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Path Exam II > Chapter 22 > Flashcards

Chapter 22 Flashcards

1
Q

symptoms of CNS pathologies

A 
degeneration
inflammation
infection
neoplasia
*SELECTIVE VARIABILITY*
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2
Q

patterns of neuronal injury

A 
neuronal
astrocytes
oligodendrocytes
microglia
ependymal cells
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3
Q

decrease in axonal transport
SWELLING of soma
displacement of Nissl substance

A

reversible neuronal injury

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4
Q

result of acute-hypoxic injury

  • SHRINKING* of soma (but axonal swelling)
  • RED NEURONS*
A

irreversible neuronal injury

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5
Q

shrinking of cell body/soma

A

red neurons

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6
Q

CNS fibrosis - astroglia or gliosis
injury –> hypertrophy and hyperplasia
enlarged nucleus

A

atscrocytes (neuronal injury pattern)

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7
Q

glial filament sprout; activated and change shapes

type of astrocyte injury pattern

A

gemistocytic astrocyte

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8
Q

produce myelin in CNS
acquired demyelinating disorders and leukodystrophies
ENLARGED nucleus

A

oligodendrocytes (neuronal injury pattern)

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9
Q

resident PHAGOCYTES of CNS
proliferate and enlarge: injury, infection, trauma
demyelination, infarction, hemmorhage

A

microglia (neuronal injury pattern)

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10
Q

line ventricles and spinal cord
infections: cytomegalovirus (CMV)
irregularities of ventricular surface (ependymal GRANULATIONS)
may involve CHOROID plexus

A

ependymal cells (neuronal injury pattern)

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11
Q

3 types of intracellular inclusions

A

viral infections
neurodegernative diseases
lipofusion

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12
Q

rabies: NEGRI BODY
CMV: owl’s eye
types of which intracellular inclusion

A

viral infections

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13
Q

Parkinson’s Disease: LEWY BODIES

Alzheimer disease: B AMYLOID PLAQUES

A

neurodegenerative disease

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14
Q

lewy bodies

A

parkinson’s disease

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15
Q

negi body

A

rabies

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16
Q

owl’s eye

A

CMV

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17
Q

accumulation of lipids in neuronal areas, aging

A

lipofusion

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18
Q

fluid accumulation within the brain tissue

limited expansion, increase ICP (blood, pus, edema)

A

cerebral edema

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19
Q

BBB disruption
increase in permeability
localized: tumors, infection
generalized: severe trauma

A

vasogenic (edema)

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20
Q

neuronal/glial membrane injury
intracellular edema
hypoxic-ischemic injury, toxic exposure

A

cytotoxic (edema)

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21
Q

3 characteristics of cerebral edema are _____ GYRI, ____ SULCI, and ______

A

flatten gyri
narrowed sulci
ventricular compression

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22
Q

disturbance in CSF flow/resorption/overproduction
increase CSF volume in ventricles
communicating
noncommunicating (localized)
* 2 y.o. = increase ICP, ventricular enlargement

A

hydrocephalus

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23
Q

MC type of hydrocephalus

A

disturbed flow/resorption

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24
Q

MC treatment for hydrocephalus

A

shunting

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25
Q

hydrocephalus with infarction and neurodegeneration

A

hydrocephalus ex vacuo

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26
Q

cerebrum shifts across dura or through foramen magnum
tissue compression:
decrease blood (infarction)
injury (swelling/vasculature)

A

brain herniation

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27
Q

MC form of brain herniation with displaced cingulate gyus, under falx cerebri
abnormal posturing, coma

A

subfalcine (cingulate)

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28
Q

brain herniation with displaced temporal lobe, under anterior tentorium
involves CN III
hemiparesis, brainstem compression
DURET HEMORRHAGE

A

transtentoral (uncinate)

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29
Q

brain herniation with displaced cerebellar tonsils, through foramen magnum
cardiorespiratory arrest, hydrocephalus, headaches

A

tonsillar

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30
Q

vessels that enter the PONS are disrupted by herniation

“flame shaped” hemorrhage

A

duret hemorrhage

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31
Q

3rd leading cause of mortality in US & MC cause of NEUROLOGIC morbidity

A

cerebrovascular disease (CVA)

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32
Q

Stroke: acute dysfunction, infarction steps (3)

