神經(jīng)系統(tǒng)疾病DiseasesofNervousSystem1神經(jīng)系統(tǒng)疾病DiseasesofNervousSyst引言

神經(jīng)系統(tǒng)的功能和結(jié)構(gòu)中樞神經(jīng):

腦、脊髓、腦脊膜腦實質(zhì)：灰質(zhì)和白質(zhì)，腦室：腦脊液神經(jīng)元（神經(jīng)纖維）、膠質(zhì)細(xì)胞（膠質(zhì)纖維）小膠質(zhì)細(xì)胞周圍神經(jīng):神經(jīng)纖維、髓鞘、神經(jīng)膜植物神經(jīng):神經(jīng)節(jié)2

cerebellum3cerebellum3BetzcellNissl小體4BetzcellNissl小體4

引言

神經(jīng)系統(tǒng)疾病的特點定位與定性：1）病變定位與功能障礙之間關(guān)系密切2）相同病變在不同部位出現(xiàn)不同后果對致病因子的病理反應(yīng)較單一:1）需熟悉基本病變2）與臨床關(guān)系密切解剖生理特征的雙重影響：合并癥5

引言

神經(jīng)系統(tǒng)疾病的分類VascularD.血管疾病Infections感染Tumors腫瘤Trauma創(chuàng)傷Malformations.畸形DegenerativeD.變性疾病DemyelinativeD.脫髓鞘疾病MetabolicD.代謝性疾病…...6

§1Basicreactionstoinjury對損傷的基本反應(yīng)

§2Commoncomplications常見并發(fā)癥

§3Infections

§4CJD§5Alzheimer’sD.(老年性癡呆)§6Tumors7§1Basicreactionstoinjur§1

Basicpathologicchanges

Neuron

Degeneration變性、Necrosis壞死神經(jīng)細(xì)胞脫失（Loss）液化性壞死軸索和髓鞘的變化（Wallerdegeneration）8§1Basicpathologicchanges8Centralchromatolysis中央性Nissl小體溶解9Centralchromatolysis中央性NiRedneuron紅色神經(jīng)細(xì)胞10Redneuron紅色神經(jīng)細(xì)胞10神經(jīng)原纖維纏結(jié)Neurofibrillary

tangles11神經(jīng)原纖維纏結(jié)NeurofibrillarytanglesGhostcell鬼影細(xì)胞12Ghostcell鬼影細(xì)胞12WallerdegenerationWaller變性13Wallerdegeneration13WallerdegenerationSudan14WallerdegenerationSudan14§1

BasicpathologicchangesNeurogliaHypertrophy肥大

Proliferation增生

Astrocytes:膠質(zhì)瘢痕(gliosis)、

Oligodendrocyte:

衛(wèi)星現(xiàn)象（satellitosis）

15§1Basicpathologicchang1616Interfasclcularoligodendroglia17InterfasclcularoligodendrogliPerineuronalsatelliteoligodendroglia18Perineuronalsatelliteoligode§1

BasicpathologicchangesMicroglioExudation滲出Proliferation增生膠質(zhì)結(jié)節(jié)（glialnodule）噬神經(jīng)細(xì)胞現(xiàn)象（neuronophagia）格子細(xì)胞（latticecell）19§1BasicpathologicchangesMMicroglialnodule膠質(zhì)結(jié)節(jié)Rodcell20MicroglialnoduleRodcell202121latticecell格子細(xì)胞22latticecell格子細(xì)胞22§1

BasicpathologicchangesExudation滲出:

充血水腫炎癥細(xì)胞、小膠質(zhì)細(xì)胞（Perivascularcuffing血管套）腫瘤性增生:23§1BasicpathologicchangesE§2CommoncomplicationsBrainedema腦水腫Hydrocephalus腦積水Increasedintracranialpressure顱內(nèi)壓升高Herniation腦疝24§2CommoncomplicationsB合并癥

I.

Brainedema腦水腫Vasogenicedema血管源性腦水腫Cyotoxicedema細(xì)胞毒性腦水腫

腦實質(zhì)組織中液體貯積過多分型：肉眼：W,V,腦回寬、腦溝窄,腦室縮小,25合并癥

I.BrainedemaThesurfaceofthebrainwithcerebraledemademonstrateswidenedgyriwithaflattenedsurface.Thesulciarenarrowed.05626Thesurfaceofthebrainwith腦水腫

Vasogenicedema原因：毛細(xì)血管內(nèi)皮受損，血腦屏障發(fā)生障礙形態(tài)：細(xì)胞外間隙及血管周隙擴(kuò)大，常見于：腦腫瘤、出血、創(chuàng)傷及炎癥27腦水腫27腦水腫

Cyotoxicedema原因：細(xì)胞能量代謝障礙，細(xì)胞內(nèi)鈉水潴留形態(tài)：細(xì)胞腫脹，細(xì)胞內(nèi)水腫,常見于：缺血和中毒28腦水腫282929Neuronalvacuolation30Neuronalvacuolation303131合并癥

II.

Hydrocephalus腦積水常見于：先天性畸形，炎癥、外傷、腫瘤、出血等原因：腦脊液循環(huán)的通路被阻斷腦脊液產(chǎn)生和吸收異常腦脊液量增多伴腦室擴(kuò)張32合并癥

II.Hydrocephal33333434病變腦室擴(kuò)張，腦實質(zhì)變薄.嬰幼兒:囟門擴(kuò)大,骨縫分開.合并癥

II.

Hydrocephalus腦積水35病變腦室擴(kuò)張，腦實質(zhì)變薄.合并癥

II3636合并癥

III.顱內(nèi)壓升高腦疝正常CSF壓：0.6~1.8kPa顱內(nèi)壓升高：2kPa(200mmH2O,15mmHg)原因：顱內(nèi)容物的容積增加結(jié)果：腦組織移位、嵌入----腦疝(Herniation)37合并癥

III.顱內(nèi)壓升高合并癥

Herniation腦疝

Cingulate/subfalcineherniation扣帶回疝(大腦鐮下疝）Uncal/transtentorialherniation海馬鉤回疝（小腦天幕疝）Tonsillar/formenmagnumherniation

小腦扁桃體疝（枕骨大孔疝）

部分腦組織嵌入顱腦內(nèi)分隔處和顱骨孔道內(nèi)類型38合并癥

HerniationCingulate/subfalcineherniation扣帶回疝(大腦鐮下疝）Uncal/transtentorialherniation海馬鉤回疝（小腦天幕疝）Tonsillar/formenmagnumherniation

小腦扁桃體疝（枕骨大孔疝）

39Cingulate/subfalcinehern4040Cingulategyrusherniation(subduralhemnatoma)41Cingulategyrusherniation(sTonsillarherniation42Tonsillarherniation42合并癥Herniation腦疝腦移位，壓跡腦組織變形,出血壞死繼發(fā)改變

病變臨床病理聯(lián)系局部解剖結(jié)構(gòu)43合并癥腦移位，壓跡病變臨床病理聯(lián)系局部解剖結(jié)構(gòu)43Uncalherniationglioblastomamultiforme44Uncalherniation44Acutebrainswellingintheclosedcranialcavityisserious.Swellingoftheleftcerebralhemispherehasproducedashiftwithherniationoftheuncusofthehippocampusthroughthetentorium,leadingtothegrooveseenatthewhitearrow.057,05845AcutebrainswellingintheclTheendresultofherniationiscompressionandDurethemorrhages,asseenhereinthepons.06046The