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Neurology > Block 4 > Flashcards

Block 4 Flashcards

1
Q

what is acute atypical viral meningitis

A

meningeal signs without a known causative organisms

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2
Q

CSF analysis for viral meningitis

A

increased lymphocytes
increased protein
normal glucose

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3
Q

acute aseptic (viral) meningitis is usually caused by what virus

A

enterovirus (echovirus, coxsackie virus, polio)

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3
Q

what is the main viral cause of acute aseptic (viral) meningitis

A

enterovirus (echovirus, coxsackie virus, polio)

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4
Q

what is acute pyogenic meningitis

A

inflammation of meninges due to bacterial infection

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5
Q

what are the 2 most common causes of pyogenic meningitis

A

strep pneumoniae
neisseria meningiditis

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6
Q

what is the main symptom of infants with meningitis

A

bulging fontanelle

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7
Q

what are the 2 most common causes of pyogenic meningitis

A

strep pneumoniae
neisseria meningiditis

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8
Q

CSF analysis of pyogenic (bacterial) meningitis

A

cloudy
increased neutrophils
increased protein
decreased glucose

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9
Q

what are 2 gross morphology features of pyogenic (bacterial) meningitis

A

meningeal vessel engorgement
purulent exudate on the surface of the brain

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10
Q

what is the main microscopic feature of pyogenic (bacterial) meningitis

A

neutrophil infiltrate in subarachnoid space/perivascular spaces

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11
Q

what is a short term complication of pyogenic (bacterial) meningitis

A

phlebitis (venous thrombosis and hemorrhagic infarction)

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12
Q

what are 2 long term complication of pyogenic (bacterial) meningitis

A

-leptomeningeal fibrosis (adhesion of pia and arachnoid)
-communicating hydrocephalus

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13
Q

what are the 3 features of communicating hydrocephalus seen in pyogenic (bacterial) meningitis

A

-spasticity/hyperreflexia in limbs (stretch periventricular pyramidal tract)
-double vision (CN VI)
-blurred vision (papilledema)

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14
Q
A

gross morphology of acute pyrogenic (bacterial) meningitis with purulent exudate on the cerebral hemisphere with engorged meningeal vessels

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15
Q
A

purulent exudate on cerebral sulci as seen in acute pyogenic (bacterial) meningitis

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15
Q
A

increased neutrophil infiltrate seen on the left in the meninges as seen in pyogenic (bacterial) meningitis

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16
Q

what is the main cause of acute aseptic (viral) meningitis

A

enterovirus (coxsackievirus, poliovirus, echovirus)

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17
Q

meningitis with GI symptoms is most likely bacteria, viral, or fungal

A

viral

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18
Q

what is the treatment for acute atypical (viral) meningitis

A

usually self limiting

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19
Q

what is the treatment for acute atypical (viral) meningitis

A

usually self limiting

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19
Q

what is seen in CSF of those with acute atypical (viral) meningitis

A

increased lymphocytes
normal glucose
increase protein

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19
Q

what is seen in CSF analysis with meningitis caused by fungal or mycobacterial infection

A

increased lymphocytes
decreased glucose

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19
Q

brain abscesses are usually caused by what 2 bacterial infections

A

streptococcus
staphylococcus

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19
Q

what 4 settings can cause brain abscess due to streptococcus or staphylococcus infection

A

endocarditis
infected lungs
congenital heart disease/R->L shunt
immunosuppression

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19
Q

what are the 4 clinical features of brain abscess

A

intraparenchymal mass
liquefactive necrosis
increased ICP
HA, nausea, vomiting, seizure

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20
Q

what is the morphology of brain abscesses

A

central liquefactive necrosis surrounded by fibrous capsule and gliosis

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21
Q

what is gliosis as seen in brain abscesses

A

fibrous proliferation of astrocytes

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22
Q
A

brain abscess with liquefactive center

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23
Q
A

brain abscess to the left with normal tissue on the right
blue trichrome stain showing CT of the abscess

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24
Q

gliosis and fibrosis is seen in __ and __. everything else is only gliosis

A

CNS trauma
abscess

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25
Q
A

morphology of a brain abscess with engorged vessels and exudate on the surface

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26
Q

what is a subdural empyema

A

collection of pus between dura and arachnoid

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27
Q

subdural empyema can be caused by __ or __ infection

A

bacterial
fungal

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28
Q

what are 4 symptoms of subdural empyema

A

occlusion/infarction
fever
headache
neck stiffness

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29
Q

what is an extradural (epidural) abscess

A

inflammation involving a collection of pus between dura and bone (skull or spine)

