Central Nervous System Flashcards
[response to injury: determine the cell]
shrinkage of soma
Pynosis
Absence of nucleolus
Intense eosinophilia
acute res
[response to injury: determine the cell]
hyperplasia
hypertrophy
accumulation of GFAP
astrocyte
[response to injury: determine the cell]
proliferation
microglia
the most important histopathologic finding that indicates CNS injury
gliosis
[type of cerebral edema]
generalized hypoxic-ischemic injury
cytotoxic or vasogenic
[type of cerebral edema]
localized: adjacent to inflammation and neoplasm
vasogenic
[type of cerebral edema]
hydrocephalus
interstitial
[type of hydrocephalus]
localized: limited to upstream obstruction
non-communicating
[type of hydrocephalus]
ventricular system that communicates with subarachnoid space
communicating
[type of hydrocephalus]
increased CSF as compensation to decreased parenchymal mass;
no ventricular dilation
hydrocephalus ex vacuo
[type of herniation]
herniate through the falx cerebri
subfalcine
[type of herniation]
herniate across tentorium cerebelli
transtentorial
[type of herniation]
herniation of cingulate gyrus
subfalcine
subfalcine herniation compresses this artery
anterior cerebral artery
[type of herniation]
herniation of the medial aspect of the temporal lobe
transtentorial
Transtentorial herniation can compress this part of the brain
CN III
contralateral cerebral peduncle
[type of herniation]
pupillary dilation
hemiparesis ipsilateral to the lesion
transtentorial
[type of herniation]
herniation through the foramen magnum
tonsillar
[type of herniation]
herniation of cerebellar tonsils
tonsillar
tonsillar herniation can lead to compression of this structure
brainstem
[neural tube defect]
extension of the spinal cord and meninges through a defect in vertebral column
myelomeningocele
[neural tube defect]
extension of the meninges through a defect in the vertebra
meningocele
[neural tube defect]
diverticulum of a malformed brain tissue through a defect in the cranium
usually in the posterior fossa but can occur across the cribiform plate in anterior fossa
encephalocele
[neural tube defect]
failure of the closure of the anterior neural tube
anencephaly
[neural tube defect]
skin dimpling, a patch, a hair patch over the defect
spina bifida occulta
[posterior fossa anomalies]
enlarged posterior fossa
hypoplasia of the cerebellar vermis
cystic dilation of the fourth ventricle
Dandy-walker malformation
[posterior fossa anomalies]
Small posterior fossa with mishapen cerebellar tonsils
Non-communicating hydrocephalus (due to aqueductal stenosis)
Lumbar myelomeningocele
Arnold-Chiari Malformation
Chiari II
[posterior fossa anomalies]
low-lying cerebellar tonsils
clincally silent or hydrocephalus
Lumbar myelomeningocele
Arnold-Chiari Malformation
Chiari II
[perinatal injury]
nonprogressive neurologic motor deficits (dystonia, spasticity, ataxia/athetosis, paresis) occurring during perinatal and prenatal periods
cerebral palsy
[perinatal injury]
increased risk in preterm infants, most often near developing thalamus and caudate; can lead to hyrdocephalus
intraprenchymal hemorrhage
[perinatal injury]
surpatentorial periventricular white matter infarcts
multicystic encephalopathy: cystic lesions throughout cerebral hemispheres in extensive ischemic damage
periventricular leukomalacia
[parenchymal injuries, trauma]
most common site of contusion
frontal lobes along orbital ridges and temporal lobes
[parenchymal injuries, trauma]
axonal swellings develop coma shortly post-trauma
diffuse axonal injury
[parenchymal injuries, trauma]
depressed, retracted, yellowish brown patches involving the crest of gyri (plaque jaune)
old traumatic lesion
[parenchymal injuries, trauma]
can become epileptic foci
old traumatic lesions
[traumatic vascular injury]
lucid intervals, rapidly evolving neurologic symptoms
epidural hematoma
[traumatic vascular injury]
lentiform density
epidural hematoma
[traumatic vascular injury]
fracture to pterion ruptures ___ artery
middle meningeal artery
[traumatic vascular injury]
rupture in middle meningeal artery is associated with ____
epidural hematoma
[traumatic vascular injury]
extremes of age, slowly evolving neurologic symptoms; delayed onset
