1. Path Markers - Neuro Flashcards
Pathological Marker of Parkinson’s
- Lewy Body
- - a-synuclein intracellular inclusion
Lewy Body
- Pathological Marker of Parkinson’s
- a-synuclein intracellular inclusion
a-Synuclein Intracellular Inclusion
- Lewy Body
- Pathological Marker of Parkinson’s
(+) VDRL in CSF
- Tertiary Syphilis
CSF Test for Tertiary Syphilis
- (+) VDRL
CSF Turbidity
- Caused by an increase in protein, cells, microbial pathogens, or a combination of the three
CSF Blood
- Most commonly iatrogenic
- Can also indicate a hemorrhage into the subarachnoid space
CSF Protein
- Normal = 15-45 mg/dL
- High levels indicate increased capillary permeability (ie acute inflammation)
CSF Gamma Globulins
- Detected with CSF electrophoresis
- Normally account for CNS origin of IgG
- ——— Low index –> Inflammation
CSF Oligoclonal Gamma Globulin Bands
- Detected with High resolution CSF electrophoresis
- Indicated a demyelinating disorder:
- — MS
- — Neurosyphilis
- — Guillain-Barre
CSF Myelin Basic Protein
- MBP is a normal component of myelin
- Increased levels in CSF indicate an active demyelinating disease.
- Levels are not elevated in remissions of the demyelinating disease
CSF Glucose
- Normal = 50-75 mg/dL (.66 x serum conc.)
- —- vs. Normal serum = 70-110 mg/dL
- Decreased levels (hypoglycorrhachia) imply:
- —- Increased cellular uptake (ie neutrophils in bacterial meningitis, malignant cells)
- —- Or a defect in the glucose carrier system (frequent occurrence in bacterial and fungal meningitis)
- Normal levels can be seen in:
- —- Viral meningitis (Except Mumps, Herpes simplex, and the lymphocytic choriomeningitis virus - these produce a low glucose)
- —- Neurosyphilis
- —- Demyelinating disease
- —- Cerebral abscess
Low CSF Glucose
- (hypoglycorrhachia) implies:
- —- Increased cellular uptake (ie neutrophils in bacterial meningitis, malignant cells)
- —- Or a defect in the glucose carrier system (frequent occurrence in bacterial and fungal meningitis)
CSF WBC’s
- Normal = 0-5 mononuclear cells/mm^3
- —- Neutrophils are never normal in CSF
- High CSF WBC’s is most often due to bacterial meningitis.
- Bacterial meningitis will have predominantly neutrophils.
- Viral meningitis will have neutrophils only for the first 24h and then switch to a lymphocytic response.
- Fungal meningitis is characterized by predominance of lymphocytes and monocytes
- A parasitic meningitis usually has mixed inflammatory infiltrate (eosinophils suggest Helminth)
High CSF WBC’s
- Most often due to bacterial meningitis
- Can also be caused by viral, fungal, and parasitic meningitis
High CSF Neutrophils
- Any level of CSF neutrophils is pathologic
- Most often due to bacterial meningitis
- Can also be early viral meningitis (switches to lymphocytic response after 24h)
High CSF Lymphocytes
- Mostly viral meningitis
- Can be fungal (usually monocytes will also be present)
High CSF Eosinophils
- Parasitis meningitis (Helminths)
High CSF Lymphocytes and Monocytes
- Fungal meningitis
CSF Gram Stain
- High sensitivity for Bacterial meningitis
CSF PCR
- Detects DNA
- Extremely sensitive and specific for meningitis
Pathologic Markers of Bacterial Meningitis
- CSF turbidity
- Increased CSF protein
- Increased CSF Ig
- Decreased CSF IgG index
- Low CSF Glucose
- High CSF WBC’s - Neutrophils
- (+) CSF Gram stain
- (+) CSF Culture
- (+) CSF PCR
Pathologic Markers of Viral Meningitis
- CSF turbidity
- Increased CSF protein
- Increased CSF Ig
- Decreased CSF IgG index
- Normal CSF Glucose (Except Mumps, Herpes simplex, and the lymphocytic choriomeningitis virus - these produce a low glucose)
- High CSF WBC’s - Neutrophils (24h)
- (-) CSF Gram stain
- (-) CSF Culture
- (+) CSF PCR
Pathologic Markers of Fungal Meningitis
- CSF turbidity
- Increased CSF protein
- Increased CSF Ig
- Decreased CSF IgG index
- Low CSF Glucose
- High CSF WBC’s - Lymphocytes and Monocytes
- (-) CSF Gram stain
- (-) CSF Culture
- (+) CSF PCR
Pathologic Markers of Parasitic Meningitis
- CSF turbidity
- Increased CSF protein
- Increased CSF Ig
- Decreased CSF IgG index
- ? CSF Glucose
- High CSF WBC’s - Mixed, or Eosinophils (Helminths)
- (+) CSF Gram stain
- (+) CSF Culture
- (+) CSF PCR
CSF Stain for Cryptococcal Meningitis
- India Ink
(+) CSF India Ink Stain
- Cryptococcal Meningitis
- —- Cryptococcus neoformans
(+) TSST-1
- Staph. aureus toxic shock toxin
Extracellular b-Amyloid Plaque
- Senile plaque
- Associated with Alzheimer’s
Neurofibrillary Tangles
- Intracellular
- Abnormally phosphorylated Tau protein
- Associated with Alzheimer’s
Pathologic Markers of Alzheimer’s
- b-amyloid senile plaques
- Neurofibrillary tangles
Pick Bodies
- Intracellular
- Aggregated Tau protein
- Associated with Pick’s Disease
Pathologic Marker for Pick’s Disease
- Pick bodies (tau protein aggregates)
Pathologic Markers for MS
- High CSF IgG
- Oligoclonal bands in CSF
- Periventricular plaques on MRI
Periventricular Plaques on MRI
- Areas of Oligodendrocyte loss and reactive gliosis
- Diagnostic for MS
Pathologic Marker for Neurofibromatosis Type I
- Lisch Nodules
Lisch Nodules
- Pigmented iris hamartomas
- Associated with Neurofibromatosis Type I
Pathologic Marker for Gioblastoma Multiforme
- Butterfly shape glioma
- (+) stain for GFAP
Butterfly Shape, (+) GFAP stain
- Associated with Glioblastoma
Pathologic Marker for Schwannoma
- S-100 (+)
S-100 (+)
- Associated with Schwannoma
Pathologic Marker of Oligodendroglioma
- Chicken wire capillary pattern
Chicken Wire Capillary Pattern
- Associated with Oligodendroglioma
Pathologic Markers of Pilocytic (Low Grade) Astrocytoma
- GFAP (+)
- Rosenthal Fibers
- Cystic and Solid Mass
Rosenthal Fibers
- Eosinophilic, corkscrew fibers
- Associated with Pilocytic (Low Grade) Astrocytoma
Pathologic Marker of Medulloblastoma
- Homer-Wright rosettes
Homer-Wright Rosettes
- Associated with Medulloblastoma
Synaptophysin (+) Tumor
Tumor of neural cell origin
Pathologic Marker of Tumor of Neural Cell Origin
Synaptophysin (+)
