法醫(yī)學(xué)3法醫(yī)課程

法醫(yī)學(xué)3法醫(yī)課程第1頁(yè)/共72頁(yè)Classificationofheadinjurybyclinicopathologicalcorrelation

根據(jù)臨床病理聯(lián)系的腦損傷分類第2頁(yè)/共72頁(yè)Classificationofheadinjurybyneuroradiologicalandneuropathologicalfeatures根據(jù)神經(jīng)放射學(xué)和神經(jīng)病理學(xué)特點(diǎn)分類第3頁(yè)/共72頁(yè)Classificationofheadinjurybymechanismofproduction根據(jù)產(chǎn)生機(jī)制分類第4頁(yè)/共72頁(yè)Anarrestedgrowingfracturethatpresentedinawomanof38.Whenaskedaboutchildhoodinjuries,sherememberedthatshefallenoutofhercarriageasaveryyoungchild.A.PlainskullX-ray.B.Theexcisedportionofbone.顱骨骨折Fissuredfracture線性骨折Depressedfracture凹陷型骨折Penetratedfracture孔狀骨折Comminutedfracture粉碎性骨折Burstingfracture崩裂性骨折第5頁(yè)/共72頁(yè)沖擊點(diǎn)傷和對(duì)沖傷

Mechanismofcerebralcontusion.Arrowsindicatepointofapplicationanddirectionofforce;blackareaindicateslocationofcontusion.第6頁(yè)/共72頁(yè)Smallintracorticalcontusionsintypicalsitesatthebaseoffrontal(A)andtemporallobes(B).第7頁(yè)/共72頁(yè)Oldcontusionsonthebaseofthefrontallobes.第8頁(yè)/共72頁(yè)Extraduralhemorrhages.硬膜外出血EDH

A.Amanof60receivedablowbehindhisear.Bruisinginthetemporailsmuscleandthislinear,right-sidedtemporalfractureoverlayalargeextraduralhemorrhage,whichwasthecauseofhisdeath5hourslater.

B,Grossappearanceofabifrontalextraduralhematoma.

C.Aclassicalextraduralhematomasituatedintheparietotemporalregion.第9頁(yè)/共72頁(yè)Acuteandsubacutesubduralhematomas硬膜下血腫.SDH

A.Acutesubduralhematoma;

B.Acutesubduralhematoma;C.Subacutesubduralhematoma.第10頁(yè)/共72頁(yè)慢性硬膜下血腫（腦癱小兒）第11頁(yè)/共72頁(yè)

第12頁(yè)/共72頁(yè)外傷后大腦中動(dòng)脈閉塞性血栓栓塞梗死第13頁(yè)/共72頁(yè)

DAI彌漫性軸索損傷、腦白質(zhì)彌漫性變化、剪切損傷、彌漫性腦深部損傷胼胝體以及腦干前段的局灶性出血病變彌漫性腦損傷4類DAI彌漫性缺血缺氧損傷腦水腫彌漫性血管損傷第14頁(yè)/共72頁(yè)FrequencyofPrincipalmacroscopiclesionindiffuseaxonalinjuryandtheiranatomicaldistribution好發(fā)部位第15頁(yè)/共72頁(yè)Twodays’survivalafterinjury.

Damagedaxonsareeasilyseenonroutinestains.第16頁(yè)/共72頁(yè)Beta-APPdiagnosisaxonaldamage(2h)第17頁(yè)/共72頁(yè)第18頁(yè)/共72頁(yè)Histologyincaseswherediffusebraininjuryissuspected

診斷DAI第19頁(yè)/共72頁(yè)P(yáng)atternsandcausesofhypoxicischemicbraindamageaftertraumaticbraininjury

腦外傷后的彌漫性缺血缺氧性損傷原因及類型好發(fā)部位HippocampusCA1LaminarcorticalnecrosisInfrctioninthebounadryzonesofthemajorcerebralaeteries