subdural hematoma
[traumatic vascular injury]
bridging veins
subdural hematoma
[traumatic vascular injury]
crescent-shaped density
subdural hematoma
[traumatic vascular injury]
occurs with generalized reduction of cerebral perfusion
global cerebral ischemia
[traumatic vascular injury]
neurons most sensitive to ischemia
- pyramidal layer of hippocampus
- Cerebellar purkinje cells
- pyramidal cells of cerebral cortex
[traumatic vascular injury]
neurons most sensitive to ischemia
- pyramidal layer of hippocampus
- Cerebellar purkinje cells
- pyramidal cells of cerebral cortex
[traumatic vascular injury]
between areas of perfusion of major cerebral vessels susceptible to ischemia
watershed areas
[traumatic vascular injury, ischemic changes]
red neuron, cerebral edema, infiltration of neutrophils
acute
[traumatic vascular injury, ischemic changes]
liquefactive necrosis, influx of macrophages, reactive gliosis
subacute
[traumatic vascular injury, ischemic changes]
removal of necrotic tissue, gliosis
chronic
[traumatic vascular injury, ischemic changes]
edema, neuronal microvascularization, pyknosis + karyorrhexis, increased neutrophils
acute changes
[traumatic vascular injury, ischemic changes]
increased microglial cells, gliosis
chronic changes
[traumatic vascular injury, ischemic changes]
reduction or cessation of blood flow to a localized area of brain due to arterial occlusion of hypoperfusion
Focal Cerebral Ischemia
[hypertensive cerebrovascular disease]
small perforating vessels; involved: basal ganglia, pons, deep, white matter, thalamus
Histo: small cavitary infarcts
lacunar infarct
[hypertensive cerebrovascular disease]
small perforating vessels
rupture of small vessels due to hypertension
Histo: tissue destruction, pigment-laden macrophages and gliosis
slit hemorrhages
[diagnosis]
diffuse cerebral function
headaches, confusion, vomiting, convulsions, leading to coma
edematous brain without herniation; petechiae and fibrinoid necrosis of arterioles in gray and white matter
hypertensive encephalopathy
most common cause of deep parenchymal hemorrhages
hypertension
most common cause of lobar intraparenchymal hemorrhage
cerebral amyloid angiopathy
most common location of hypertensive intracranial hemorrhage
putamen (50-60%)
Thalamus, pons, cerebellar hemispheres are rae
[intraparenchymal hemorrhage]
charcot-bouchard microaneurysm in basal ganglia
hypertensive ICH
most common cause of subarachnoid hemorrhage
ruptured saccular berry aneurysm
most common intracranial aneurysm
saccular aneurysm
most common location of intracranial saccular aneurysm
ACA-ACoA junction
[vascular malformation]
vessels of the subarachnoid space and brain
enlarge vessels with intervening brain tissue
AVM
[vascular malformation]
located in the cerebellum, pons and subcortical region
enlarged vessels without intervening brain tissue
Cavernous malformation
[vascular malformation]
located in pons
small, thin-walled vessels with intervening brain tissue
capillary telangiectasia
[vascular malformation]
ectatic venous channels, variable location, developmental venous anomalies
venous angiomas
[meningitis]
most common cause of meningitis in infants
E. coli and GBS
[meningitis]
most common cause of meningitis in adolescents
N. meningitidis
[meningitis]
most common cause of meningitis in elderly
S. pneumoniae
L. monocytogenes
[meningitis]
Infiltrate: PMN
sugar: very low
protein: high
culture positive
bacterial
[encephalitis]
exudates on basal cisterns
obliterative endartrisits
hydrocephalus
TB
[meningitis]
infiltrate: lymphocytes
protein: high
sugar: very low
TB
[neurosyphilis]
frontal lobe affected
severe dementia, progressive impairment with mood alteration
paretic
[neurosyphilis]
dorsal columns
locomotor ataxia
charcot joints
lightning pains
agryll-robertson pupil
tabes dorsalis
[meningitis: type of virus]
hemorrhagic necrotizing temporal lobe encephalitis
HSV
[meningitis: type of virus]
subacute encephalitis involving paraventricular subependymal region
periventrucular necrosis and calcification
CMV
[meningitis: type of virus]
flaccid paralysis, muscle wasting, hyporeflexia
neuronophagia of the anterior horn motor neurons of the spinal cord
poliomyelitis
[meningitis: type of virus]
