病变可导致定位特征选择性功能障碍.pptVIP

Chapter 16：Disease of Central Nervous System Cerebral Vascular Disorders Hemodynamic Derangement Cerebral 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 NeuronAsOligoEndo Gray MatterWhite Matter 3rd、5th、6th layers of cortex are most vulnerable 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. 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 Cause： thrombosis, embolism, space occupying lesion, local vessels compressed by hernia Types: 1. thrombotic: on the sites of atherosclerosis the symptoms: from weakness of muscles to semiplegia or coma 2. embolic: the emboli often are cardiogenic , or from atherosclerotic plaqu