11-18 NeuroPATH I.D.

Question 1

Gerstmann-Straussler

Answer 1

autosomal dominant prion disease

—ataxia—>dementia—>death

Question 2

PrP^sc

Answer 2

the bad version of the prion gene (sc for scrapie, je crois)

—PrP^c = constitutive/normal version

Question 3

CJD presentation

Answer 3

involuntary myoclonic jerks
—classic EEG findings
—“spongiform encephalitis” —> neuropil fills w/ vacuoles, neurons die in large numbers —> astrocytosis
—may also have Kuru-like amyloid plaques

Question 4

CSF in viral encephalitis

Answer 4

lymphocytosis
—glucose ~nl
—prot a little elev

Question 5

Herpes encephalitis usually sets up shop where?

Answer 5

temporal lobe

Question 6

what type of inflammation do you see with viral CNS infx?

Answer 6

lymphocytic w/ MOs

—perivascular lymphocytic cuffs

Question 7

polio attacks?

Answer 7

anterior horn cells

Question 8

neuronophagia

Answer 8

microglial digestion of neurons

—microglial make nodules

Question 9

Cowdry bodies

Answer 9

inclusion body of HERPES

—kind of fried egg-like

Question 10

What organ is #2 affected by HIV?

Answer 10

le cerveau!

Question 11

Path appearance of HIV-encephalitis

Answer 11

—microglial nodule comme toujours

—giant cells

Question 12

most important 4 AIDS-assoc’d disease

Answer 12

1. Toxoplasma gondii
2. Cryptococcal
3. PML (JC virus +immunosupp —> deadly WM dz
4. B-cell lymphoma - cerebral or disseminated (EBV dormant in neurons + HIV-immunosupp —> CNS B-lymphoma)

Question 13

PML

Answer 13

JC Virus (dsDNA polyomavirus)
—most people infected in renal tubule and oligodendrocytes
—extensive myelin loss —> starts multifocal WM lesions that all grow together
—present w/ sx of encephalopathy (clouding of mentation), but more slowly than viral

Question 14

toxoplasmosis

Answer 14

—cats!
—intracellular parasite forms pseudocy
—NBD if you have a competent immune system
—BAD if you are preg (destroys fetal neurons) or immunocompromised
—might see intracranial calcifications

Question 15

CSF findings with bacterial infection

Answer 15

—neutrophilia
—low glucose
—high protein

Question 16

Bacterial meningitis: Causative agents in 0-2months

Answer 16

E.coli, GBS, Listeria monocytogenes

Question 17

Bacterial meningitis: Causative agents in 2mo-5y/o

Answer 17

completely diff from neonates: Pneumococcus, Meningococcus, M.tb, Haemophilus (way less now w/ vaccine)

Question 18

Bacterial meningitis: Causative agents in >5 y/o

Answer 18

Lose Haemophilus (Pneumococcus, Meningococcus, M.tb)

Question 19

Bacterial meningitis: Causative agents in elderly

Answer 19

—Listeria and haemophilus back;
—pneumococcus and M. tb still there
—meningococcus gone

Question 20

What space does pus collect in bacterial meningitis?

Answer 20

subarachnoid space (does not invade parenchyma)
—however cytokines do—>inflamm —> herniation

Question 21

What actually kills kids w/ bacterial meningitis?

Answer 21

Herniation from inflammation from swelling from pro-inflamm cytokines
—i.e. NOT the bacteria themselves

Question 22

post-meningitis infarct

Answer 22

dx—>abx—>fine
—later return w/ “catastrophic CNS event
—Type III hypersensitivity rxn centered on BVs in subarachnoid space