@<12x6x26
Y
_/|,?GT
;L%1'1L6@<1xQ

;/?GT%,e o
2.3.1.3.Tổn thơng phối hợp thông động tĩnh mạch màng cứng và màng nuôi
-Giải phẫu bệnh:
;f$@.T57
;T.57*55[,XijsI#
-Hình ảnh:
;1T5 ?*3
;T57LT ?5
2.3.2. Dị dạng tĩnh mạch:
2.3.2.1. U máu tĩnh mạch( venous angioma)
-Giải phẫu bệnh:
.Sx4#BE 0'?
;SxQG*3
;"Hx'EL
-Nguyên nhân:
;u##@,<,Y%,<xQ
;L5'<e4'9<'EL6-%@JR#R
;O%D*'1L4e0%;
Tuổi giới, tỷ lệ:
.S[,%._jf2G,<
;L $ ?%'<e#5;
;G'1%]f6$A$H;
;S[,*(Acbj0#T6*A_bj;
Biểu hiện lâm sàng:
;me7cij
;/@e7`ij @ 0Xb_ij6>bij6.bXbj
-Đặc điểm hình ảnh:
./|,E ?'EL^ Ex1x*34
E 0'?pij6#_ij6@<@,4xQ
*5 5(.;

;/|,Y,*-#(B.=@<,ex
;/|,?GTX*5VW@<1 LP.6#(B@
<,ex6@<1E.
2.3.2.2. Dị dạng tĩnh mạch Galen
Xp
-Định nghĩa:
;"@CAJ%
;/@ [ <5-S&
-Nguyên nhân và bệnh học
{FELxS&BHeB-#4*eB
2
{/ ?1,J'C
;/ ?#5C-
;d?C1,*J-7
;/ ?% 2(* CJ^=B
^ ?#
{S0pijLo,@'1Lx
m@%k,<1 42t
-Các thể:
;KwR9, ?xTd*S&
;KwwuJ ?x* CJ&Q^@<[,
GU
;Kwww
f$,7,6,Bo,www
L[,U#6@#7e05*5
@9f#Z
;KwIuJ ?x@Q*5C f
*5S&
-Hình ảnh:
{)(

;)(u,,&5,e.'1L*&
;"1_'J +
;L@71
{/|,
;/+ 2 J
;y Jf$
;dAJ'N5,$,,RZ
{/|,/KI
;1%BP'<4#
;"1B#(B.=
;/@71
;/@eoM
{/|,/O
;/! J 9<4f$*5
;11eB/KI
;/@<19%Bx*5 fB$
;/O1 [ <4f$
2.3.2.3. Giãn tĩnh mạch
x%NL,Bo,*J ?x
?x57(}@< $ ?;
2.3.3. Dị dạng mao mạch,
2.3.3.1. Giãn mao mạch/,&#
-Bệnh học:
Xh
;>,o,4f@5'1L9$$*5#o

;"'EL
;/@<@14@40.
-Vị trí:
;/@<'1%]$*54

;O[,$G0*54
-Dịch tễ:
;O[,*557J%f2Jx
[,1
;L[,@Af$
-Lâm sàng:
;L[(#5
;/@<.15%,Bo,*<
-Hình ảnh:
;/|,L%,ef$6@<1 ;
;/|,/KI%(BL'EL6@(B@<1*8r
Z%:
;/|,/O
1A*.-e(VW*5&
/@<1 *8-e#%(B
2.3.3.2. Giãn mao mạch chảy máu di truyềnFe&~#&W&'&
{uAAM#Y<L6495?70%
{f$
f$G*5(
uJ,eV_j#B'e
;m.`jJ ?x
;cjJx
;XV6bj'<e<Jd
#(3
;uJ ?xA$@<,e
|,#B@2@A
;uJ6P
sI%._ij
d,fXbVij
{F<e#5

