大脑及脑干多发性灶性出血.PPTVIP

Epidemic encephalitis B 乙型脑炎病毒(RNA virus) 夏秋 变质性炎 蚊子 变质---卫星现象/嗜神经细胞现象/软化灶 渗出---血管套 增生---胶质结节 临床症状 嗜睡昏迷 颅神经麻痹 颅内压升高—brain hernia 脑膜刺激症 MENINGITIS 脑膜炎 呼吸道传染 菌血症/败血症 脑膜炎 症状 Patients typically show systemic signs of infection superimposed on clinical evidence of meningeal irritation and neurologic impairment, including headache, photophobia畏光, irritability, clouding of consciousness, and neck stiffness. 脑脊液 A spinal tap水龙头 yields cloudy or frankly purulent CSF, under increased pressure, with as many as 90,000 neutrophils/mm3, a raised protein level, and a markedly reduced glucose content. 细菌 Bacteria may be seen on a smear or can be cultured, sometimes a few hours before the neutrophils appear. Untreated, pyogenic meningitis can be fatal. 治疗 Effective antimicrobial agents markedly reduce mortality associated with meningitis. 化脑---蛛网膜下腔/化脓性炎 On microscopic examination, neutrophils fill the entire subarachnoid space in severely affected areas and are found predominantly around the leptomeningeal blood vessels in less severe cases. 症状 颅内压升高 脑膜刺激症---颈项强直/角弓反张episthiotonus/Kernig征 颅神经麻痹 并发症 脑积水 颅神经损伤 脑底脉管炎---管腔阻塞---脑缺血和梗死 2. Cerebrovascular Diseases 脑出血 脑内出血 蛛网膜下腔出血 硬脑膜外出血 硬脑膜下出血 Brain Tumors The four major classes of brain tumors : Gliomas Neuronal tumors Poorly differentiated neoplasms Meningiomas GLIOMAS Gliomas, derived from glial cells, include astrocytomas, oligodendrogliomas, ependymomas MENINGIOMAS Atypical meningiomas (WHO grade II/IV) Anaplastic (malignant) meningioma (WHO grade III/IV) CASE 1 病史摘要： 死者被人用塑料凳子打伤头部而入院，晚上突然死亡。 病 理 诊 断 1. 弥漫性蛛网膜下腔出血伴二侧脑室小凝血块； 2．大结节性肝硬变伴胆管增生扩张慢性炎；脾缺如； 3．肺水肿。 讨论 1 死者的内脏经病理学检查证实，其生前主要患有大脑、脑干及小脑弥漫性蛛网膜下腔出血，但脑基底动脉未见畸形或血管瘤等病变，故此蛛网膜下腔出血应考虑系由外力作用引起。 2 死者生前患有严重的大结节性肝硬变。肝硬变可导致患者凝血功能降低，在外伤情况下，易诱发出血。 CASE 2 死者在劳动时突发右侧头部抽动感，四肢及全身抽搐，伴呕吐。当时体检：“血压130/82mmHg，神志欠清，瞳孔对光反射迟钝，颈部有抵抗，四肢及全身肌肉抽搐。”予安定等处理，于当天因抢救无效死亡。 病 理 诊 断 1. 右大脑基底节及中脑灶性出血伴右侧脑室出血；（后枕部硬膜外血肿）； 2．心脏肥大，左冠状动脉粥样硬化狭窄Ⅱ级； 3．肺水肿。 讨论 1．死者生前主要患有右大脑基底节及中脑灶性出血，右侧脑室出血；