CNS Pathology - I

Bleeding in theSkullRegion

Jaroslava DuškováInst. Pathol. ,1st Med. Faculty, Charles Univ. Prague

Bleeding in the Skull Region extracranial

(kefalhaematoma externum, subperiostal, subaponeurotic)

intracranialextracerebral intracerebral

v.cerebri magna Galeni

EDSD

SA IP

Bleeding in the Skull Region – intracranial haemorrhages

extracerebralepiduralsubduralsubarachnoideal

intracerebralcapillaryvenousarterialcircumscribeddestructive

Fetal & Neonatal Bleeding

Germinal Zone (GZ) Bleeding

25% preterm neonates (decreasing recently)

GZ: periventricular, large calibre capillaries, highly vascularized esp. in the 3rd. trimestre

Patogenesis of GZ Bleeding

Perinatal ev. intranatal hypoxia– disorder of cerebral perfusion autoregulation– ischemic endothelial capillary lesions in the GZ– myocardial energy reserves exhausted– perinatal circulation failure– cerebral hypoxia venous haemorrhage

Blood pressure increase– muscle activity of neonate– resuscitation– arteficial ventilation

Closed Cerebral Trauma –traumatology classification

Type of injury Diffuse

– commotion– diffuse axonal injury

Focal– contusion

Compression– hematomas (epidural,

subdural, intracranial)– hygroma

Therapy Conserv.

Conserv.sometimesevacuation

SURGICAL

Punch-Drunk Syndrome – (dementia pugilistica)

clinically obvious years after the last fight three stages:

– affective disorders, mild incoordination– dysphasia, apraxia, agnosia, apathy, blunting of

affects– global cognitive decline & parkinsonism

present in 20% of profess. boxers over 50 more likely to develop in boxers with long

careers SN degeneration, neuronal loss, Alzheimer

intracellular changes

Brain Perfusion FailureEncephalomalacia

whiteredmixed

Causes ischemia venostasis

Postencephalomalatic pseudocyst (event.)

Cerebral Arteries Atherosclerosis

Morphological features – encephalomalacia– encephalopathia angiosclerotica:

atrophia cerebri diffusa status cribrosus status lacunaris hydrocephalus ext. et int. e vacuo

Cerebral Arteries Atherosclerosis

Clinical features – cerebral infarction (event. death)– pyramidal and extrapyramidal signs– atherosclerotic (multiinfarct)

demention (-100ml!)