神經(jīng)系統(tǒng)教學(xué)課件：Neurology-2017

神經(jīng)系統(tǒng)疾病感染性疾病流行性腦脊髓膜炎流行性乙型腦炎神經(jīng)系統(tǒng)腫瘤特點變性疾病Alzhieimer病Parkinson‘s病[自學(xué)]中樞神經(jīng)系統(tǒng)并發(fā)癥[自學(xué)]流行性腦脊髓膜炎

Epidemiccerebrospinalmeningitis兒童和青少年冬春寒冷季節(jié)基本病變：彌漫性化膿性炎病變部位：軟腦膜、珠網(wǎng)膜和腦脊液病因及傳染途徑病原菌：腦膜炎雙球菌傳染途徑：呼吸道局部大量繁殖→菌血癥或敗血癥→血腦屏障→腦脊髓膜炎腦膜充血蛛網(wǎng)膜下腔內(nèi)膿性滲出腦膜腦炎病理變化Acutepyogenicmeningitis病理與臨床聯(lián)系腦膜刺激癥狀頸強直Kernig征（+）顱內(nèi)壓升高癥狀顱神經(jīng)麻痹腦脊液改變Kernig’ssign:resistancetocompletextensionoftheleg.Brudzinski’ssign:apassiveflexionoftheneckmayevokeflexionsofhipsandknees.結(jié)局痊愈后遺癥腦積水顱神經(jīng)受損腦梗死Waterhouse-Friederichsen

綜合征暴發(fā)性腦膜炎球菌敗血癥嚴(yán)重敗血癥合并感染性休克兩側(cè)腎上腺嚴(yán)重出血、皮質(zhì)功能衰竭流行性乙型腦炎

EncephalitistypeB10歲以下兒童流行季節(jié)：7、8、9月傳染源：患者、家禽和家畜傳播媒介：蚊病因及傳染途徑病原體嗜神經(jīng)性乙型腦炎病毒傳染途徑蚊—傳染源—病毒蚊—健康者—病毒血癥→隱性感染/病變病理變化病變性質(zhì)：變質(zhì)性炎病變部位：大腦灰質(zhì)軟腦膜血管擴(kuò)張充血腦實質(zhì)充血、水腫，點狀出血散在灰白色，半透明，軟化灶病理變化（大體）病理變化（鏡下）變質(zhì)：神經(jīng)細(xì)胞變性，壞死神經(jīng)細(xì)胞腫脹，尼氏小體消失神經(jīng)細(xì)胞固縮，核消失小腦蒲肯野氏細(xì)胞喪失變質(zhì)：神經(jīng)細(xì)胞變性，壞死噬神經(jīng)現(xiàn)象衛(wèi)星現(xiàn)象軟化灶形成—格子細(xì)胞病理變化（鏡下）滲出淋巴細(xì)胞套增生膠質(zhì)結(jié)節(jié)病理變化（鏡下）臨床病理聯(lián)系嗜睡、昏迷腦疝結(jié)局痊愈后遺癥癡呆、肢體癱瘓、顱神經(jīng)麻痹神經(jīng)系統(tǒng)腫瘤中樞神經(jīng)系統(tǒng)膠質(zhì)瘤、髓母細(xì)胞瘤、腦膜瘤周圍神經(jīng)系統(tǒng)神經(jīng)鞘瘤、神經(jīng)纖維瘤轉(zhuǎn)移性腫瘤肺癌、乳腺癌、黑色素瘤和白血病占位性病變壓迫、破壞周圍腦組織浸潤性生長和腦脊液轉(zhuǎn)移顱外和錐管外轉(zhuǎn)移少見顱內(nèi)腫瘤臨床特點Notehowthismeningiomabeneaththedurahascompressedtheunderlyingcerebralhemisphere.Rarely,meningiomascanbemoreaggressiveandinvade.Atmediumpower,thismeningiomaiscomposedofwhorlednestsofcells.Avarietyofpatternsarepossible.Meningioma(gradeI)Astrocytoma(gradeII)GFAP+Oligodendroglioma(gradeII)GlioblastomaAhighlymalignantastrocytegliomawithnecrosisandvascularproliferation.(gradeIV)Schwannoma變性疾病一組原因不明的中樞神經(jīng)系統(tǒng)疾病選擇性地累及某一部位的神經(jīng)元并產(chǎn)生特定的臨床癥狀共同病理特點為神經(jīng)原萎縮、死亡和星形膠質(zhì)細(xì)胞增生阿爾茨海默病

