病理学中枢神经系统疾病(英文).ppt

* When the extent of the herniation is large enough, the contralateral cerebral peduncle may also be compressed, resulting in hemiparesis ipilateral to the side of the heiniation. Because usually, hemispheric lesions typically cause contralateral weakness, this ipsilateral hemisparesis can be a false localizing sign that would suggest to the examiner that the patient has a lesion in the opposite, unaffected hemisphere. The changes in the peduncle in this setting are known as Kernohan’s notch. * * Progression of transterntorial herniation is often accompanied by hemorrhagic lesions in the midbrain and pons, termed Duret hemorrhages. These linear or flame-shaped lesions usually occur in the midline and paramedian regions, and are believed to be due to tearing of penetrating veins and arteries supplying the upper brain stem. The presence of Duret hemorrhages implies a grim prognosis. * Lacunar infarcts in the caudate and putamen. This is the microscopic appearance of a lacunar infarct. Note that it is a cystic space from the resolved liquefactive necrosis. * Kernig征 病员仰卧,先屈髋及膝成直角,再将小腿上抬。由于屈肌痉挛,因而伸膝受限而小于130度并有疼痛及阻力。Kernigs sign? in meningitis, inability to completely extend the leg when sitting or lying with the thigh flexed upon the abdomen; when in dorsal decubitus position, the leg can be easily and completely extended. Brudzinski征 检查方法正确:被检查者仰卧,双下肢伸直,检查者在右侧,右手按于被检查者胸前,左手托起其枕部,作头部前屈动作时,观察双膝关节是否自动屈曲。 an involuntary flexion of the hip and knee when the neck is passively flexed. It can occur in patients with meningitis. Inflammation feature Stereotyped Reaction neurons: degeneration, necrosis secondary demyelination limited exudation with perivascular cuffing formation Presence of BBB (blood –brain barrier) and V-R space limits the spread of inflammation Absence of intrinsic lymphatic and lymphoid tissue T/B cells are blood born(exogenic) glia nodule formation microglial nodule in early stage. astrocytic nodule in later st