/.}hbj
F970%
;bijJd,fC,f
;F<e%JG66?;;;
2.3.3.Dị dạng u máu thể hang/*&#
2.3.3.1.U máu thể hang trong não
Bệnh học:
d<f$ 3-A@:*2=
'eZ
;OEfCAB@@,?%@#o
;/@*2$,B
Xq
;/@P.'(1>6@9%B'(
;m@5'(f$
;f72=LY Z&#&
{uA
< $Uf$ $ ?6!XiXbj f$
<S E
;uAM#Y<L
;/@Af$pbjLo,
;f'9 f&L/O1 f%-6#Bo6-1f$
Dịch tễ:
;/9%.XbjJ%f2
;/9%.i;bi6pj#B
Vị trí:
;hij(A
;m.X_Lo,@A$f
;d%G5762x
Tuổi giới:
;L'<efVi`i

;m(
Lâm sàng:
;L%@1e#5
;/.GLUn`i
;u1e9|0%
Hình ảnh:
/|,
;L'ELoP.=1,
;d%@<1 1BE?
x#
/KI
;dC$8rZ%%(B
;L@*@
;"1B7 ?%
/O
;OEY'3*-ego,6*A.
-e2=
;S&@<1Af$%'(
;OE('GL%]%.
Tổn thơng phối hợp:
O,Bo,1*f$%J6
sI6J;
?#BLo,,Bo,*5*5 B

3.3.2. U máu thể hang ngoài não.
Vị trí:
L[,G2
57
Hình ảnh:
/|,

Vi
;d?57
;8 >*5 ZB%k5
/O%B-*557B5
2.4. §ét qôy ( stroke)
2.4.1.§¹i c¬ng:
dJx'C@BZ*A(9|0 
%1,-
FB<-4 ?=|
X"C9hij
V/.Xbj
_/.%e
`BYx;
/l#f AJ91,-LYLncL5
@< oC,|# AJ-o,
/+ E. @*P1=Z+ 6 9<*5
&: AJ9;
/(-4 ?=|
"L5 "LU U&
/9,
y$*H ?
"C
"C
F@ ?
Fe
(-
"C      'e  
'+#
O9%Bx
Fe  C  0

A;;;
uJMZ
;/@%._eL'J ?=•G•
;O58@`ii;iiibii;iiiL
;d757'l*GL#'e
*5
;/@<8T ohij
2.4.2.ThiÕu m¸u vµ nhåi m¸u n·o cÊp:
2.4.2.1. Tãm t¾t sinh lý bÖnh:
S.o(
;S.5<6T*T <
;9
1'
5o"
{
6/

6/
{{
*5*59'5
"M<
KY Z59'5B
9 ??H?
;5'.*e9'51
;9'59
VX
;A6e7%B
/*.
;/$.1 @@
IC.

I3*5A
;/9'5-.$
9'50% eE##&
9'50% e-&&
9'5?;
F9 f4*9
;f9
f$9'5% oC,|
1.9'5 A'Jf$
9< <E5fC
;I*f9
/9'5@<#B o#*5L9
/e, AJ7#B*@$5;
2.4.2.2. Nguyªn nh©n
uYbij
Y3ECf%9Vij
/|Y
;Fe
KJ,69%Bx
I(?
…0x
;m,.'e
I(Y ?
Yz6%-
I(
;Fe2$.)K‚
;I(.
/'e%
;S.
;/Y#*zJ6.e

;F1L 
8 6
F1LC0EA
;I(Yx
;FeYd.T,E.(%:(

2.4.2.3. H×nh ¶nh.
Chôp m¹ch-! J 1,6!95%@! J(#o
9
;OEY`ibijLo,
;uP.>6%k5LlB ?
Xbj
;1'5eVij
;I%@bj
VV
;I8Vij
; ?xXiji
;Oe7%B`ij
Siªu ©m xuyªn sä:
",eY*5#Y
/1e
;Y 0 ?H%-eP.
;Y 02dH,fu,,&'(%B
6@8#7.
;Y>!,e oGT*
Chôp c¾t líp vi tÝnh
;K58%5 0*E o95
;/@|+ 2 J*5+ ,'e
.66C.
C¸c dÊu hiÖu

