医学精品课件：3法医CNS trauma 2014.pptx

1、CNS Trauma竺可青2014-3-11Classification of head injury by clinicopathological correlation根据临床病理联系的脑损伤分类Classification of head injury by neuroradiological and neuropathological features 根据神经放射学和神经病理学特点分类Classification of head injury by mechanism of production 根据产生机制分类An arrested growing fracture that pr

2、esented in a woman of 38.When asked about childhood injuries,she remembered that she fallen out of her carriage as a very young child.A.Plain skull X-ray.B.The excised portion of bone.颅骨骨折颅骨骨折Fissured fracture 线性骨折线性骨折Depressed fracture 凹陷型骨折凹陷型骨折Penetrated fracture 孔状骨折孔状骨折Comminuted fracture 粉碎性骨折

3、粉碎性骨折Bursting fracture 崩裂性骨折崩裂性骨折冲击点伤和对冲伤Mechanism of cerebral contusion.Arrows indicate point of application and direction of force;black area indicates location of contusion.Small intracortical contusions in typical sites at the base of frontal(A)and temporal lobes(B).Old contusions on the base of

4、 the frontal lobes.Extradural hemorrhages.硬膜外出血硬膜外出血 EDHA.A man of 60 received a blow behind his ear.Bruising in the temporails muscle and this linear,right-sided temporal fracture overlay a large extradural hemorrhage,which was the cause of his death 5 hours later.B,Gross appearance of a bifrontal

5、extradural hematoma.C.A classical extradural hematoma situated in the parietotemporal region.Acute and subacute subdural hematomas 硬膜下血肿硬膜下血肿.SDHA.Acute subdural hematoma;B.Acute subdural hematoma;C.Subacute subdural hematoma.慢性硬膜下血慢性硬膜下血肿肿（脑瘫小儿）（脑瘫小儿）外伤后大脑中动脉闭塞性血栓栓塞梗死外伤后大脑中动脉闭塞性血栓栓塞梗死 DAI弥弥漫性轴索损伤、脑

6、白质弥漫性变漫性轴索损伤、脑白质弥漫性变化、剪切损伤、弥漫性脑深部损伤化、剪切损伤、弥漫性脑深部损伤胼胝体以及脑干前段的局灶性出血病变弥漫性脑损伤4类DAI弥漫性缺血缺氧损伤弥漫性缺血缺氧损伤脑水肿脑水肿弥漫性血管损伤弥漫性血管损伤Frequency of Principal macroscopic lesion in diffuse axonal injury and their anatomical distribution 好发部位Two days survival after injury.Damaged axons are easily seen on routine stains.

7、Beta-APP diagnosis axonal damage(2h)Histology in cases where diffuse brain injury is suspected诊断DAIPatterns and causes of hypoxic ischemic brain damage after traumatic brain injury 脑外伤后的弥漫性缺血缺氧性损伤原因及类型好发部位好发部位Hippocampus CA1Laminar cortical necrosisInfrction in the bounadry zones of the major cerebr

8、al aeteries 弥漫性血管损伤弥漫性血管损伤车祸后脑外伤死亡，广泛脑出血导致死亡反复脑损伤与痴呆反复脑损伤与痴呆 儿科脑损伤儿科脑损伤Vascular PathologyDistribution of the blood in the various forms of intracranial hemorrhages 颅内出血原因Berry aneurysm Diffuse subarachnoid hemorrhage动脉瘤出血部位动脉瘤出血部位 根据出血部位判断动脉瘤位置根据出血部位判断动脉瘤位置Giant atherosclerotic aneurysmsA.Anterior c

9、erebral artery.B.Basilar artery高血压与高血压性脑血管病高血压与高血压性脑血管病基底核出血Intracerebellar hemorrhage 小脑出血突然头痛、眩晕、呕吐；眼震；昏迷；枕骨大孔疝迅速死亡。Brainstem hemorrhage 脑干出血延髓、中脑罕见，脑桥多见；突然发病；眼部症状；呼吸障碍；感觉运动障碍；深昏迷；去脑强直；数小时或24小时内死亡。脑叶出血、皮质下白质出血脑叶出血、皮质下白质出血额叶额叶：精神障碍，智能障碍，近记忆力、计算力、判断力障碍，运动性失语。颞叶颞叶：破入蛛网膜下腔出现脑膜刺激症，感觉性或命名性失语，精神症状。顶叶顶叶：下

10、肢较上肢及颜面部重的偏瘫及感觉障碍。枕叶枕叶：对侧偏盲，皮质盲，瞳孔光反射存在。Vascular malformations.A.Medial frontal cerebral arteriovenous aneurysm.B.Vein of Galen aneurysm.脑血管畸脑血管畸形主形主要要4种种动静脉血管畸形动静脉血管畸形AVM静脉血管畸形静脉血管畸形海绵状血管畸形海绵状血管畸形毛细血管扩张毛细血管扩张Multiple lobe hemorrhages in a patient with leukemia 白血病 贫血性梗死贫血性梗死Hemorrhagic infarcts 出血性梗死注意出血病理动态变化过程注意出血病理动态变化过程 脑梗死原因脑梗死原因脑动脑动脉粥样硬化好发部位脉粥样硬化好发部位Evolution of lesions caused by atheromatous carotid stenosis判断栓子The risk of temporal herniation大脑后动脉梗死椎基底动脉系统 小结