Chapter 22 Flashcards
What is the selective variability within the CNS
Functionality, level of activity, connections, neurotransmitters, metabolic requirements
What is swells within a neuronal injury
-swelling of soma and axons (“spheroids”)
What is displaced within a reversible neuronal injury
The Nissl body (central chromatolysis)
What neuronal injury is associated with red neurons
Irreversible
What is an acute neuronal injury
Irreversible
What are 2 characteristics of irreversible neuronal injury
- Eosinophil
- 12-24 hours
What neuronal injury deals with shrunken soma or “red neurons”
Irreversible injury
What performs gliosis
Astrocytes (astroglia)
What is activation of an astrocyte
Gemistocytic astrocyte
What happens to oligodendrocytes when activated
They get enlarged
What are phagocytes of the CNS
Microglia they perform neuronophagia
What lines the ventricles and spinal cord
Ependymal cells
What is it called when ependymal cells become infected
It is cytomegalovirus
What happens when ependymal cells get infected
Possible choroid plexus dysfunction
What is associated with the negri body
Rabies
What has an owl eye appearance in intracellular inclusions
Cytomegalovirus
What is associated with lewy bodies in intracellular inclusions
Parkinson’s disease
What two intracellular inclusions are associated with alzheimer’s disease
- neurofibrillary tangles
- b-amyloid plaques (Tau proteins)
What is associated with lipofuscin in intracellular inclusions
Aging, lipid accumulation
What happens in cerebral edema
Fluid accumulation, limited expansion, increased intracranial pressure (blood, pus, tumor)
What is vasogenic edema
Disrupted BBB
What happens in cytotoxic edema
Disrupted neuronal/glial membrane
What are 3 identifiers of cerebral edema
Gyri are flattened, suli narrowed, ventricles compressed
What is hydrocephalus
Increased volume of CSF within ventricles
What causes hydrocephalus
Disturbed CSF flow or resorption
Which type of hydrocephalus is bilateral or even
Communicating
What kind of hydrocephalus is localized, unevenn
Noncommunicating
How old are you if you cranium expands in hydrocephalus
<2 yrs old
What age are you when there is an increases in ICP and enlarged ventricles with hydrocephalus
> 2 years old
What is the treatment for hydrocephalus
Shunting MC
What is hydrocephalus ex vacuo
Infarction or neurodegeneration
What happens in a herniation of the CNS
Shifting/protrusion of CNS tissue
Where does brain tissue shift during a herniation
Through foramen magnum
What is the positive feedback loop of herniation within CNS
Ischemia to infarction to inflammation to edema
What is the most common type of CNS herniation
Subfalcine (cingulate)
What happens in a subfalcine herniation
Displaced cingulate gyrus causing abnormal posturing/coma
Which type of herniationn displaces the temporal lobe
Transtentorial
What causes a duret hemorrhage
A transtentorial herniation
What happens in a tonsillar herniation
Cerebral tonsils through FM
What causes decorticate rigidity
Injury between the cortex and red nuclei (midbrain)
What causes decerebrate rigidity
Injury to the brainstem, between red nuclei and vestibular nucleus
What does a duret hemorrhage do
Disrupts vessels in the pons
Which type of Arnoldܿ-Chiari Malformations is MC
Type 1 it is mild
Who is most susceptible to type 1 Arnoldܿ-Chiari Malformations
Adults
Who is most susceptible to type 2 Arnoldܿ-Chiari Malformations
In utero or infants, most severe
What is the 5rh MC cause of mortality in USA
Cerebrovascular disease
What is the number one cause of neurologic morbidity
Cerebrovascular disease
How does a stroke happen from Cerebrovascular disease
Acute dysfunction, due to cerebral infarction
What two things cause a stroke in Cerebrovascular disease
- thrombosis or embolic occlusion
- vascular rupture (dissection)
What is a mini stroke
TIA =transient ischemic attack
What 3 results of ischemia in CNS
Hypotension, TIA, stroke = permanent