A

thrombotic occlusion
embolic occlusion
vascular rupture

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33
Q

temporatory neurological dysfunction (<24 hours)

A

transient ischemic attack (TIA)

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34
Q

SPOT A STROKE acronym

A

F (face drooping)
A (arm weakness)
S (speech difficulty)
T (time to call)

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35
Q

liquefactive necrosis

A

ischemia/hypoxia

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36
Q

decrease in O2, partial pressure (hypoxemia)

decrease in O2 availability (CO, anemia, cyanide)

A

functional hypoxia

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37
Q

hypotension
occlusion
TRANSIENT (temporary)
STROKE (permanent)

A

ischemia

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38
Q

widespread ischemic-hypoxic injury
decrease perfusion
mild confusion (TIA) –> severe (stroke)

A

global cerebral ischemia

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39
Q

widespread NEURONAL death
cerebral EDEMA
RED NEURONS
neurological impairment: COMA

A

severe global cerebral ischemia

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40
Q

arterial occlusion–> localized ischemia
collateral flow limits injury: circle of Willis
*emboli
*thrombi

A

focal cerebral ischemia

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41
Q

deep tissues have ___ collateral supply (thalamus, basal ganglia, deep white matter)

A

minimal

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42
Q

MC form of focal cerebral ischemia
cardiac mural thrombi
valave disease

A

emboli

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43
Q

atherosclerotic plaques

carotid artery, aortic arch, middle cerebral artery

A

thrombi

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44
Q

intercranial hemorrhage injury that is MC due to HTN

A

vessel wall injury

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45
Q

SPONTANEOUS hemorrhage that leads to CLOT and then to cavity formation
MC cause= HTN
can be clinically SILENT to DEVASTATING (severe)
Avg age= 60 y.o.
cerebral MICROBLEEDS

A

primary brain parenchymal hemorrhage

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46
Q

blood fills the subarachnoid space
patient says “this is the worst headache I’ve ever had” (abrupt)
TUNIA MEDIA defect –> aneurysm
commonly recur

A

subarachnoid hemorrhage

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47
Q

ruptured saccular (BERRY) aneurysm is MC for _______ and in the _______ circulation

A

subarachnoid hemorrhage

anterior circulation

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48
Q 
tangle of arteries and veins (worm-like)
connected via 1+ fistula
MALES= 2x
age= 10-30
risks- hemorrhage, seizures
headaches= 50% OF ALL CASES
A

arteriovenous malformation (AVM)

49
Q

HTN weakens vessel walls –> rupture

  1. Massive parenchymal hemorrhage
  2. Lacunar infarct
  3. Slit hemorrhage
  4. Acute hypertensive encephalothy
A

hypertensive cerebrovascular disease

50
Q

single artery occlusion in DEEP brain tissues (silent –> devastating)

A

lacunar infarct (hypertensive cerebrovascular disease)

51
Q

ruptured small cerebral vessel, hemorrhage, resorbed, “slit-like cavity” remains

A

slit hemorrhage (hypertensive cerebrovascular disease)

52
Q

global cerebral dysfunction

A

acute hypertensive encephalopathy (hypertensive cerebrovascular disease)

53
Q

various causes of vessel wall inflammation that infers with blood flow –> infarct
polyarteritis nodosa
primary angiitis of CNS

A

vasculitis

54
Q

systemic AI vasculitis, fibronoid necrosis, small cerebral arteries and heart

A

polyarteritis nodosa

55
Q

chronic inflammation, multiple parenchymal and subarachnoid vessels
-limited to brain and spinal cord
-IDIOPATHIC
MC MALES
diffuse encephalopathy (decrease cognition)

A

primary angiitis of CNS

56
Q

CNS trauma is silent in _____, disabling in _____ and fatal in _____

A

frontal
cord
brainstem

57
Q

condition that is 2x MC in males, assess airway, breathing, circulation and disability (ABCD)

58
Q

traumatic parenchymal injury
concussion
diffuse axonal injury

A

CNS trauma

59
Q

standard hemorrhage/bruise of brain; rapid displacement, vessel disruption
-gyri are suspectible

A

contusion (traumatic parenchymal injury)

60
Q

tearing of cerebral parenchyma, vascular disruption, hemorrhage

A

laceration (traumatic parenchymal injury)

