CNS病理生理脑功能障碍.ppt

Structural Basis for Consciousness cerebral cortex Brain stem reticular formation thalamus Brain stem reticular formation 上行激动系统(ARAS) 上行抑制系统(ARIS) ARAS的投射纤维终止于大脑皮层广泛区域 主要维持大脑皮层兴奋性，维持觉醒状态和产生意识活动 ARIS发出的上行纤维行走于ARAS大体一致 主要对大脑皮层兴奋性起抑制作用 ARAS ARIS Hypothalamus 由多个核团组成 特异性核团: 向大脑皮层传递各种特异性感觉信息 非特异性核团: 接受脑干 网状结构上行纤维并向 大脑皮层广泛部位投射， 参与维持大脑皮层觉醒状态 损害可致长期昏睡。 Major manifestations of conscious disorder Delirium Confusion Stupor Coma 谵妄 精神错乱 昏睡 昏迷 Delirium：意识内容异常为主的急性精神失常状态 常有睡眠-觉醒周期紊乱及错觉、幻觉、兴奋性增高为主的精神运动性改变等。 Confusion：觉醒与意识内容均出现异常，一种似睡似醒的状态，常伴有睡眠-觉醒周期颠倒。 Stupor：觉醒状态与意识内容均降至最低水平，强烈疼痛刺激可出现睁眼、眼球活动等反应，但很快又陷入昏睡状态，病人几乎无随意运动，但腱反射尚存。 Coma：觉醒状态、意识内容随意运动持续丧失（6h）或完全丧失的严重意识障碍。可出现病理反射，强烈疼痛刺激可引出简单的防御性肢体运动，但不能觉醒。 Etiology and Pathogenesis Acute brain injury e.g. Diffuse encephalic infection, diffuse brain trauma, subarachnoid hemorrhage, etc. Acute brain intoxication Endogenous poisonous lesion Exogenous poisonous lesion Intracranial extrusion and destructive lesion Rapidly expanding or destructive lesions Pathogenesis of conscious disorder Pathogenic factors Acute brain lesion Brain intoxication Brain tumor Direct damages to neurons Axonal injury, cell swelling Abnormal neurotransmitters Suppress the brain and brain stem Abnormalities in the cortex and BSRF function Conscious disorder Abnormalities in energy metabolism Abnormalities in plasma membrane * Principles in Prevention and Therapy Urgent management Making a definitive diagnosis ASAP (as soon as possible) Monitoring vital signs and conscious state Brain protections Outline Biology of the brain Cognitive disorders Conscious disorder Summary * Glossary Cognition, cognitive disorder, Broca’s aphasia, Wernicke’s aphasia, dementia Conscious disorder, delirium, excitatory toxicity 2. Questions What is the characteristics of brain disorders? What is the pathogenesis of cognitive disorder? What is the pathogenesis of consciousn disorder? A case study for you Brain is located inside the skull, which protects brain from injury. O