3. Neuropathology Flashcards by Franz Biehl

Primary brain vesicles

Forebrain (prosencephalon) - tele and dien
Midbrain (mesencephalon) - mesen
Hindbrain (rhombencephalon) - meten and myelen

How well did you know this?

Not at all

Perfectly

Secondary brain vesicles

Telecephalon
Diencephalon
Mesencephalon
Metencephalon
Myelencephalon

How well did you know this?

Not at all

Perfectly

Primary neurulation

Formation of neural plate (day 18-19)
Neural folds (20-21)
Closure of neural tube (22)
Rostral then caudal

How well did you know this?

Not at all

Perfectly

Secondary neurulation

Development of neural tube (day 28)

species specific

How well did you know this?

Not at all

Perfectly

What spinal level does spinal cord end during prenatal life at 12 week, 15 week and 24 week?

C5, S3, S1

How well did you know this?

Not at all

Perfectly

What spinal level does spinal cord end at newborn and adult life?

L3, L1-2 (end of dura/arachnoid sac at S2)

How well did you know this?

Not at all

Perfectly

Tissue repair in fetus vs adult brain

Macrophages cause phagocytosis (without gliosis) -> pseudoprimary malformation
(hydranencephaly or porencephalic cyst before or at early 2nd trimester)

How well did you know this?

Not at all

Perfectly

Subependymal germinal matrix hemorrhage occur in which population?

Prematurely born (<1500 kg) within 3 days after delivery

How well did you know this?

Not at all

Perfectly

Pathogenesis of germinal matrix hemorrhage?

Periventricular area with fragile microcirculation stroma

Hypoxic stress -> autoregulation fails and excessive perfusion ruptures GM microcirculation

How well did you know this?

Not at all

Perfectly

Grades of GM hemorrhage

I confined in GM
II filling lateral ventricles
III with distention
IV parenchyma

How well did you know this?

Not at all

Perfectly

Usual location of GM hemorrhage

Head of caudate > thalamus > behind foramen of monro

How well did you know this?

Not at all

Perfectly

Where do contusions occur most frequently?

Frontal and temporal lobes

How well did you know this?

Not at all

Perfectly

Traumatic epidural hematoma source of bleeding?

Middle meningeal artery

Less common: laceration of venous sinus (transverse sinus from occipital fracture)

How well did you know this?

Not at all

Perfectly

Duret hemorrhage?

Delayed upper brainstem hemorrhage from rapidly evolving descending transtentorial herniation

How well did you know this?

Not at all

Perfectly

Pathophysiology of Duret hemorrhage

Stretching/laceration of pontine perforating branches of basilar artery

How well did you know this?

Not at all

Perfectly

Diffuse axonal injury?

Axonal damage

parasagittal white matter, corpus callosum, internal capsule, cerebellar peduncles

How well did you know this?

Not at all

Perfectly

Duret hemorrhage vs brainstem small tissue-tear hemorrhages in DAI?

Both in upper brainstem, but Duret is delayed and in paramedian areas, whereas DAI located in dorsolateral brainstem

How well did you know this?

Not at all

Perfectly

Microscopic timeline picture of DAI?

2-12h
Axonal swellings (beta-amyloid precursor protein), then axonal disconnection, then microglial clusters around degenerating axons (5-10 days)

How well did you know this?

Not at all

Perfectly

Classify DAI

I: frontal/temporal, cerebellar and internal capsule
II: corpus callosum (splenium)
III: brainstem/cerebellar peduncles and corticospinal tracts

How well did you know this?

Not at all

Perfectly

Biochemical changes in DAI

1h: neurofilament immunoreactivity
4-5: accum of bAPP
6h: ubiquitin
1d-2m: axonal swelling
2m-y: wallerian degeneration/demyelination

How well did you know this?

Not at all

Perfectly

Which type of temporal bone fracture results in conductive hearing deficit?

Longitudinal temporal bone fracture

Transverse causes more direct nerve damage ith sensorineural hearing deficit (more forceful)

How well did you know this?

Not at all

Perfectly

Most striking microscopic finding in lisencephaly type I?

Cortex made from 4 layers (molecular - external neuronal - cellular - internal nuronal)

How well did you know this?

