外伤性脑梗死17例观察  

Traumatic cerebral infarction: a histopathological study of 17 cases

作　　者：宋一璇[1] 姚青松[1] 祝家镇[2] 

机构地区：[1]广州市刑事科学技术研究所,510030 [2]汕头大学医学院法医教研室

出　　处：《中华病理学杂志》2004年第5期416-418,共3页Chinese Journal of Pathology

基　　金：公安部科技基金资助项目 ( 2 0 0 0 44 2 110 1); ;广州市公安局科技基金资助项目 ( 99 0 3 )

摘　　要：目的　观察外伤性脑梗死的形态学特点 ,并探讨其发病机制。方法　在 81例重型脑外伤标本中 ,选出 17例伴脑梗死脑行肉眼、光镜观察。结果　 (1)全部外伤性脑梗死病变均为出血性 ,切面呈楔形、类楔状或不规则形 ,分别位于枕回 (8例 )、枕部楔叶回 (3例 )、基底核及其周围 (3例 )、扣带回 (2例 )及枕颞外侧回 (1例 )等部位。镜下表现为淤血、水肿及围管性出血 ,病变从皮、髓质交界区开始 ,逐渐累及全皮层及蛛网膜下腔 ,出血灶融合成片 ,尚见血栓形成、神经组织和血管坏死。 (2 )脑肿胀 ,全部均有脑疝形成 ,其中 8例见大脑后动脉被压在钩回与大脑脚之间 ,动脉受挤压变扁。结论　外伤性脑梗死系外伤后引起脑水肿、脑疝形成并压迫血管 ,引起局部 (静脉 )淤血、出血及 (动脉 )流入血量减少 。Objective To assess the morphologic changes in traumatic cerebral infarction and to discuss its mechanism. Methods Specimens from seventeen cases of cerebral infarction were selected from 81 patients with severe brain injury, and subject to routine gross and histological examinations. Results (1) The cerebral infarction in all cases was hemorrhagic in nature with a wedged or irregular shape upon gross inspection. The lesions were found in occipital gyrus (8 cases), occipital lobes (3 cases), basal nuclei (3 cases), cingulate gyrus (2 cases), and lateral occipitotemporal gyrus (1 case) . Histologically, the lesions were located at the junction between the cortex and medulla, showing congestion, edema, hemorrhage, necrotic nerve tissue and blood vessels. In severe cases, the lesion extended into the entire cortex and subarachnoid spaces. (2) Swelling of the brain and cerebral hernia were found in all cases, 8 of which demonstrated that the posterior cerebral artery was compressed and stenotic within the space between the crus cerebri and uncus. Conclusion Brain tissue necrosis in traumatic cerebral infarction is the result of brain swelling and cerebral hernia formation, following congestion, bleeding and ischemia due to vasculature compression.

关 键 词：外伤性脑梗死 出血 观察 脑疝形成 动脉 血管 淤血 目的观 结论 融合 

分 类 号：R651.15[医药卫生—外科学]