神经外科学课件Increased ICP颅内压增高颅脑损伤讲稿.docx

神经外科学课件Increased ICP颅内压增高颅脑损伤讲稿.docx

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神经外科学课件IncreasedICP颅内压增高颅脑损伤讲稿

教案及讲稿（教案）

课程名称

神经外科学

年级

2013级

授课专业

五年制

教师

夏海坚

职称

副教授

授课方式

√大课示教

学时

6

题目章节

1、IncreasedIntracranialPressure；2、颅内压增高；3、颅脑外伤

教材名称

1、医学英文原版改编双语教材《外科学》；2、《外科学》

作者

1、LawrenceW.WayGerardM.Doherty；2、吴在德，吴肇汉

出版社

1、科学出版社；2、人民卫生出版社

版次

1、第1版；2、第8版

教

学

目

的

要

求

1、PathologyandPhysiologyofIncreasedIntracranialPressure

2、ManifestationsandManagementsofIncreasedIntracranialPressure

3、颅内压增高的诊断

4、颅内压增高的治疗原则

5、脑损伤的受伤机制

6、原发性脑损伤和继发性脑损伤的发病原理及临床表现

教

学

难

点

1、RegulationofIntracranialPressure

2、脑疝的发生机制

3、颅脑损伤的受伤机制

教

学

重

点

1、ManifestationsofIncreasedIntracranialPressure

2、脑疝的临床表现

3、原发性脑损伤和继发性脑损伤的发病原理及临床表现

外语要求

English

教学方法手段

1、Multimedia（Powerpoint）Teaching

2、LectureandDiscussionintheClass

3、利用多媒体图片及幻灯紧密结合临床实际，提问式讲解教材并举例说明

参考资料

1、王忠诚主编《王忠诚神经外科学》第一版

2、MarkS.Greenberg,M.D.HandybookofNeurosurgery,theFourthEdition.

教研室意见

准备充分，内容详实，时间安排合理，教学方法丰富，经过教研室内集体备课及试讲，达到为本科生上大课要求。

教学组长：

教研室主任：

年月日

教学内容

辅助手段

时间分配

IncreasedIntracranialPressure

Outline:

A.Attention-GettingPoints

Question:

“Whyshallwehavetolearnincreasedintracranialpressure?

”

Definition:

Increasedintracranialpressureisthepressureinsidethecranialvault,createdbythetotalvolumeoftheintracranialcontentsandexertoncranialwall.

B.MainPart

1.AnatomyanddefinitionofICP

2.Definitionofincreasedintracranialpressure

3.Pathogenesis（Causes）ofincreasedICP

4.ClinicsymptomsandsignsofincreasedICP

5.DiagnosisofincreasedICP

C.Conclusion

IncreasedIntracranialPressure

Hollow,everyone.MayIhaveyourattention,please!

Welcometoneurosurgicalclass!

Iknowallofyouhavestudiedinthisuniversityformanyyears,andmostofyouwillbedoctorsinthenearfuture.Butmaybeitisyourfirsttimetocontactwithneurosurgery,andtodayIamverygladtostandhereandsharesomebasicneurosurgicalknowledgewithyou,Ihopeitwillbehelpful.

Speakingofneurosurgery,first,wewillcometothefundamentalpartofneurosurgery------（thatis）IncreasedIntracranialPressure.WhatisIncreasedIntracranialPressure?

Fromtheword,intracranialpressure,intra-meansin,-cranialreferstohead,soIntracranialPressuremeansthepressureinhead,wealsocallitICP;andtherefore,IncreasedIntracranialPressuremeansthepressureinheadisincreased.WealsocallitraisedICPorIntracranialhypertension.

Maybeyouarewondering:

thediseasesofneurosurgerymeanbraintrauma,tumor,infectiousandvasculardiseases,etal.

WhyshouldwebeginwithIncreasedIntracranialPressure?