第20頁(yè)/共72頁(yè)彌漫性血管損傷車禍后腦外傷死亡，廣泛腦出血導(dǎo)致死亡第21頁(yè)/共72頁(yè)反復(fù)腦損傷與癡呆

第22頁(yè)/共72頁(yè)兒科腦損傷第23頁(yè)/共72頁(yè)第24頁(yè)/共72頁(yè)VascularPathology第25頁(yè)/共72頁(yè)Distributionofthebloodinthevariousformsofintracranialhemorrhages顱內(nèi)出血原因第26頁(yè)/共72頁(yè)第27頁(yè)/共72頁(yè)Berryaneurysm第28頁(yè)/共72頁(yè)第29頁(yè)/共72頁(yè)第30頁(yè)/共72頁(yè)

第31頁(yè)/共72頁(yè)Diffusesubarachnoidhemorrhage第32頁(yè)/共72頁(yè)動(dòng)脈瘤出血部位第33頁(yè)/共72頁(yè)

根據(jù)出血部位判斷動(dòng)脈瘤位置第34頁(yè)/共72頁(yè)Giantatheroscleroticaneurysms

A.Anteriorcerebralartery.B.Basilarartery第35頁(yè)/共72頁(yè)高血壓與高血壓性腦血管病第36頁(yè)/共72頁(yè)第37頁(yè)/共72頁(yè)基底核出血第38頁(yè)/共72頁(yè)Intracerebellarhemorrhage小腦出血

突然頭痛、眩暈、嘔吐；眼震；昏迷；枕骨大孔疝迅速死亡。第39頁(yè)/共72頁(yè)Brainstemhemorrhage腦干出血

延髓、中腦罕見(jiàn)，腦橋多見(jiàn)；突然發(fā)病；眼部癥狀；呼吸障礙；感覺(jué)運(yùn)動(dòng)障礙；深昏迷；去腦強(qiáng)直；數(shù)小時(shí)或24小時(shí)內(nèi)死亡。第40頁(yè)/共72頁(yè)第41頁(yè)/共72頁(yè)第42頁(yè)/共72頁(yè)

腦葉出血、皮質(zhì)下白質(zhì)出血額葉：精神障礙，智能障礙，近記憶力、計(jì)算力、判斷力障礙，運(yùn)動(dòng)性失語(yǔ)。顳葉：破入蛛網(wǎng)膜下腔出現(xiàn)腦膜刺激癥，感覺(jué)性或命名性失語(yǔ)，精神癥狀。頂葉：下肢較上肢及顏面部重的偏癱及感覺(jué)障礙。枕葉：對(duì)側(cè)偏盲，皮質(zhì)盲，瞳孔光反射存在。第43頁(yè)/共72頁(yè)Vascularmalformations.

A.Medialfrontalcerebralarteriovenousaneurysm.

B.VeinofGalenaneurysm.腦血管畸形主要4種動(dòng)靜脈血管畸形AVM靜脈血管畸形海綿狀血管畸形毛細(xì)血管擴(kuò)張第44頁(yè)/共72頁(yè)Multiplelobehemorrhagesinapatientwithleukemia白血病第45頁(yè)/共72頁(yè)

貧血性梗死第46頁(yè)/共72頁(yè)Hemorrhagicinfarcts出血性梗死第47頁(yè)/共72頁(yè)注意出血病理動(dòng)態(tài)變化過(guò)程第48頁(yè)/共72頁(yè)第49頁(yè)/共72頁(yè)

腦梗死原因第50頁(yè)/共72頁(yè)腦動(dòng)脈粥樣硬化好發(fā)部位

第51頁(yè)/共72頁(yè)第52頁(yè)/共72頁(yè)Evolutionoflesionscausedbyatheromatouscarotidstenosis第53頁(yè)/共72頁(yè)判斷栓子第54頁(yè)/共72頁(yè)第55頁(yè)/共72頁(yè)第56頁(yè)/共72頁(yè)Theriskoftemporalherniation第57頁(yè)/共72頁(yè)大腦后動(dòng)脈梗死第58頁(yè)/共72頁(yè)椎基底動(dòng)脈系統(tǒng)第59頁(yè)/共72頁(yè)第60頁(yè)/共