X11,-ncL
/@<'ELVbbij[$'1Lˆ
8rZ49%BVbbij
S.ˆrZ4'<e.ˆ > ?12*35L
2
V/1,-XVV`L
S.rZ4A
L1Y*512
y?e7%B#
_/1,-?X_5
I.rZE(
"G.12*51Y
Oe7%B8
/@<21e.A6*3
Chôp céng hëng tõ:/O@ ?$#*|,/KI
X/1e7E
11eP%@-eP.Gf$
XW8-ePP.>pbj
/|,/OEYhij
/O%9ƒƒ#w8-e6.e#B%94
V11,-TXcL
XWy?6,A?6112*51
Y
VW@<'EL
_/1,-cV`L
XWe7%B8650*f$@<8-e
VW8-e*f$
f/O8 !,o,*7 ?[4C1,*51e
#5
`/1,-?X_5

XWOe7%B868-e45*5. 8-
e4:$
VW8-e6<#.@<.-e
V_
2.4.3. Nhồi máu và thiếu máu não bán cấp:
2.4.3.1. Sinh lý bệnh học: 59<4C1,
2.4.3.2. Hình ảnh:
Chụp cắt lớp vi tính.
/09 <,e.C
/1e
XF1,#`p5
/P1e,*5e7%B
/.C@<21e
/@<11B.=?
VF1,?Xh0
1e7%B
/@<@*GU&
/P1B4?
_?#AA8
&6M
S1*5?
I9[,
m1B.=#(
fg
Chụp cộng hởng từ.
-/O09 <,e.
/1e
XF1,#`p5
;XW1BT
;VW/.Vbj68-e*3

Xbj6@<@,A41Y
VF1,?Xh0
;XWIQ1B.=
Oe7%B16 <.@<1B
B;v`ij
;VW.-e'1Le7#$
_-#AA8
;X&6%96&'(4B60

;VW--e4M&&,6-
.
2.4.4. Nhồi máu theo các vị trí cấp máu.
2.4.4.1. Nhồi máu ổ khuyết:
"Cf%99%.Vij ?=6LY2(46
L9,68z;;;
/*f$
;2(#* CJ
;I'D6'6'5
;/0
"Cf%9L@'<e#5% [e55l
L69|.lL6B A5lL;;;
OE.
V`
;/?GT5,$,,8%B1
;f$PnX68-e(VW
;IJ-f$1=Z <+ ,'e;
2.4.4.2. Nhåi m¸u vïng trªn lÒu:
X"C ?H
/9pbhijC
Y55 ?H*E(?T"'(*3.

1Y*5126.A
Y ?H#'D*f$T1'(
56(%f$
Y3*f$E(3*3
V;"C ?# 757
_;"C ?
`"Cgo,
/'D*
d?
/2( CJ;;;
2.4.4.3. Nhåi m¸u vïng díi lÒu:
Xd?A
I4A
;"C,0# CJ
./B
;I+6]$#1,
/2(40f$@ B0
Vd?<(
/!@TV_jC1,G*<6bij*d<(
Y]
Y'0<
_d?<#f$#'(r6#<66*
?
`d?<19[,6f$*'(4'0<
;
2.5. Viªm m¹ch hÖ thÇn kinh trung ¬ng( vasculitis)
I(4e0%$'GA( %6+
,'eR*58%f<#5*5>#5L,.
#9 <+ 2 J;
Nguyªn nh©n:

I(M
;"M%+6#(*6166
;OwI
I(eB
;I(A$@A|,&##
;I(9'5%fC„*(L
;I(%#
;Fe%&
;uJ7
;;;
I(#*##
Vb

×