神经幻灯.ppt

单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,概,述,(,Outline),特殊性,1,病变定位与功能障碍关系密切,相同病变在不同部位,出现不同结果,3,对各种致病因子的反应：,4,脑的病变均可引起颅高压和脑疝,5,血,-,脑积液屏障、血管周围间隙构成天然防线，限制炎症向脑实质扩散,6,脑内无固定淋巴组织和淋巴管,7,脑内恶性肿瘤罕见颅外转移,一,感染性疾病,Infective diseases,infective source,：,routes of infection,：,血源性,局部扩散,直接感染,经神经感染,1,流行性脑脊髓膜炎,Epidemic cerebrospinalmeningitis,pathogenesis,脑膜炎双球菌,-,上呼吸道入血,-,菌血症或败血症,-,脑脊髓膜化脓性膜炎,Epidemic cerebrospinalmeningitis,Epidemic cerebrospinalmeningitis,Epidemic cerebrospinalmeningitis,Epidemic cerebrospinalmeningitis,Section of brain with,Epidemic cerebrospinalmeningitis,镜下：珠网膜血管扩张充血；,珠网膜下腔增宽；内大,量中性粒细胞纤维蛋白，少量单核及淋巴细胞渗出；,找到细菌,脑水肿,brain edema,microscopically,Exudate in arachnoid space,Clinical-pathologic relation,（1）发热,（2）神经症状,颅内压升高,脑膜刺激症：颈项强直；角弓反张；屈髋伸膝征,（3）颅神经麻痹,（4）脑脊髓液改变,结局,1,及时治疗,2,治疗不当：脑积水；颅神经麻痹；颅底血管炎,暴发性脑膜炎球菌性败血症,儿童，起病急,表现：周围循环衰竭，休克，紫癜，沃-佛综合征,（Warterhouse-friedrichsen syndrome）,W-F syndrome,病变：部位,:,脑实质,:,大脑,基底核,视丘,肉眼,表面：切面：,镜下,1,血管套及炎症反应,:,(Perivascular inflammatory infiltration),充血,水肿,2,神经细胞变性坏死,（,Neuron necrosis),:,肿胀,尼氏小体,崩解消失,;,卫星现象,(,satellitosis),噬细胞现象,(,neuronophagia),3,软化灶形成,(,Reticular softening lesions,),4,胶质细胞小结,(,glial node),:,小胶质细胞结节状增生,Perivascular inflammatory infiltration,Cerebral edema,Neuronal degeneratoin and satellitosis,Neuron necrosis,neuronophagia and glial node,satellitosis,Neuron necrosis and neuronophagia,Reticular softening lesions,Reticular softening lesions,Glial nodule,Clinical-pathologic relation,1 嗜睡,昏迷-神经原广泛坏死,2 头痛,呕吐-脑血管扩张充血，,脑水肿 颅内压增高,脑疝,(brain hernia),小脑扁桃体,疝 呼吸中枢受压致呼吸骤停,4,脑膜刺激症,5,脑脊液中细胞数增多,预后,及时治疗,少数留下后遗症,三,脊髓灰质炎,(,poliomyelitis,),概述,病因,脊髓灰质炎病毒,传染途径,病毒,经黏膜入血,毒血症,侵入中枢神经系统,脊髓前角运动细胞,病变,部位,:,脊髓运动神经原,(,腰膨大,颈膨大,),肉眼,:,脊膜和脊髓前角充血,出血,坏死,前角及前根萎缩,前,根变细,瘫痪肢体肌肉萎缩,镜下,脊膜,:,充血,淋巴细胞浸润,脊髓前角,:,充血水肿,神经,原变性坏死,L,M,N,和小胶质细胞增生,噬神经细胞现象,泡沫细胞和星形细胞增生,形成胶质瘢痕,Ghost cell and,neuronophagia,Glial node,Clinical-pathologic relation,轻型,毒血症表显,:,头痛,发热,咽部不适,非麻痹型,轻微神经系统症状,:,项背部肌肉强直,脑脊液细胞和蛋白质增多,麻痹型,病毒损害运动神经原,:,下肢瘫痪,腰膨大；,上肢瘫痪,颈膨大,预后,tumors of the nervous system,Outline,(,一,),胶质瘤,(,glioma,),特点,良、恶性的相对性：均呈浸润性生长，无包膜,局部浸润：不向颅外转移，只浸润血管周围隙，脑膜，室管膜,星形细胞瘤（,astrocytoma,）,占,78%,，男性多见,大体 结节,-,巨块状，灰白灰红半透明,分化好,-,境界不清；,分化差,-,境界较清；,镜下 细胞形态：纤维状，原浆型,肥胖型，毛细胞,astrocytoma,astrocytoma,Glioblastoma mutifoeme,胶母,2 少突胶质细胞瘤,（,oligodendriglioma,）,成人多，源于少突胶质细胞，,好发部位 皮质浅层,大体 灰红，半透明，界限清楚，,出血，囊性变，钙化,镜下 细胞大小一致，核周空晕，有环绕,神经原排列倾向，血管丰富，砂粒体,大体,oligodendroglioma,3 室管膜瘤（,ependymoma,）,源于室管膜细胞，第四脑室多见，儿童、青年居多,大体 