Not at all

Perfectly

Macroscopic and microscopic picture of mesial temporal lobe (hippocampal sclerosis)

Ammon’s horn sclerosis
Macroscopic: hippocampus smaller than other side, enlarged temporal horns

Microscopic: neuronal loss in CA1, gliosis

How well did you know this?

Not at all

Perfectly

Rasmussen syndrome

Rare disorder in children
Progressive unilateral neurologic deficit + sudden onset epilepsy refractory to medical treatment.
Hemiplegia, hemianopsia, intellectual deterioration

Microscopic picture of Rasmussen syndrome

Like chronic viral encephalitis - lymphocyte cuffs around blood vessels, microglial nodules

What are rosenthal fibers

Eosinophilic bodies See in neoplasms (juvenile pilocytic astrocytomas), around craniopharyngiomas, multiple sclerosis plaques, Alexander disease

Classifications of astrocytomas

``` Grade 1 (juvenile pilocytic): GFAP staining, rosenthal fibers Grade 1 (subependymal giant cell): assoc. with tuberous sclerosis Grade 2 (diffuse): nuclear atypia but no mitosis, moderately increased cellularity Grade 2 (pleomorphic xanthoastrocytoma): pleomorphic lipidized cells in bg of reticulin network) Grade 3 (Anaplastic): nuclear atypia and mitosis Grade 4 (GM): nuclear atypia, mitosis, microvascular proliferation and necrosis Grade 4 (Gliomatosis cerebri): extensively diffuse at least 3 lobes, superficial and/or deep gray matter ```

Primary vs secondary glioblastoma

Primary (age>55, males) - EGFR overexpression, PTEN | Secondary (younger, women) - 2/3 TP53 mutations and no EGFR amplifications

Colloid cysts

Usually anterior 3rd ventricles Glistening cysts with mucin - outer fibrous connective tissue capsule lined by ciliated pseudostratified epithelium, PAS+ mucin

Craniopharyngioma histology

Squamous epithelium, keratin

Schwannoma histology

Verocay body (Antoni A -dense and B - loose patterns) - palisading nuclei

What are verocay bodies?

Densely packed whorled arrangements in palisaded cells of Antoni A areas of schwannomas

Which tumors show dual histologic patterns?

Schwannomas | Pilocytic astrocytoma

Stains for schwannoma

S100, Leu7, laminin, vimentin, collagen IV

Central neurocytoma histology

Neuroepithelial tumor with uniform round cells with nucleus-free areas of neuropil. Synaptophysin positive

Which bone tumors have giant cells?

Giant cell tumor | Aneurysmal bone cyst

S100 + stains which tumors (7)?

``` Schwannoma Eosinophilic granuloma Paraganglioma Hemangioblastoma Chordoma Esthesioneuroblastoma Meningioma (20%) ```

Specific stains for melanoma

MART-1 and HMB-45

Subtypes of meningiomas that are PAS+?

Secretory meningioma

Secretory meningiomas stain what +?

PAS Cytokeratin CEA

2 common + stains for meningiomas

EMA and vimentin

Hemangiopericytoma stains

Reticulin, vimentin, vWF

EMA stains distinguish which tumors?

Hemangiopericytoma (-) vs meningioma (+)

Stains for germinoma

PLAP (placental alk phos), c-kit

Blepharoplasts

Intracytoplasmic basal bodies | Ependymoma

Which chromosomes are assoc. with meningioma progression?

Chromosome 1 alteration and chr22 deletion

Derivative of schwann cells

neural crest cells

Mode of inheritance of neurofibromatosis type 1

Chr 17, autosomal dominant

Fried egg appearance on H&E tumor?

Oligodendroglioma

Reed-sternberg binucleated cells tumor?

Hodgkin

Flexner-Wintersteiner rosettes tumor?

Retinoblastomas

Small, round blue cell tumors of childhood?

``` Neuroblastoma Chondrosarcoma Rhabdomyosarcoma Lymphoma Ewing sarcoma ```

Classification of human prion dx?

1. Idiopathic (CJD, sporadic fatal insomnia) 2. Familial 3. Acquired (kuru, CJD)

CJD on histology

Spongiform appearance (vacuoles)

Alzheimers on histology

Senile plaques and neurofibrillary tangles, neuronal loss

What are senile plaques?

Deposits of Abeta peptides

What are neurofibrillary tangles?

Intracellular inclusion bodies (tau proteins)

Alzheimer macroscopically?

Cerebral atrophy in mesial temporal structures