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					    Classification of diseases of
          nervous system
   Vascular diseases
   Degenerative diseases
   Demyelinizing diseases
   Traumatic diseases
   Neuropathies
   Tumors
   Malformations of nervous system
Cerebro-vascular diseases
 Typical      are    acute
  disruptions   of cerebral
  blood circulation on the
  background             of
  atherosclerosis       and
  hypertension
  Cerebro-vascular diseases
           include:
 Diseases connected with ischemic
  pathology
 Intracranial hemorrhages
 Hypertensional cerebro-vascular
  diseases

 Clinically term «stroke» is used
  Intracranial hemorrhages

 Most often cases are:
 Intracerebral hemorrhages in hypertension
  (hemorrhagic stroke)
 Subarachnoidal hemorrhage caused by rupture
  of aneurysm
       Hemorrhagic stroke

 Multiple intracranial hematomas appear,
  caused by rupture of microaneurysms or
  malformations of vessels
 Hemorrhagic component appears because of
  diapedesis in demarkative zone
Hemorrhage in the area of basal ganglions in
patient with hypertension
Hemorrhagic infarction of the brain, caused by
embolism of an artery. Edema is noticeable.
The ventricle on the left side is decreased in
size
  Subarachnoid hemorrhage

 In 65% of patients with spontaneous
  subarachnoid hemorrhages the cause is
  rupture of saccular aneurysm of one of main
  cerebral arteries
 In 5% - rupture of vascular malformations
 In 5% - spreading of hematoma into
  subarachnoid space
Subarachnoid hemorrhage from a ruptured
aneurysm. Mortality is 25 to 50%
Diffuse subarachnoid hemorrhage which
spreads from base of brain to lateral surface
of frontal and temporal areas
           Ischemic stroke

 Ischemic infarction (white)
 Hemorrhagic infarction (red)
 Most frequently area of medial cerebral artery
  is affected
 Most frequent causes:
 thromboembolism in cerebral vessels;
 thrombosis and atherosclerosis with stenosis
  of cerebral arteries;
 inflammative affection of arterial net of the
  brain
Affection of medial cerebral artery with
consequent grey softening of the brain
On the right multiple macrophages can be
seen, which are destroying the lipidic remains
of colliquative necrosis
Selective necrosis of neurons
 (ischemic encephalopathy)
 Ischemic encephalopathy is connected to
  chronic ischemia, caused by atherosclerosis
  of cerebral arteries. Typical is ischemic
  damage of neurons with development of
  coagulatory necrosis and apoptosis. At the
  site of dead cells gliosis develops. In
  prolonged process atrophy of cerebral cortex
  may develop.
       Degenerative diseases:
        Alzheimer’s disease
 Presenile dementia develops, there are
  considerable intellectual disorders and
  emotional lability
 There is known connection to senile cerebral
  amyloidosis - development of plaques in
  cerebral vessels, tunics, vascular plexus
 Atrophy of cerebral cortex in frontal, parietal,
  occipital areas, often hydrocephaly develops
The brain in Alzheimer’s disease.
The cerebral atrophy seen here mainly in
the frontal and parietal regions is
characterized by narrowed gyri and
widened sulci.
In this case of
Alzheimer's disease,
there is more marked
atrophy seen
superiorly and
laterally, with sparing
of the occipital region.
Senile plaques in brain tissue
Senile plaques in brain tissue, seen with silver
stain
With the thioflavin stain under
immunofluorescence, the Alzheimer's plaques
as well as the vessels involved with amyloid
angiopathy appear bright green.
A number of neuritic plaques with Alzheimer's
disease are seen here. They have an amyloid
core as seen here with Congo red stain.
This is a neurofibrillary "tangle" of Alzheimer's
disease. The tangle appears as long pink filaments
in the cytoplasm. They are composed of
cytoskeletal intermediate filaments.
Two more neurons with neurofibrillary tangles
are seen here in a patient with Alzheimer's
disease.
Neurofibrillary tangles of Alzheimer's disease
are also seen best with a silver stain, as shown
here.
        Lateral amyotrophic
             sclerosis
 It is a progressive disease of nervous system,
  connected to simultaneous affection of motor neurons
  of anterior and lateral columns of spinal cord and
  peripheral neurons
 Selective atrophy of ventral motor spinal roots, dorsal
  roots are not affected
 Neural cells are contracted, large areas of
  disappearance of neurons
 In nervous fibers there is demyelinization, uneven
  swelling, disintegration and death of axons
Macroscopically on transverse section of spinal cord in
lateral amyotrophis sclerosis the corticospinal tracts are
pale in color because of degeneration
Atrophy of lateral columns of spinal cord with gliosis in
lateral amyotrophic sclerosis
An area of spinal cord in lateral amyotrophic sclerosis.
Cells of anterior horns are absent
Neuronophagy in lateral amyotrophic sclerosis
      Demyelinizing diseases:
      disseminated sclerosis
 It is a chronic disease, characterized by appearence of
  multiple foci of sclerosis - plaques - in the brain and
  spinal cord (white substance).
 Because of multiple localization of foci the clinical
  signs vary
 On early stage there are foci of demyelinization around
  the vessels, especially veins and venules - the
  perivenous demyelinization
 On late stage small foci merge together, demyelinize,
  proliferations from cells of microglia appear, in the end
  typical plaques appear, in which there are no
  oligodendrocytes
In the white substance there is a large «plaque» of
demyelinisation, of grey-brown color - typical for
disseminated sclerosis.
Demyelinised plaque in a patient with disseminated
sclerosis
            Post-reanimation
            encephalopathy
 Usually the brain damage after cardiac arrest are
  limited to selective necrosis of neuron, without
  significant infarction
 In patients who had lived for 12 hours after cardiac
  arrest microscopically can be seen extended and
  significant necrosis of neurons, which is especially
  active in hippocampus and Purkinje’s cells
 After a few days the dead neurons disappear, there is
  intensive reaction of astrocytes, microglia, capillaries
Affection of Purkinje cells between molecular and
granular layers of cerebellum, which are sensitive to
anoxia - cytoplasmatic borders are indistinct, there is
karyolysis
                       Tumors
   astrocytic (50%)
   oligodendroglial (5%)
   ependymal (6%)
   embryonic neuroectodermal
   ingrowing into cranial cavity
   various
Astrocitoma
Astrocitoma in a child
Oligodendroglioma
Ependymoma
Ependymoma
Papillary ependymoma
Medulloblastoma
Glioblastoma
Meningioma
Meningioma
Traumatic neuroma
Meningioma

				
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posted:3/25/2012
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Description: Pathologic anatomy subjects