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30
Q

what is Pott’s Puffy Tumor

A

sinusitis that leads to osteomyelitis

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31
Q

what are 3 causes of chronic bacterial meningoencephalitis

A

mycobacterium tuberculosis
treponema pallidum
borrelia species

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32
Q

what morphology is seen in tuberculous meningoencephalitis

A

fibrinous exudate in perivascular space at the base of the brain

well formed granulomas

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33
Q

what is the difference between mycobacterium avium intracellulare and mycobacterium tuberculosis in terms of granuloma formation

A

MAI- poorly formed granulomas
m. tuberculosis- well formed granulomas

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34
Q
A

TB meningitis with well formed granuloma

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35
Q
A

TB meningitis with exudate at brain base

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36
Q
A

mycobacterium avium intracellulare poorly formed granulmoa

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37
Q

what is seen in CSF in tuberculous meningitis

A

pleocytosis with occasional neutrophils
increased protein
normal or slightly decreased glucose

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38
Q

what are 2 complications of tuberculous meningoencephalitis

A

obliterative endarteritis–>infarction
arachnoid fibrosis–>hydrocephalus

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39
Q

what are 2 causes of neurosyphilis

A

tertiary stage of treponema pallidum
tabes dorsalis

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40
Q

meningovascular neurosyphilis is associated with __

A

obliterative endarteritis

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41
Q

what is paretic neurosyphilis

A

cortical atrophy with dementia from damage to the frontal lobe due to treponema organisms

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42
Q

what are 2 main symptoms of paretic neurosyphilis

A

mood alterations (grandiose delusions)
dementia

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43
Q

what occurs in tabes dorsalis

A

damage to the dorsal root sensory neurons leads to loss of proprioception, vibratory sense, and ataxia

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44
Q

what are 3 symptoms of neuroborreliosis (lyme disease) caused by Borellia Burgdorferi

A

facial nerve palsy
aseptic meningitis
encephalopathy

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45
Q

what is the difference in who is affected by herpes simplex 1 vs 2

A

1= immunocompromised young adults
2= infants due to vaginal exposure

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46
Q

herpes simplex virus affects what part of the brain

A

temporal/frontal lobe with necrotizing hemorrhage

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47
Q

what is the clinical feature of herpes simplex virus

A

alterations in mood, memory, and behavior

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48
Q

what 2 features are seen microscopically in herpes simplex virus

A

eosinophilic Cowdry A intranuclear inclusions
perinuclear halo

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49
Q
A

herpes simplex virus hemorrhage in the temporal lobe

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50
Q
A

Cowdry A intranuclear inclusion body in herpes simplex virus

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51
Q

what is the effect of cytomegalovirus in fetuses

A

microcephaly
calcified brain

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52
Q

what is the receptor of cytomegalovirus

A

integrin

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53
Q

what morphology change is seen with cytomegalovirus

A

periventricular necrosis with hemorrhage and calcification

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54
Q

what is seen microscopically in those with cytomegalovirus

A

intracytoplasmic and intranuclear inclusions with an “owl eye” appearance

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55
Q
A

“owl eye” inclusion bodies seen in cytomegalovirus

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56
Q
A

cytomegalovirus inclusion bodies

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57
Q

varicella zoster remains latent where before being reactivated as shingles

A

dorsal root ganglion

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58
Q

varicella zoster can cause __

A

encephalitis

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59
Q

encephalitis caused by varicella zoster is characterized by __ and __

A

demyelination
necrosis

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60
Q

what is post-hepatic neuralgia

A

pain in an area previously affected by shingles

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61
Q

polio virus usually causes __itis

A

gastroenteritis

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62
Q

poliomyelitis affects what structures

A

motor neurons of the ventral horn

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63
Q

what are the 3 main symptoms of polio

A

flaccid paralysis
hyporeflexia
muscular atrophy

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64
Q

poliomyelitis can cause death due to __

A

diaphragm paralysis

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65
Q

rabies virus attaches to what receptors

A

nicotinic cholinergic receptors using glycoproteins

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66
Q

does rabies virus ascend or descend

how long can it take

A

ascends (axonal transport)
1-3

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67
Q

rabies virus colonizes what 2 brain structures

A

cerebellum
hippocampus (temporal lobe)

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68
Q

what are the symptoms of rabies encephalitis

A

altered mental state
violent motor response
pharyngeal spasms
flaccid paralysis

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69
Q

death from rabies virus is due to what

A

respiratory center failure

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70
Q

with rabies virus, widespread neuronal necrosis and inflammation is most severe in what 3 strictures