widespread neuronal degeneration most severe in brainstem
presence of negri bodies
Rabies
[meningitis]
brain abscesses near the gray-white junction (cerebral cortex)
CT: ring enhancing lesions,
Central foci of necrosis surronded by tachyzoites and bradyzoites
toxoplasma
[meningitis]
affects basal leptomeninges
soap bubble appearance
gelatinous material within the subarachnoid space and small cysts in basal ganglia
cryptococcus
[prion disease]
subtle memory change to progressive dementia
startle myoclonus
cerebellar ataxia
spongiform transformation
CJD
most common demyelinating disorder
multiple sclerosis
viral cause of progressive multifocal leukoencephalopathy
JC virus
[diagnosis]
unilateral optic neuritis
nystagmus
intention tumor
scanning speech
moderate pleocytosis, elevated protein, increased IgG
multiple sclerosis
__ triad of MS
nystagmus
intention tumor
scanning speech
charcot triad
[MS plaques]
evidence of partial and incomplete remyelination
shadow plaque
[neurodegenerative disease]
AB, Tau
alzheimer
[neurodegenerative disease]
alpha-synuclein, tau
parkinson
[neurodegenerative disease]
polyglutamine aggregates
huntington
[neurodegenerative disease]
TPD-43, FUS
ALS
[neurodegenerative disease]
lesion in the cortex
dementia
[neurodegenerative disease]
lesion in the basal ganglia and brainstem
parkinsonism
[neurodegenerative disease]
lesion in the spinal cord and cerebellum
ataxia
[neurodegenerative disease]
lesion in the motor neurons
muscle atrophy
[diagnosis]
insidious impairment of higher intellectual function, slow, unrelenting
presence of neuritic plaques, neurfibrillary tangles
alzheimer
[diagnosis]
tremor, rigidity, bradykinesia
pallor of substansia nigra
presence of lewy body
parkinson
[diagnosis]
loss of striatal neurons that dampen motor output,
excessive motor output, generalized jerky, hyperkinetic, dystonic
caudate atrophy, loss of striatal neurons, frontal lobe atrophy
dilation of lateral and third ventricle
huntington
[diagnosis]
progressive ataxia, spasticity, weakness, sensory neuropathy, cardiomyopathy
betz cells, involvement of CN VIII, X, XII
degeneration of cerebellum, and clarke column
friedrich ataxia
[diagnosis]
loss of UMN in cerebral cortex
loss of LMN in the spinal cord and brainstem
atrophic B4,6
bunina bodies
ALS
[diagnosis]
seen in remaining neurons, PAS (+), remnant of vacuoles
seen in ALS
bunina bodies
[diagnosis: type of enceph]
psychotic symptoms
ophthalmoplefia
ataxia, confusion, ophthalmoplegia
reversible with B1
Wernicke enceph
[diagnosis: type of enceph]
short term memory disturbances, confabulation
confabulation, hallucinations, amnesia
chronic
irreversible with B1
Korsakoff Syndrome
[metabolic diseases]
resemble ischemic brain injury
hypoglycemia
carbon monoxide
[metabolic diseases]
may damage anterior vermis of the cerebellum
ethanol
most common primary tumor of the brain
gliomas
[diagnosis: brain tumor]
children: cerebellum
Adults: cerebral cortex
astrocytoma
[diagnosis: brain tumor]
4th-5th decade of life
cerebral cortex (white matter)
oligodendroglioma
[diagnosis: brain tumor]
1st to 2nd decade: near the 4th ventricle
Adults: spinal cord
ependymoma
[WHO Grading of astrocytoma]
Atypia + mitosis
Grade III, anaplastic
[WHO Grading of astrocytoma]
Atypia + mitosis + endovascular proliferation or necrosis
pseudopalisading pattern of cells around necrosis
Glioblastoma, IV
[diagnosis: brain tumor]
limited infliltration
bipolar cells with thin hair-like processes, rosenthal fibers
eosinophilic granular bodies
pilocytic astrocytoma
[diagnosis: brain tumor]
fried-egg appearance
aleration of 1p19q co-deletion
tumor cells arrayed around neurons
oligodendroglioma
ependymoma located here is almost imposible to remove
4th ventricle
[diagnosis]
children with hydrocephalus, cerebellum
can disseminated to CSF “drop metastasis”
radiosensitive, homer-wright rosettes, small, round blue cells
medulloblastoma
most common origin of primary CNS lymphoma
B cell lymphoma
most common subtype of primary CNS lymphoma
DLBCL
most common primary CNS lymphoma in ICC
EBV(+)
meningothelial cells of arachnoid
meningioma
[diagnosis: brain tumor]
located in parasagittal, dura over lateral brain convexity
psammoma bodies
meningioma
