升主动脉夹层动脉瘤.pptVIP

Cerebrovascular Diseases Zhu keqing 竺可青 Department of Pathology, Department of Neurobiology Zhejiang University School of Medicine 2012-12-24 案例1 病史摘要 男，29岁。 被发现死在值班室内的地面上。 病理诊断 １．左大脑基底节大片出血伴脑室出血； ２．左右冠状动脉轻度粥样硬化； ３．肺轻度淤血、水肿。 讨　论 １．死者生前主要患有左大脑基底节大片出血伴脑室出血。在排除暴力因素致死的基础上，可以认定其死因主要系由于上述脑出血导致脑组织大片破坏，脑脊液循环急性受阻和颅内压增高，脑干生命中枢功能障碍所致。 ２．根据临床病理实践，结合其出血部位来看，其脑出血的原因可能由于原有高血压病所致。 ３．后经详细询问病史，死者当时一边看黄色录象一边手淫；可能为诱发因素。 1 Cerebrovascular disease as two processes Hypoxia, ischemia, and infarction resulting from impairment of blood supply and oxygenation of CNS tissue 缺 Hemorrhage resulting from rupture of CNS vessels 出 2 Two principal types of acute ischemic injury Global cerebral ischemia (ischemic/hypoxic encephalopathy) occurs when there is a generalized reduction of cerebral perfusion, such as in cardiac arrest, shock, and severe hypotension. 全脑 Focal cerebral ischemia follows reduction or cessation of blood flow to a localized area of the brain due to large-vessel disease (such as embolic or thrombotic arterial occlusion, often in a setting of atherosclerosis) or to small-vessel disease (such as vasculitis or occlusion secondary to arteriosclerotic lesions seen in hypertension). 局灶 Sequential organization of cerebral infarcts 24 hours well-circumscribed area of necrosis, softening, discoloration in an arterial territory. Circumscribed penumbral zone. Days 1-2 Minimal polymorphonuclear leukocyte infitrate Days 2-5 Blood-brain barrier breakdown and cerebral edema Days 3-5 Axonal retraction balls at the edge of infarct , usually in white matter Days 5-7 Appearance of lipid-laden macrophages at periphery; hyperplastic blood vessels Day 14 Sheets of lipid-laden macrophages Days 10-20 Surrounding rim of gemistocytic astrocytes 3 months Cystic space surrounded by fibrillary astrocytes 4 Infarction from Obstruction of Local Blood Supply (Focal Cerebral Ischemia) Excitatory amino acid ne