61
Q

impact site of contusion injury

A

coup injury

62
Q

opposite of impact site of contusion injury

A

contrecoup injury

63
Q

movement of 1 brain region, relative to another
ANGULAR ACCELERATION
causes diffuse WHITE MATTER/AXONAL damage
cause of 50% OF POST-TRAUMATIC COMAS

A

diffuse axonal injury (DAI)

64
Q

reversible altered consciousness from head injury in the absence of contusion
neuroimaging studies are normal (don’t show abnormalities), but may still be done to rule out more severe injury

A

concussion

65
Q

CNS trauma: disrupts vessels –> hemorrhage

  • CONFUSION*, HA, PROGRESSIVE NEURO DYSFXN, COMA
    1. subarachnoid
    2. intraparenchymal
  • EPIDURAL HEMATOMA*
  • SUBDURAL HEMATOMA*
A

traumatic cerebrovascular injury

66
Q

dural ARTERY damage
compresses brain tissue
neurosurgical emergency

A

epidural hematoma

67
Q

rapid movement tears VEINS

subdural bleed –> compresses brain

A

subdural hematoma

68
Q

MC artery involved in epidural hematoma; very aggressive within hours

A

middle meningeal artery

69
Q

spina bifida occulta
myelomeningocele
anencephaly
encephalocele

A

neural tube defects

70
Q

MC CNS malformation

A

neural tube defects

71
Q

bony defect, failed bony fusion

A

spina bifida occulta

72
Q

extension of CNS through (lumbrosacral) vertebral defect, LE motor and sensory

A

myelomeningeocele

73
Q

absence of brain, rostral aspect

leads to stillbirth

A

anencephaly

74
Q

CNS diverticulum through cranium (usually occipital region)

A

encephalocele

75
Q

hydromyelia

syringomyelia

A

spinal cord abnormalities

76
Q

cyst within the cord, adults

A

syringomyelia

77
Q

intraparenchymal hemorrhage
infarct
cerebral palsy

A

perinatal brain injuries

78
Q

prematurity, near ventricles, may cause hydrocephalus

A

intraparenchymal hemorrhage (perinatal brain injury)

79
Q

prematurity, supratentorial white matter, chalky plaques, possible cysts

A

infarct (perinatal brain injury)

80
Q

non-progessive defects in motor neurons, and decrease is cognition/learning

A

cerebral palsy

81
Q

MC type of infection of nervous system

A

hamatogenous

82
Q

2 types of infections in the nervous system

A

epidural abcess

subdural empyema

83
Q

nervous system infection– adjacent infection (sinusitis, osteomyelitis) –> epidural space
NEUROSURGICAL EMERGENCY

A

epidural abcess

84
Q

nervous system infection– infection of skull or sinus –> SUBDURAL space
*emergency

A

subdural empyema

85
Q

subarachnoid inflammation of LEPTOMENINGES
1 acute pyogenic
2 aseptic
3 chronic

A

meningitis

86
Q 
type of meningitis with:
RAPID ONSET
HA
NUCHAL RIGIDITY
PHOTOPHOBIA
CSF- increase PRESSURE (pus), increase NEUTROPHILS
A

acute pyogenic (bacterial)

87
Q

type of meningitis with:
acute onset
SELF LIMITING
CSF- increase lymphocytes

88
Q 
chronic meningitis with:
HA
malaise
confusion
"tuberculoma" in brain
A

tuberculous

89
Q

chronic meningitis with:
syphilis or lyme disease
neuronal loss
progressive loss of cognitive and physical fxn

A

spirochetal

90
Q

3 parenchyma infections

A

bacterial abscess
viral encephalitis
fungal

91
Q

localized, liquefactive necrosis
progressive neuro destruction
R-to-L shunt
pulmonary infection

A

bacterial absess (parenchyma infection)

92
Q

diffuse
associated with meningitis, mononuclear WBCs
rabies virus, poliovirus, rubella virus, west nile, etc

A

viral encephalitis (parenchyma infection)

93
Q

localized of diffuse
granulomas
MC among immunospressed
candida albicans

A

fungal (parenchyma infection)

94
Q

MC disorder of MYELIN
DYMELINATION
episodic neurologic deficts
“RELAPSING REMITTING”