A

basal ganglia
brainstem
spinal cord

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71
Q

what is seen microscopically in rabies

A

negri body eosinophilic cytoplasmic inclusions

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72
Q

negri bodies from rabies virus are found in what 2 cell types

A

hippocampal pyramidal cells
cerebellar purkinje cells

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73
Q
A

intracytoplasmic eosinophilic negri bodies seen in rabies virus

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74
Q

HIV infects what cell types

A

microglia

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75
Q

what receptors does HIV use

A

CD4 and chemokine

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76
Q

what is immune reconstruction inflammatory syndrome

A

deterioration after starting HIV therapy

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77
Q

what causes HIV associated dementia

A

HIV

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78
Q

what are 4 gross morphological features of HIV

A

microglial nodules
multinucleated giant cells
necrosis
gliosis

79
Q

what 3 parts of the brain are affected most by HIV

A

subcortical white matter
diencephalon
brainstem

80
Q

progressive multifocal leukoencephalopathy is caused by what

A

JC papovavirus

81
Q

what cells does JC virus infect

A

oligodendrocytes

82
Q

what type of inclusion is seen in progressive multifocal leukoencephalopathy

A

intranuclear

83
Q

death from progressive multifocal leukoencephalopathy occurs due to __

A

diaphragmatic paralysis

84
Q

subacute sclerosing panencephalitis is a sequela of what infection, especially in children

A

untreated measles

85
Q

what are the 2 main clinical features of subacute sclerosing panencephalitis

A

cognitive decline
seizure

86
Q

what 4 morphological features are seen in subacute sclerosing panencephalitis

A

inclusions in oligodendrocytes or neurons
demyelination
neurofibrillary tangles
gliosis

87
Q

what 4 fungi can cause meningitis

A

histoplasmosis
blastomycosis
coccidiodes
cryptococcus

88
Q

diabetic ketoacidosis is associated with what fungus

A

mucur

89
Q

4 characteristics that can be seen microscopically of candida fugus

A

pseudohyphae (image)
hyphae
budding
germtube

90
Q

soap bubble lesions are characteristic of meningitis caused by __

A

cryptococcus

multiple cyst like soap bubble lesions in perivascular space

91
Q
A

soap bubble lesions of cryptococcus

92
Q

besides soap bubble lesions, what is seen in cryptococcus

A

thick capsule

93
Q

mucicarmine stain is characteristic for what infection

A

cryptococcus

94
Q

besides mucicarmine stain, what other stain can be used for cryptococcus

A

india ink

95
Q
A

mucicarmine stain showing cryptococcus

96
Q

what fungus shows narrow base budding

A

cryptococcus neoformans

97
Q

what fungus shows acute branching and acute septal hyphae

A

aspergillus

98
Q

what fungus shows right angle branching

A

mucor/rhizopus

99
Q

what fungus are spherical, thick walled spherules containing small uninuclear endospores

A

coccidiodes

100
Q
A

aspergillus

101
Q
A

mucor/rhizopus

102
Q
A

coccidiodes

103
Q

what fungus is found as intracellular yeasts inside macrophages

A

histoplasmosis

104
Q
A

histoplasmosis found as intracellular yeasts in macrophages

105
Q

what are 3 characteristics of fetal toxoplasmosis infection

A

cerebritis
multifocal necrotizing lesions
periventricular calcification

106
Q

how are humans infected with toxoplasmosis

A

ingestion of fecal oocyte of tissue cyst from cat feces

107
Q

what shows in imaging for toxoplasmosis

A

multiple ring-enhancing lesions

108
Q

encephalitis caused by toxoplasmosis may result from tachyzoites infecting what cells

A

astrocytes

109
Q

abscesses caused by toxoplasma contain __ and __

A

tachyzoites and bradyzoites

110
Q

calcification of the brain may occur in what 2 infections

A

toxoplasmosis
congenital cytomegalovirus

111
Q
A

toxoplasmosis with multiple ring enhancing lesions

112
Q
A

toxoplasma bradyzoites in cysts in astrocytes

113
Q

which parasite causes dystrophic brain calcifications

A

toxoplasma

114
Q

acanthamoeba meningoencephalitis is characterized by __

A

focal granulomatous lesions

115
Q
A

acanthamoeba encephalitis

116
Q

how do naegleria meningoencephalitis and acanthamoeba encephalitis differ in brain structure impact

