![](https://medtion-image.medtion.com/pgc/20220518/b53bba6f2deafcff9aeba9f348180b3d.gif)
颅内压升高的常见症状和体征:头痛,精神状态改变、特别是易怒和警觉性、注意力水平降低,恶心和呕吐,视神经乳头水肿,视力丧失,复视,库欣反应(三联征):血压升高、心动过缓和呼吸不规则
视乳头水肿眼底镜下特点:
●视盘肿胀,边缘模糊 (Optic disc swelling with blurred margin)
●视盘充血(Disc hyperemia)
●视盘旁出血(Peripapillary hemorrhage)
●静脉充血扩张(Venous engorgement)
![](https://medtion-image.medtion.com/pgc/20220518/4d94a8d8cbd008649322d5ad2b579fa5.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20220518/694a4450f0e6709cf71904050ee8bed2.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20220518/0f2c617091923590f70a4130a8f4d6d5.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
正常视盘
与视乳头水肿相关的关键解剖结构
视神经硬膜鞘(视神经周围硬脑膜)
-包络视神经全程直至眼球,并与颅内脑膜连续
视神经蛛网膜下腔
-多腔管状系统,盲端在球后,与颅内蛛网膜下腔相连
-颅内压变化可经视神经蛛网膜下腔传递至视神经乳头
![](https://medtion-image.medtion.com/pgc/20220518/30545fbd167be62801a6685161f346b8.png?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20220518/3f612e9f62f53c37f6a7bdd7a9de3d11.png?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
视神经乳头水肿的机制
■脑脊液由侧脑室、第三脑室和第四脑室的脉络丛产生,经脑(脊髓)蛛网膜和软脑(脊)膜间的蛛网膜下腔循环。
■脑脊液经蛛网膜颗粒或某些淋巴管被静脉吸收。
■如果脑脊液循环受阻(如静脉阻塞或梗阻性脑积水)或脑容量增加(如肿瘤、脑水肿、出血),增加的颅内压通过视神经蛛网膜下腔传递到视神经乳头,从而导致视神经乳头水肿。
![](https://medtion-image.medtion.com/pgc/20220518/76473d211ba6a89c194d8e58db3a5c4a.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
正常脑脊液(CSF)循环和乳头水肿的发病机理示意图
![](https://medtion-image.medtion.com/pgc/20220518/b5c124974cfa71fe90284862614f8aef.png?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20220518/f035d0add3e9bca5e73c55f05faea2a8.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20220518/eb6856e2149bdcb49c3978a6e8a218b7.png?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20220518/ad2fa8e6b7d798436d356b46d2347319.gif)
参考书资料:
奈特人体解剖学彩色图谱 第6版
Kim G, Kim S K, Yoon W, et al. Papilledema[C]. European Congress of Radiology-ECR 2017, 2017.
![](https://medtion-image.medtion.com/pgc/20220518/5e01fda1c654e240f2b1cfe0550d63a5.png?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
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