神经系统疾病总论

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2021/4/27,*,*,单击此处编辑母版标题样式,2021/4/27,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2021/4/27,*,神经系统疾病总论,神经系统疾病总论神经系统疾病总论 引言 神经系统的功能和结构中枢神经:,脑、脊髓、脑脊膜,脑实质：灰质和白质， 脑室：脑脊液,神经元（神经纤维）、胶质细胞（胶质纤维）,小胶质细胞,周围神经: 神经纤维、髓鞘、神经膜,植物神经: 神经节2021/4/272医学课件园,引言,神经系统的功能和结构,中枢神经:,脑、脊髓、脑脊膜,脑实质：灰质和白质， 脑室：脑脊液,神经元（神经纤维）、胶质细胞（胶质纤维）,小胶质细胞,周围神经:,神经纤维、髓鞘、神经膜,植物神经:,神经节,2021/4/27,2,cerebellum,2021/4/27,3,Betz cell,Nissl,小体,2021/4/27,4,引言,神经系统疾病的特点,定位与定性：,1）病变定位与功能障碍之间关系密切,2）相同病变在不同部位出现不同后果,对致病因子的病理反应较单一:,1）需熟悉基本病变,2）与临床关系密切,解剖生理特征的双重影响：,合并症,2021/4/27,5,引言,神经系统疾病的分类,Vascular D. 血管疾病,Infections 感染,Tumors 肿瘤,Trauma 创伤,Malformations. 畸形,Degenerative D. 变性疾病,Demyelinative D. 脱髓鞘疾病,Metabolic D. 代谢性疾病, .,2021/4/27,6,1,Basic reactions to injury,对损伤的基本反应,2,Common complications,常见并发症,3,Infections,4,CJD,5,Alzheimers D. (老年性痴呆),6,Tumors,2021/4/27,7,1,Basic pathologic changes,Neuron,Degeneration变性、Necrosis,坏死,神经细胞脱失（ Loss ）,液化性坏死,轴索和髓鞘的变化,（ Waller degeneration）,2021/4/27,8,Central chromatolysis,中央性,Nissl,小体溶解,2021/4/27,9,Red neuron,红色神经细胞,2021/4/27,10,神经原纤维缠结,Neurofibrillary,tangles,2021/4/27,11,Ghost cell,鬼影细胞,2021/4/27,12,Waller degeneration,Waller 变性,2021/4/27,13,Waller degeneration,Sudan,2021/4/27,14,1,Basic pathologic changes,Neuroglia,Hypertrophy,肥大,Proliferation 增生,Astrocytes:,胶质瘢痕 (gliosis )、,Oligodendrocyte:,卫星现象（satellitosis）,2021/4/27,15,2021/4/27,16,Interfasclcular oligodendroglia,2021/4/27,17,Perineuronal satellite oligodendroglia,2021/4/27,18,1,Basic pathologic changes,Microglio,Exudation 渗出 Proliferation 增生,胶质结节（glial nodule）,噬神经细胞现象（neuronophagia）,格子细胞 （lattice cell）,2021/4/27,19,Microglial nodule,胶质结节,Rod cell,2021/4/27,20,2021/4/27,21,lattice cell,格子细胞,2021/4/27,22,1,Basic pathologic changes,Exudation 渗出:,充血水肿,炎症细胞、小胶质细胞,（Perivascular cuffing,血管套,）,肿瘤性增生:,2021/4/27,23,2 Common complications,Brain edema,脑水肿,Hydrocephalus,脑积水,Increased intracranial pressure,颅内压升高,Herniation,脑疝,2021/4/27,24,合并症,I.,Brain edema 脑水肿,Vasogenic edema,血管源性脑水肿,Cyotoxic edema,细胞毒性脑水肿,脑实质组织中液体贮积过多,分型：,肉眼：,W , V , 脑回宽、脑沟窄, 脑室缩小,2021/4/27,25,The surface of the brain with cerebral edema demonstrates widened gyri with a flattened surface. The sulci are narrowed.,056,2021/4/27,26,脑水肿,Vasogenic edema,原因,：毛细血管内皮受损，血脑屏障发生障碍,形态,：细胞外间隙及血管周隙扩大，,常见于,：脑肿瘤、出血、创伤及炎症,2021/4/27,27,脑水肿,Cyotoxic edema,原因,：,细胞能量代谢障碍，细胞内钠水潴留,形态,：,细胞肿胀，细胞内水肿,常见于,：,缺血和中毒,2021/4/27,28,2021/4/27,29,Neuronal vacuolation,2021/4/27,30,2021/4/27,31,合并症,II.,Hydrocephalus 脑积水,常见于,：,先天性畸形，炎症、外伤、,肿瘤、出血等,原因,：,脑脊液循环的通路被阻断,脑脊液产生和吸收异常,脑脊液量增多伴脑室扩张,2021/4/27,32,2021/4/27,33,2021/4/27,34,病变,脑室扩张，脑实质变薄.,婴幼儿: 囟门扩大, 骨缝分开.,合并症,II.,Hydrocephalus 脑积水,2021/4/27,35,2021/4/27,36,合并症,III.,颅内压升高 脑疝,正常CSF压：0.61.8kPa,颅内压升高：2kPa (200mmH2O, 15mmHg),原因：颅内容物的容积增加,结果：脑组织移位、嵌入,-,脑疝,(Herniation),2021/4/27,37,合并症,Herniation,脑疝,Cingulate / subfalcine herniation,扣带回疝(大脑镰下疝）,Uncal / transtentorial herniation,海马钩回疝（小脑天幕疝）,Tonsillar / formen magnum herniation,小脑扁桃体疝（枕骨大孔疝）,部分脑组织嵌入,颅脑内分隔,处和,颅骨孔道,内,类型,2021/4/27,38,Cingulate / subfalcine herniation,扣带回疝(大脑镰下疝）,Uncal / transtentorial herniation,海马钩回疝（小脑天幕疝）,Tonsillar / formen magnum herniation,小脑扁桃体疝（枕骨大孔疝）,2021/4/27,39,2021/4/27,40,Cingulate gyrus herniation (subdural hemnatoma),2021/4/27,41,Tonsillar herniation,2021/4/27,42,合并症,Herniation 脑疝,脑移位，压迹,脑组织变形, 出血坏死,继发改变,病变,临床病理联系,局部解剖结构,2021/4/27,43,Uncal herniation,glioblastoma multiforme,2021/4/27,44,Acute brain swelling in the closed cranial cavity is serious. Swelling of the left cerebral hemisphere has produced a shift with herniation of the uncus of the hippocampus through the tentorium, leading to the groove seen at the white arrow.,057,058,2021/4/27,45,The end result of herniation is compression and Duret hemorrhages, as seen here in the pons.,060,2021/4/27,46,059,Acute cerebral swelling can also often produce herniation of the cerebellar tonsils into the foramen magnum. Note the cone shape of the tonsils around the medulla in this cerebellum.,2021/4/27,47,2021/4/27,48,Thank You,世界触手可及,携手共进，齐创精品工程,