A

naegleria meningoencephalitis causes diffuse meningoencephalitis

acanthamoeba causes focal, granulomatous lesion

117
Q

how does infection occur with naegleria meningoencephalitis

A

nasal–>cribiform plate—>olfactory nerve–>brain

118
Q

how does infection occur with acanthamoeba encephalitis

A

lower respiratory tract ulcerated skin/mucosa–>blood stream–>CNS

119
Q

what is a major cause of mortality from P. falciparum

A

cerebral malaria

120
Q

what are 4 consequences of cerebral malaria

A

ataxia
seizure
coma
long term cognitive deficits

121
Q

what parasite causes neurocysticercosis

A

taenia solium from pork

122
Q

what is the main cause of acquired epilepsy in developing countries

A

neurocysticercosis

123
Q

typical cases of neurocysticercosis are from __

A

immigrants from latin america and asia

124
Q

cysticercotic encephalitis is characterized by what 3 features

A

edema
collapsed ventricles
multiple enhancing lesions

125
Q

seizures/epilepsy, abnormal behavior, HA, stroke, and rarely a fever all characterize what infection

A

neurocysticercocsis

126
Q

rickettsia CNS infection can cause ___

A

aseptic meningitis

127
Q

what are physical findings of rocky mountain spotted fever complications caused by rickettsia

A

hemiplegia
athetosis (slow worm-like movement of limbs or trunk)
transverse myelitis

(occasional CNS vasculitis)

128
Q

what type of neurodegeneration occurs with transmissible spongiform encephalopathy (prion disease)

A

rapidly progressive

129
Q

what causes the spongiform changes in the brain seen with transmissible spongiform encephalopathy

A

neuronal and glial intracellular vacuoles (holes in glial cells)

130
Q

what change occurs in prions that leads to pathogenesis

A

alpha helix to beta sheet activates the protein

131
Q

what genetic link is there in Creutzfeldt-Jakob disease

A

PRNP gene increases the risk of PrPsc formation

132
Q

what is seen microscopically in those with Creutzfeldt-Jakob disease

A

spongiform transformation of grey (cerebral cortex) and deep grey
(caudate/putamen) matter

133
Q

what is seen morphologically in Creutzfeldt Jakob disease

A

neuronal loss
reactive gliosis
vacuoles in neurons

134
Q

corneal implant/transplant, contaminated human growth factor, and deep implantation of electrodes in the brain have all been known to cause ___

A

Creuzfeldt Jakob disease

135
Q

what are 3 consequences of Creuzfeldt Jakob disease

A

dementia/memory changes (cortical lesion)
involuntary jerks (basal ganglia)
death in less than 1 year

136
Q

myoclonic jerks in a young patient with acute neurological deterioration with mood changes is characteristic of ___

A

Creuzfeldt Jakob

137
Q

does Creuzfeldt Jakob or Varient Creuzfeldt Jakob disease have a mutation in PRNP gene

A

Creuzfeldt Jakob

138
Q

how is variant Creuzfeldt Jakob disease (Mad Cow disease) acquired

A

blood transfusion
infected meat

139
Q

is variant Creuzfeldt Jakob disease (Mad Cow disease) slow or fast progressive

A

slow

140
Q

progressive cerebellar ataxia is seen in what prion disease

A

Gerstmann Strausser Scheinker

141
Q

what neurological structural effect is seen in fatal familial insomnia

A

neuronal loss in thalamus
reactive gliosis

142
Q

what are 2 ways in which astrocytes adapt to injury

A

hypertrophy
hyperplasia

(gliosis)

143
Q

how do oligodendrocytes adapt to injury

A

demyelination

144
Q

how does ependyma react to injury

A

passive submission

145
Q

how do microglia respond to injury

A

granulomatous inflammation
microglial nodules
scars

146
Q

how do microglia differ from gitter cells

A

microglia have elongated nuclei lack visible cytoplasm

gitter cells have small round nuclei with abundant cytoplasm

147
Q
A

red neurons 12-24 hours after injury

148
Q
A

gitter cells

*macrophages stuffed with debris

149
Q

what are gemistocytic astrocytes

A

astrocytes filled with cytoplasm containing glial filaments and eccentric nucleus

150
Q
A

gemistocytic astrocyte

151
Q
A

neovascularization

152
Q

perinatal brain injury with hypoxia lead to __

A

cerebral palsy

153
Q

prolonged jaundice can lead to what in a newborn

A

kernicterus

154
Q
A

intraventricular hemorrhage (germinal matric hemorrhage)

155
Q

what is seen histologically in infants with intraventricular hemorrhage (germinal matric hemorrhage)

A

blood cells intermingled with parenchyma and noncohesive germinal matrix cells

156
Q

what is one of the main symptoms of kernicterus

A

hearing loss

157
Q

what causes kernicterus

A

high levels of bilirubin

158
Q

what are the regions of the brain most commonly affected by kernicterus

A

basal ganglia (especially globus pallidus and subthalamic nucleus)