A

multiple sclerosis

95
Q 
risks: 
YOUNG ADULTS
FEMALES (2x)
family Hx.
HLA-DR2
*PLAQUES* in CNS
sexual dysfxn, seizures, motor/sensory impairment, bowel issues, vision
A

multiple sclerosis

96
Q 
nutritional/metabolic disorder:
wenicke-koraskoff syndrome
confusion
memory
macrophages in THALAMUS
A

thiamine (B1)

97
Q 
nutritional/metabolic disorder:
demyelination
"subacute combined degeneration of spinal cord"
ataxia
paraplegia
A

cobalamin (B12)

98
Q

nutritional/metabolic disorder:
mimics global hypoxia (edema)
hippocampus is susceptible to injury

A

hypoglycemia

99
Q 
nutritional/metabolic disorder:
unctrolled DM
hyperosmolar state
confusion
stupor
coma
A

hyperglycemia

100
Q

cellular DEGENERATION OF CNS
PATTERNS of neuronal loss
cortex- memory, language, insight/planning
DEMENTIA

A

neurodegenerative disease

101
Q

impaired MEMORY
decrease FUNCTIONING
COMMON FEATURE OF neurodegenerative disease

102
Q 
MC cause of DEMENTIA
B-AMYLOID deposits
INSIDIOUS/PROGRESSIVE
DISORIENTATION
LETHAL INFECTION- MC= PNEUMONIA
down syndrome
A

alzheimer disease

103
Q 
MOTOR DISTURBANCES (tremor)
BRADYKINESIA (slow)
damage to DOPAMINERGIC neurons
SUBSTANTIA NIGRA
LEWY BODY-- PALE HALO
PROGRESSIVE
A

parkinson disease (neurodegenerative disease)

104
Q 
COGWHEEL RIGIDITY
PILL ROLLING (thumb, index finger)
Poker Face
Dementia
Hallucinations
A

parkinson disease (neurodegenerative disease)

105
Q 
AUTOSOMAL DOMINANT
severe cerebral ATROPHY
CAUDATE AND PUTAMEN NUCLEI
primary feature: CHOREA
SEVERE DEMENTIA
delayed onset, but present at birth
progressive
A

Huntington Disease (neurodegenerative disease)

106
Q 
affects LMN and UMN
preserves EXTRAOCULAR motor fxn
MC: MALES
40-50 y.o.
DENERVATION ATROPHY
asymmetric distal extremity weakness
rapid progression (muscle atrophy &amp; strength)
respiratory PARALYSIS
A

ALS (neurodegenerative disease)

107
Q

CNS tumors are usually _____ tumors and ______

A

primary

non-resectable

108
Q

features of CNS tumor

A

HA
seizures
increase cranial pressure

109
Q

types of gliomas

A

astrocytoma
oligodendeoglioma
ependymoma

110
Q 
80% of adult gliomas
poorly circumscribed
CEREBRAL
NEURO DEFECTS
MALIGNANT
NECROTIC
POOR PROGNOSIS
*GLIOBLASTOMA*
A

DIFFUSE astrocytoma

111
Q

BENIGN astrocytoma
cerebellar
cystic

112
Q

diffuse astrocytoma with:
leaky angiogenesis
MEAN SURVIVAL: 15 months

A

glioblastoma

113
Q

benign or malignant glioma
CEREBRAL
prognosis- 5-20 YEARS

A

oligodendoglioma

114
Q

glioma that affects ependymal cells
periventricular regions: pediactrics
spinal canal: adults

A

ependymoma

115
Q

MC embryonal malignancy
20% of pediatric brain tumors
EXCLUSIVELY CEREBELLAR
HIGHLY RADIOSENSITIVE and MALIGNANT

A

medulloblastoma

116
Q

medulloblastoma may have ______ appearance on brain

A

homer-wright rosettes

117
Q

diffuse LARGE B CELL LYMPHOMA- inside CNS

MC in immunosupressed (AIDS)

A

primary CNS lymphoma

118
Q

MC benign tumor of ADULTS-FEMALES
transformed ARACHNOID CELLS
RISK: History, irradiation

A

meningioma

119
Q

25-50% of intracranial tumors
affects gray/white junction
carcinomas: lungs, breast, melanoma, kidney, GI tract

A

CNS metastasis

Path Exam II (2 decks)

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