（Alzheimerdisease)AloisAlzheimer1864-19151901firstcase1906firstreport阿爾茨海默病

（Alzheimerdisease)老年性癡呆臨床表現(xiàn)：進(jìn)行性癡呆病因和發(fā)病機制NormalcortexDementiacortexAtrophy:lossoftheneurons病變特點部位：大腦額葉、頂葉及顳葉肉眼：萎縮性改變Alzheimer病海馬區(qū)大腦皮質(zhì)區(qū)AlzheimerHemisphereNormalHemisphereThecerebralatrophyseenheremainlyinthefrontalandparietalregionsischaracterizedbynarrowedgyriandwidenedsulci.TheatrophyseenherewasduetoseniledementiaoftheAlzheimer'stype(Alzheimer'sdisease).InthiscaseofAlzheimer'sdisease,thereismoremarkedatrophyseensuperiorlyandlaterally,withsparingoftheoccipitalregion.病變特點鏡下神經(jīng)斑(老年斑)神經(jīng)原纖維纏結(jié)顆粒空泡變性hirano小體ACongoredstainNeuriticplaquesNeurofibrillarytanglesofAlzheimer'sdiseasearealsoseenbestwithasilverstain,asshownhere.Microscopiclesions:,Amyloid-(A)=Neuriticplaques;

=Neurofibrillarytangles;=FundmentallesionsinAlzheimerdiseaseMicrogliocyteAstrocyteNeuriticplaqueNeuronThecoreofneuriticplaqueisconstitutedbyamyloid-proteins(A)(thecleavagefragmentsfromatrans-membraneprotein:amyloidprecursorprotein(APP),functionasareceptor.)Neurofibrillarytanglescontaintauproteinswhicharehyperphosphoried(tauproteinsareinassociationwithmicrotubularnetwork)正常神經(jīng)原微管（黃色）—傳遞信號和營養(yǎng)神經(jīng)原τ蛋白（蘭色）—支持微管病變神經(jīng)原τ蛋白增生呈雙螺旋鉸鏈狀神經(jīng)原纖維纏結(jié)神經(jīng)細(xì)胞顆?？张葑冃耘两鹕。≒arkison'disease）震顫性麻痹（paralysisagitans)臨床表現(xiàn)：震顫、肌強直和步態(tài)不穩(wěn)等病因和發(fā)病機制病變特點部位：黑質(zhì)肉眼：黑質(zhì)和藍(lán)斑脫色ThelossofpigmentationinthesubstantianigraofthemidbrainattheleftinapatientwithParkinson'sdiseaseiscontrastedwithanormalmidbrainattheright.Parkinson'sdiseaseismarkedclinicallybya"pill-rolling"tremoratrest,mask-likefacies,andcogwheelrigidityoflimbs,amongotherfindings.病變特點鏡下黑質(zhì)細(xì)胞變性、脫失lewy小體形成Attheleft,normalnumbersofneuronsinthesubtantianigraarepigmented.Attheright,thereislossofneuronsandlossofpigmentationwithParkinson'sdisease.Attheleft,anHandEstaindemonstratesaroundedpinkcytoplasmicLewybodyinaneuronofthecerebralcortexfromapatientwithdiffuseLewybodydisease,whichcanbeacausefordementia.LewybodiescanalsobeseeninsubstantianigrawithParkinson'sdisease.Animmunoperoxidasestainforubiquitin,seenattheright,helpsdemonstratetheLewybodiesmorereadily.常見并發(fā)癥顱內(nèi)壓升高和腦疝形成腦水腫腦積水腦水腫腦組織中液體貯積過多SubfalcineherniationTranstentorialherniationTonsillarherniation腦疝扣帶回疝（大腦鐮下疝）中線易位，患側(cè)扣帶回從大腦鐮游離緣向?qū)?cè)膨出。小腦天幕疝（海馬鉤回疝）小腦天幕以上額葉或顳葉腫大，導(dǎo)致顳葉的海馬鉤回經(jīng)小腦天幕孔向下膨出。小腦扁桃體疝（枕骨大孔疝）小腦和延髓向枕骨大孔移位。Acutebrainswellingintheclosedcranialcavityisserious.Swellingoftheleftcerebralhemispherehasproducedashiftwithherniationoftheuncusofthehippocampusthroughthetentorium,leadingto

thegrooveseenatthewhitearrow.小腦扁桃體疝TheendresultofherniationiscompressionandDurethemorrhages,asseenhereinthepons.小腦扁桃體疝腦積水腦脊液量增多伴腦室擴(kuò)張本課件參考資料：1,KumarV,AbbasAK,AsterJC.RobbinsandContranpathologicbasisofdisease,9thedition.Philadelphia:ElsevierSander,2015.2,《病理學(xué)》,陳杰,李甘地主編,第2版,北京:人民衛(wèi)生出版社,2010本課件教學(xué)圖片來源：1,KumarV,AbbasAK,AsterJC.RobbinsandContranpathol