CNS Pathology I Bleeding in the Skull Region

CNS Pathology - I Bleeding in the Skull Region Jaroslava Dušková Inst. Pathol. , 1 st Med. Faculty, Charles Univ. Prague

Bleeding in the Skull Region v extracranial (kefalhaematoma externum, subperiostal, subaponeurotic) v intracranial extracerebral intracerebral

ED SD v. cerebri magna Galeni SA IP

Bleeding in the Skull Region – intracranial haemorrhages extracerebral epidural subarachnoideal intracerebral capillary venous arterial circumscribed destructive

Fetal & Neonatal Bleeding

Germinal Zone (GZ) Bleeding 25% preterm neonates (decreasing recently) GZ: periventricular, large calibre capillaries, highly vascularized esp. in the 3 rd. 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 Therapy u Diffuse u Conserv. – commotion – diffuse axonal injury u Focal – contusion u Compression – hematomas (epidural, subdural, intracranial) – hygroma u Conserv. sometimes evacuation SURGICAL

Punch-Drunk Syndrome – (dementia pugilistica) clinically obvious years after the last fight u three stages: u – affective disorders, mild incoordination – dysphasia, apraxia, agnosia, apathy, blunting of affects – global cognitive decline & parkinsonism u present in 20% of profess. boxers over 50 u more likely to develop in boxers with long careers u SN degeneration, neuronal loss, Alzheimer intracellular changes

Brain Perfusion Failure Encephalomalacia white red mixed Causes ischemia venostasis Postencephalomalatic pseudocyst (event. )

Cerebral Arteries Atherosclerosis Morphological features encephalomalacia – encephalopathia angiosclerotica: – atrophia cerebri diffusa v status cribrosus v status lacunaris v hydrocephalus ext. et int. e vacuo v

Cerebral Arteries Atherosclerosis Clinical features cerebral infarction (event. death) – pyramidal and extrapyramidal signs – atherosclerotic (multiinfarct) demention – (-100 ml!)