Toanswerthisquestion,atthebeginningwewillreviewrelatedanatomyofcraniumandbrainandfinally,Ithink,youwillgettheanswerbyyourselves!

1.AnatomyandDefinitionofIntracranialPressure

Asweknow,thecraniumcanbethoughtofahollow,rigidspherewithconstantvolume,justlikeaclosedcontainerwithpoordistensibility.Thereisonelargevent,theforamenmagnum,andanumberofsmallerforaminaforcranialnervesandbloodvessels.

Thereare3majorcomponentsofcranium:

theyarebrain,cerebrospinalfluid（CSF）,andblood.Allthesecomponentsareessentiallynoncompressible.Sowehaveanimpression:

thecraniumisaclosedcontainerwhichcannotextendeasily,andthe3majorcomponentscannotbecompressedveryeasily.

Asforthethreecomponents,Iwillintroducethemonebyone:

Braintissue:

brainismadeofbilateralhemispheres,brainstemandcerebellum.Cerebralhemisphereincludesfrontal,parietal,occipital,temporalandinsularlobe.

CSF:

Thisisapictureofthebrain.Inthebrain,therearefourventricles;ventriclesarejustlikethedrainagesystemofthebrain.Theshapeoftheventriclesisirregular,andventriclesarefullofCSF.

Fromtheseaspects.Wecanseetherearefourventriclesinthebrain.Thetwolateralventriclesareonthetop,thenthethirdoneinthemiddle,andtheforthventricleisatthebottom.Theventriclesareconnectedwitheachother.

However,howdoesCSFproduceandcirculate?

CSFissecretedbychoroidplexusintheventricles.Thechoroidplexusismadeentirelyofvessels,andsowecanunderstandCSFisfromthebloodvesselsystem,thatis,CSFisfromthecirculatorysystem.

CSFismostlysecretedfromchoroidplexusinthetwolateralventricles,thengoesdowntothethirdventricleandfinallythefourthventricle.Afterthat,CSFwillflowoutoftheventricularsystemandcomestothesubarachnoidspaces.

SomeCSFflowsfirstlytothespinalsubarachnoidspacesandthentothecerebralsubarachnoidspaces,someCSFflowsdirectlytothecerebralsubarachnoidspaceswhichareonthesurfaceofthebrain.Intheend,allCSFwillbeabsorbedintothesuperiorsagittalsinusbythearachnoidgranulationswhichlaybothsidesofvenoussinuses.Thisisacoronalscanofsuperiorsagittalsinus.Wecanfindarachnoidgranulation,hereandthere.

Becausesuperiorsagittalsinusbelongstothecirculatorysystem（belongstothebloodvesselsystem）.SoatlastCSFflowsbackintothebloodvesselssystem.Foranadult,everyday,about500mlCSFissecretedandthenabsorbedbyarachnoidgranulationstokeepahomeostasis.（keepabalance）

Ingeneral,thereare3majorcomponentsinthecranium------brain,blood,andCSF.Brainisthemajorpart,bloodvesselssystemiswithinthebrain.CSFissecretedbythebrain,circulatingintheventricularsystemandsubarachnoidspaces.

2.DefinitionofIncreasedIntracranialPressure

Now,wehaveageneralideaoftherelationshipsamongbrain,cerebralblood,CSF,andthecranium,WhichiseasierforustounderstandthedefinitionofIncreasedIntracranialPressure.

Atfirst,letustosee:

whatisICP?

Definition:

Intracranialpressureisthepressureinsidethecranialvault,createdbythetotalvolumeoftheintracranialcontentsandexertonthecranialwall.

NormalICPhasavaluebetween0.7kPa（kilopascal）to2.0kPaforadultsand0.5kPato1.0kPaforchildren.

ICPfluctuatesbecauseofintracranialarterialpulsationswhichaffectedbycardiacandrespiratorycycles.

WhenICPispersistentlyhigherthan200mmH2O（15mmHg,2kPa）,wecallitincreasedICP,orintracranialhypertension.ThisisthedefinitionofincreasedICP.Butbecautious!