瘤体境界清楚，灰白，出血，囊性变,镜下（1）围绕血管有长胞突与血管相连-假菊形团,（2）腺管状排列-菊形团,ependymoma,（二）髓母细胞瘤,（,medulloblastoma,）,原始神经外胚层肿瘤，细胞原始，,未分化，儿童多见，恶性度高，预后差,部位：多在小脑小脑蚓部，,发生：由小脑蚓部原始上皮或小脑蚓部胚胎性外颗粒细胞发生,大体,灰红，鱼肉状,镜下,medulloblastoma,（三）脑膜瘤（,meningioma,）,仅次于胶质瘤，颅内核椎管内常见肿瘤之一，良性，易手术切除,起源：上矢状窦的蛛网膜绒,毛的细胞巢或脑膜的成,纤维细胞,部位：与硬膜紧密相连，,大体：,有包膜，球形，膨胀性生长，,灰白，颗粒状，可见钙化砂粒体,脑膜瘤,Alzheimers Disease,老年斑、神经原纤维缠结、颗粒空炮变性、Hirano小体,Alzheimers disease leads to cerebral atrophy.Shown here,is the external surface of the brain with widened sulci and,narrowed gyri,mostly over the frontal and parietal regions,gross.,Alzheimers disease with cerebral atrophy on coronal section of the brain shows the characteristic hydrocephalus ex vacuo,or ventricular dilation resulting from loss of cortex,gross.,In the neuropil of the cerebral cortex there is fragmentation of neurites(neuronal processes)within gray matter producing the characteristic senile plaques.These are degenerative presynaptic endings.The plaques may also contain a few astrocytes,and microglia.Bielschowsky silver stain,microscopic.,The thioflavin stain viewed with fluorescence microscopy highlights the neuritic plaques of Alzheimers disease with amyloid deposition which fluoresces bright green,as shown here.,Alzheimers disease,senile plaque.Older plaques contain a central amyloid core,seen here with Congo red stain,microscopic.,Alzheimers disease,neurofibrillary tangle.The neurons demonstrate intracytoplasmic proliferation of twisted filaments producing the visible neurofibrillary tangle under the microscope.These are commonly found in the pyramidal cells of the Hippocampus and the cerebral cortex.H and E stain,microscopic.,Alzheimers disease,neurofibrillary tangle.The tangles are,best demonstrated with Bielschowsky silver stain as shown,here,microscopic.,Parkinsons Disease,病理特点：,1.黑质、蓝斑脱色是大体特点，镜下可见神经黑色素细胞丧失，残留的神经细胞中有Lewy小体,2.多巴胺合成减少，与乙酰胆碱的平衡失调,A normally pigmented substantia nigra is seen grossly in the midbrain on the right,but the midbrain on the left from the patient with Parkinsons disease shows a pale substantia nigra.,A normally pigmented substantia nigra is seen on the left,but the patient with Parkinsons disease has decreased neurons and pigment as seen microscopically at the right.,A rounded pink cytoplasmic Lewy body is seen microscopically with H and E stain at the left,while immunoperoxidase staining with antibody to ubiquitin reveals the appearance at the right.,Thanks,for listening to my lectures,