病变疾病,脱髓鞘疾病精神病课件.ppt

Chapter 16 Chapter 16 : : Disease of Central Disease of Central Nervous Nervous System System Cerebral Vascular Disorders Cerebral Vascular Disorders Zhu keqing 竺可青 Department of pathology Department of Neuroscience ZJUCBB Hemodynamic Derangement & Cerebral Hemodynamic Derangement & Cerebral Vascular Disorders 406 Vascular Disorders 406 Circulation disturbances: 1. ischemic encephalopathy 2. infarction( thrombotic or embolitic) 3. hemorrhage Vascular disorders: arterosclerosis, atherosclerosis, arteritis, aneurysm, ateriovenous malformation(AVM) Cerebral injury caused by hypertension, cardiac arrest, hemorrhage and shock. Predisposing factors : ? higher metabolic rate : more susceptible Neuron>As>Oligo>Endo Gray Matter>White Matter 3rd 、 5th 、 6th layers of cortex are most vulnerable 1. Ischemic Encephalopathy 4 4 Focal ischemic insults Focal ischemic insults ? Focal blockage of cerebral artery ? Typically embolic (cardiac, atherosclerotic carotid disease) ? Can be thrombotic (venous thrombosis) ? Persistence and severity of ischemia mild ischemia: no remarkable change severe ischemia, survive few hours before death: not remarkable moderate ischemia, survive more than 12 hours : typical changes ? Architecture of cerebral arteries the location at the border zone of cerebral arteries is much more vulnerable. Ischemic Encephalopathy Changes: ? 1. laminar cortical necrosis : neurons in 3rd, 5th, 6th layers of cortex involved ? 2. hippocampal sclerosis : pyramidal neuron death ? 3. border zone infarction : early stage :“C” shaped infarct later stage: astrogliosis (granular atrophy) cardiopetal development → global necrosis(respirator brain) CPC : weakness sensation abnormalities → coma, vegetable status → death 1. Ische