159
Q
A

kernicterus

160
Q
A

kernicterus

161
Q

cause of intraparenchymal nontraumatic heorrhage

A

hypertension

162
Q

cause of subarachnoid nontraumatic hemorrhage

A

berry aneurysms

163
Q

what is the size of Charcot Bouchard microaneurysms

A

<1mm

164
Q
A

hypertensive hemorrhage

165
Q

berry aneurysm is commonly associated with what 3 diseases/disorders

A

polycystic kidney disease
type IV Ehler Danlos
Marfan

166
Q

medial defect aneurysms are often associated with __ and __

A

valsava
orgasm

167
Q

a sudden, excruciating headache can be due to __

A

medial defect aneurysm

168
Q

berry aneurysm most commonly occurs at what artery

A

*anterior communicating
anterior cerebral

169
Q
A

subarachnoid hemorrhage

170
Q

ruptured AVM hemorrhage age range is usually __-__ years

subarachnoid hemorrhage age range is usually __-__ years

A

AVM= 10-35
subarachnoid= 35 and above

171
Q

3 clinical symptoms of normal pressure hydrocephalus

A

abnormal gait
urinary incontinence
bradyphrenia
dementia

172
Q

what is the characteristic of CSF in normal pressure hydrocephalus

A

normal

173
Q

what are 4 characteristics that point in the direction of normal pressure hydrocephalus

A

40 years or older
abnormal gait
urinary incontinence
dementia

174
Q

how can normal pressure hydrocephalus be differentiated from dementia

A

the onset of gait and urinary symptoms is usually not as early in progression in dementia as it is in normal pressure hydrocephalus

175
Q

what is hydrocephalus ex vacuo

A

enlargement of CSF spaces in response to brain parenchyma loss

176
Q
A

hydrocephalus ex vacuo

177
Q

how can you differentiate a hemorrhagic infarct from a thrombotic infarct

A

hemorrhagic occurs suddenly
thrombotic evolve over time

178
Q

what is the most common site of a cerebral infarct

A

middle cerebral artery

179
Q
A

middle cerebral artery infarct

180
Q
A

middle cerebral artery infarct

181
Q
A

embolic infarct

182
Q

what is seen with bone marrow embolization

A

white matter hemorrhages

183
Q
A

massive “shower” fat embolism of bone marrow

184
Q

what are 4 causes of global ischemia

A

CO poisoning
MI/cardiogenic shock
hypovolemic shock
septic shock

185
Q

border zone “watershed” infarcts are commonly seen after ___

A

hypotension

186
Q

what site is at the greatest risk for border zone “watershed” infarct

A

anterior cerebral artery-middle cerebral artery intersection

187
Q

what are 3 factors seen with hypertensive cerebrovascular disease

A

lacunar infarct
hyaline arteriolar sclerosis
slit hemorrhages (<15mm vessel rupture)

188
Q

hypertensive encephalopathy is associated with what 2 symptoms

A

edema
herniation

189
Q
A

lacunar infarct with hyaline arteriolar sclerosis

190
Q

lacunar infarcts affect what 2 brain structures the most

A

basal ganglia
brainstem

191
Q

lacunar infarcts with hyaline arteriolar sclerosis involve __mm vessels while Charcot Bouchard microaneurysms involve __mm vessels

A

<15mm

<1mm

192
Q

slit hemorrhages are mainly caused by __

A

hypertension

193
Q

what is seen microscopically with slit hemorrhages

A

pigment laden macrophages

194
Q

what are the 2 most common sites for hypertensive intracranial hemorrhages

A

basal ganglion (putamen)
internal capsule

195
Q

what is the Cushing Response

A

the nervous system response to increased ICP

196
Q

what is the Cushing’s triad seen in the Cushing Response

A

increased BP
irregular breathing
decreased HR

197
Q

if astrocytes are involved, GFAP will stain positive or negative

A

positive

198
Q

no p53 loss occurs in what type of astrocytoma

A

pilocytic astrocytoma

199
Q

what type of astrocytoma is associated with p53 loss and PGDF A overexpression

A

well differentiated astrocytoma

200
Q

the transition to a higher grade astrocytoma is associated with disruption of what tumor suppressor genes

A

RB
p16/CDKNaA

201
Q

loss of RB and p16 is associated with what type of astrocytoma

A

anaplastic astrocytoma

202
Q

EGFR amplification is associated with what type of astrocytoma

A

glioblastoma

203
Q

pilocytic astrocytoma is rated a grade __

A

I

Neurology (11 decks)

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