IncreasedICPisnottemporary;thehigherICPusuallylastsforalongperiodoftimeuntilapropertreatmentisgiven.

HowtomeasureICP?

TherearetwomethodscanhelpustomeasureICP.

Lumbarpunctureisthefirstone.It’squiteeasytoperformandthemostcommonlyusedmethod.

Butthismethodisindirect.Normally,spinalsubarachnoidspacescancommunicatewithcerebralsubarachnoidspaces.Whenpatientlyingonhisside,thepressureinthespinalsubarachnoidspacesisequaltothepressureinthecerebralsubarachnoidspaces.Whenwetakespinaltap（lumbarpuncture）,thepressureofCSFcanrepresentICP.However,whenthereisafaultofcommunicationfromintracranialspacetospinalcanal,thepressureofCSFcann′trepresentICP.Inaddition,lumbarpuncturehasadangerofacutebrainherniation,soweshouldtakeitseriously.

The2ndwaytomeasureICPisICPmonitoring.Inthismethod,weputthepressuremonitoringprobelikethisintothebrain,orwithintheventricle,orinthesubduralspaceorbetweenduraandskull,tomeasureICPdirectly.However,itisatraumaticexamination.

3.Pathogenesis（Causes）ofIncreasedICP

ThecausesofincreasedICParemainly:

A.increasedvolumeofnormalintracranialcontents.

B.aspaceoccupyinglesion.

C.congenitalmalformation.

D.otherdiseases.

A..Theincreaseinvolumeofnormalintracranialcontentsmaybedueto:

Ⅰ、theincreaseinvolumeofbrainincluding---cerebraledemaand---benignintracranialhypertention.Ⅱ、TheincreaseinvolumeofCSF------likehydrocephlus.Ⅲ、Theincreaseinvolumeofblood-----likevasodilatationduetohypercapnia.

B.Spaceoccupyinglesionincluding:

intracranialhematoma,brainabscess,braintumorandsoon.

Thisisapictureofthebrainwithaspaceoccupyinglesion,fromitwecansee:

thevolumeofthehemispherewithtumorisobviouslymorethantheoppositehemisphere,forhereisatumor;theincreasedICPforcedthebrainshiftfromthehighICPareatothelowerICParea.

ThisisaCTscanofintracranialhematoma,wecaneasilyseethatthishematomaherecompressedthebrainimmensely.Themidlinestructureshifttotheoppositeside.

C.Congenitalmalformation.Craniostenosis.Thecongenitalmalformationsusuallyoccurinchildren.Fromthesepictures,wecansee,withthedevelopmentofthebrain,thechild’scraniumhavenotdevelopedcorrespondingly,comparedwiththebrain,thecraniumissmall,andincreasedICPoccurs.

D.Otherdiseases.Likethiskindoffracture,thecraniumgotsmallerthannormal,andthebrainisalmostincompressible,asaresult,increasedICPmayoccur.

4.ClinicalSymptomsandSignsofIncreasedIntracranialpressure.

Althoughthecausesofincreasedintracranialpressurearedifferent,someoftheclinicalmanifestationsarethesame,including:

A.HeadacheTheheadacheassociatedwithincreasedintracranialpressureisusuallyworseonwakinginthemorningandisrelievedbyvomiting.ICPincreasesduringsleepprobablybecauseofthedisturbanceofvenousreturnduetolyingdown.

ThecauseoftheheadacheinincreasedICPisprobablythetractiononthebloodvessels,andcompressionoftheduramaterbecausetheyarepain-sensitivestructure.

B.Nauseaandvomiting.Thisisaverypopularsymptoms,italmosthappenedineverypatientwithincreasedICP.

C.Drowsiness.ItisthemostimportantclinicalfeatureofincreasedICP.Itistheportentofrapidneurologicaldeteriorationandmustbebrushedasid