病理学教学课件：central nervous system.ppt

Summary Basic pathologic changes in CNS red neuron, central chromatolysis, Wallerian Degeneration, neurophagia, reactive astrogliosis, demyelination The three important complications The cerebrovascular disease Global cerebral ischemia Focal cerebral ischemia the most frequent cause: Atherosclerosis) hemorrhagic/ nonhenorrhagic infarctions Intracranial hemorrhage the most frequent cause: hypertension Infections of CNS acute pyogenic menigitis viral encephalitis Homework Please compare the different features of epidemic cerebrospinal meningitis and epidemic encephalitis type B? * Cerebral infarctions can be accompanied by Wallerian degeneration of descending tracts, as shown here at high power in the brainstem. * * Transterntorial (uncinate) herniation Occurs when the medial aspect of the temporal lobe is compressed against in the free margin of the tentorium. Swelling of the left cerebral hemisphere has produced a shift with herniation of the uncus of the hippocampus through the tentorium, leading to the groove seen at the white arrow. * * As the temporal lobe is displaced, the third cranial nerve( the oculomotor nerve) is compromised, resulting in ptosis, and dilation papillary of the pupil ipsilateral to the lesion, with loss of the firect response to light shone in the affected eye and of the consensual response to light shone in the opposite eye and impairment of ocular movements on the side of the lesion(brown pupil). Dilation of the pupil is the earliest consistent sign of tentorial herniation and may occur before there is any impairment of consciousness. * * 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