第十一章 02 中枢系统疾病二

§3Infections病因诊断技术Electronmicroscope

Immunohistochemistry

免疫组织化学

Hybridizationinsitu原位杂交Cultivation培养

Immunoassay免疫检测

PCR多聚酶链反应神经系统感染性疾病I.Acutepyogenicmeningitis急性化脓性脑膜炎

病因青少年:

meningococcus

脑膜炎双球菌

发病机制病人带菌者飞沫呼吸道上呼吸道脑膜血

Epidemicmeningitis

流行性脑膜炎（流脑）

局部炎症病变Pyogenicinflammationofleptomeninges软脑膜蛛网膜的化脓性炎肉眼：脑脊膜血管高度扩张充血，蛛网膜下腔充满脓性渗出物光镜：嗜中性白细胞为主的炎细胞浸润AcutepyogenicmeningitisHereisanotherexampleofanacutemeningitisfrombacterialinfection.Thecerebrospinalfluid(CSF)insuchcasestypicallyhasalowglucose,highprotein,andmanyPMN's.Agramstainshouldbedonetoidentifyorganisms.agramstainrevealsgramnegativediplococciwithinaneutrophil,typicalforNeisseriameningitidis.Gramstainandculturecanbeperformedoncerebrospinalfluidobtainedvialumbarpuncture.Avarietyofbacteriacancausemeningitis,butseveralaremorecommon,andhaveanincidencemorefrequentatcertainages:191临床病理联系颅内压增高脑膜刺激症状脑脊液变化结局和后遗症脑膜粘连颅神经受损Acutepyogenicmeningitis

角弓反张暴发性脑膜炎球菌败血症机制和病变Septicemia败血症Shock循环衰竭DICHemorrhageinskinAdrenalhemorrhage&necrosis

Waterhouse-Friederichsensyndrome沃-弗综合征Theseadrenalsareblack-redfromextensivehemorrhageinapatientwithWaterhouse-Friderichsensyndrome.Thisisthemicroscopicappearanceoftheadrenalswithmeningococcemia.Thereismarkedhemorrhagicnecrosiswithacuteadrenalinsufficiency.005004ThepatientwithWaterhouse-FriderichsensyndromehassepsiswithDICandmarkedpurpura.006神经系统感染性疾病

viralencephalomyelitis

病毒性脑脊髓炎病因发病血管内皮病毒血症

细胞外传播病毒血CNS吞噬细胞血脑屏障NC,GC内寄生

病毒的致病性病毒本身：病毒血症寄生（NC,后期GC）---溶细胞作用病毒膜抗原激发的特异性免疫杀伤靶细胞，炎症反应viralencephalomyelitis

基本病变：Injuryofneuron:Degeneration

Necrosis

Viralinclusionbody病毒包含体

InflammatoryExudation:L,M,P

Perivascularcuffing血管套microglialnodule胶质结节&Neuronophagia噬神经细胞现象

SetallitosisGliosisTropism亲合性（定位）Viralinclusion(Negribody)Lewybody发病机理：病毒性脑脊髓炎1.EpidemicencephalitisB流行性乙型脑炎病因:

乙型脑炎病毒（夏季流行，儿童）

动物蚊人内皮细胞单核细胞病毒血症CNS隐性感染动物Braincortex,basalganglia皮层、基底核……Spinalcord部位病变特点

Brainhyperemia,edemaFociofsoftening软化灶（筛状软化）

......EpidemicencephalitisBFocusofsofteningMicroglialnoduleFocusofsoftening

lattiscell格子细胞临床病理联系

Cranialnerves:

Brainedema,ICP:后遗症Ｄementia

EpidemicencephalitisB

病因：Poliovirus发病机理病毒性脑脊髓炎

2.Poliomyelitis脊髓灰质炎Infantileparalysis小儿麻痹症消化道粘膜上皮内增殖病毒血症motoneuron隐性感染

病变特点

Spinalcord:hyperemia,hemorrhage,necrosis......Anteriorspinalroot&muscle:atrophy病变部位

motoneuron运动神经元

脊髓前角>中央前回,…

PoliomyelitisPoliomyelitis1412后遗症

Muscleatrophy

临床病理联系

Lumbar/cervicalenlargement:CranialnervesMedullaoblongata延髓:Poliomyelitis

§4

Prion-AssociatedDiseases

阮病毒病发生于人和动物的神经变性病，其病因和发病学与prionprotein(PrP)有关。PrionproteinPrPMW60000KB1982Prusiner瘙痒病仓鼠脑中分离出

Proteinaceousinf