Serdar Balcı

Hücrede büzüşme, piknozis, nükleol kaybı, Nissl cisimciği kaybı, sitoplazmada belirgin eozinofili (kırmızı nöron)

Nükleus da büzüşen hücre gibi köşeli şekil alır

Robbins Basic Pathology

Injured axons undergo swelling and show disruption of axonal transport

Swellings (spheroids) can be recognized on H&E stains and can be highlighted by silver staining or immunohistochemistry.

Axonal spheroids are visible as bulbous swellings at points of disruption, or altered axonal transport.

Robbins Basic Pathology

Axonal injury

-leads to cell body enlargement and rounding

-peripheral displacement of the nucleus

-enlargement of the nucleolus

-peripheral dispersion of Nissl substance (central chromatolysis)

C: With axonal injury there can be swelling of the cell body and peripheral dispersal of the Nissl substance, termed chromatolysis.

Robbins Basic Pathology

Robbins and Cotran Pathologic Basis of Disease

Traumatic Diseases of CNS

Serdar BALCI, MD

Central Nervous System Trauma

Penetrating trauma

Blunt trauma

Open injury

Closed injury

Traumatic Parenchymal Injuries

Contusions, wedge-shaped, widest aspect closest to the point of impact

Acute contusions are present in both temporal lobes, with areas of hemorrhage and tissue disruption

Robbins Basic Pathology

In contrast with ischemic lesions, in which the superficial layer of cortex may be preserved, trauma affects the superficial layers most severely

Robbins Basic Pathology

Old traumatic lesions have a characteristic macroscopic appearance

**-depressed, retracted, yellowish brown patches involving the crests of gyri **

Robbins Basic Pathology

Autopsy Pathology: A Manual and Atlas

Remote orbital surface contusions

Diffuse axonal injury

Trauma can also cause more subtle but widespread injury to axons within the brain

Movement of one region of brain relative to another is thought to disrupt axonal integrity and function

Angular acceleration, even in the absence of impact, may cause axonal injury as well as hemorrhage

50% of patients who develop coma shortly after trauma are believed to have white matter damage and diffuse axonal injury


reversible altered consciousness from head injury in the absence of contusion

loss of consciousness, temporary respiratory arrest, and loss of reflexes

neurologic recovery is complete, amnesia for the event persists

The pathogenesis of the sudden disruption of nervous activity is unknown

Traumatic Vascular Injury

Robbins Basic Pathology

Epidural Hematoma

Epidural hematoma covering a portion of the dura

Robbins Basic Pathology

Subdural Hematoma

Robbins Basic Pathology

Manifest within the first 48 hours after injury

Most common over the lateral aspects of the cerebral hemispheres and may be bilateral

Acute subdural hematoma

Collection of freshly clotted blood apposed to the contour of the brain surface

Without extension into the depths of sulci

Underlying brain is flattened

Subarachnoid space is often clear

Venous bleeding is self-limited

Breakdown and organization of the hematoma take place over time

**Evolving subdural hematoma. The semiliquid membrane-bound mass of blood in the subdural space **

Autopsy Pathology: A Manual and Atlas

Subdural hematomas organize

1 week → lysis of the clot

2 weeks → growth of granulation tissue from the dural surface into the hematoma

1 to 3 months → fibrosis

Autopsy Pathology: A Manual and Atlas

Large organizing subdural hematoma attached to the dura

Organized hematomas are attached to the dura, but not to the underlying arachnoid

subdural membranes

Fibrosing lesions may retract, leave a thin layer of connective tissue

Subdural hematomas commonly rebleed

chronic subdural hematomas

From the thin-walled vessels of the granulation tissue, leading to microscopic findings consistent with hemorrhages of varying age

Robbins Basic Pathology