What is indicative of a global cerebral ischemia
Widespread ischemic-hypoxic injury
What happens in a severe global cerebral ischemia
Widespread neuronal death
- cerebral edema, red neurons, gliosis
- neurological impairment, coma
What provides some collateral flow
Circle of willis
What is the purpose of the circle of willis
Limits ischemia injury, deep tissues have minimal collateral supply
What are the two types of focal cerebral ischemia
Emboli MC, thrombi (plaques)
What is common in non-hemorrhagic stroke
Liquefactive necrosis
What is common in a hemorrhagic stroke
Reperfusion
What happens secondly in a cerebral infarction
Nuclear fragmentation (karyorrhexis), liquefaction
What is a primary brain parenchymal hemorrhage
Spontaneous intraparenchymal bleed, cerebral microbleed
What is the MC cause of Primary Brain Parenchymal Hemorrhage
HTN
What is the average age of Primary Brain Parenchymal Hemorrhage
About 60
What is a silent Primary Brain Parenchymal Hemorrhage
Small
What is a lethal Primary Brain Parenchymal Hemorrhage
Large
What is subarachnoi hemorrhage
Bleeding into subarachnoid space
Within the first episode what is the % of death in a subarachnoid hemorrhage
25-50%
What are 3 causes of a subarachnoid hemorrhage
- ruptured saccular aneurysm MC
- malformed vessel
- tumor
What is another name for saccular aneurysm and when is it MC
Berry aneurysm, and MC in anterior circulation arteries
What might a saccular aneurysm produce
A scar and produce hydrocephalus
What contains a vascular fistula
Ateriovenous malformation (AVM)
What was the percentage of headacches in an ateriovenous malformation
50%
Who is more likely to have an ateriovenous malformation
Males (2x) age= 10-30 yares
What causes a hypertensive cerebrovascular disease
HTN weakens vessel walls producing a rupture
What is a lacunar infarct in hypertensive cerebrovascular disease
Occlusion of a single artery
What is a slit hemorrhage in a hypertensive cerebrovascular disease
Ruptured small cerebral vessel, hemorrhage, resorbed, “slit like cavity” remains
What is a hypertensive ecephalopathy in hypertensive cerebrovascular disease
Global cerebral disfunction, diastolic BP>130 = severe ICP
What is vasculitis
Vessel wall inflammation
What is primary angiitis of the CNS
Chronic inflammation of Multiple parenchymal and subarachnoid vessels injury produces diffuse encephalopathy
What is polyarteritis nodosa associated with
Vasculitis
Who is more common in CNS trauma
males 2x
What are the ABCD’s and what are they for
for CNS trauma
Airway, breathing, circulation, disability
What is a contusion
Brain bruise = trauma disrupts vessels producing hemorrhage and injury to parenchyma
What is a coup injury
Contusion at impact site
What is a contrecoup injury
Contusion at opposite site of impact
What is a laceration in traumatic parenchymal injury
Tearing of cerebral parenchyma, disrupts vasculature producing hemorrhage
What is a diffuse axonal injury
Movement of one brain region to another
What does a diffuse axonal injury produce
Angular acceleration/shaking, diffuse white matter damage
What produces 50% of post traumatic comas
Diffuse axonal injury
What can be used in a concussion to rule out hemorrhage
CT
What assesments are used to evaluate a concussion
- cognitive assesment of attention and memory
- neurological assesment
What causes a concussion most
Upper limb contact to head
What is indicative of a traumatic vascular injury
Confusion, HA, progressive neuro. Dysfunx, coma
What is an epidural hematoma
Dural artery damage, compresses brain tissue, may be lucid during bleeding
What happens in a subdural hematoma
Rapid movements tear veins, subdural bleed compresses the brain
What is MC involved in an epidural hematoma
Middle meningeal artery, is very aggressive, can be lethal in hours
What is common in subdural hematoma
Venous bleeds are MC, self limited, but still a medical emergency
What is spina bifida occulta
Bony defect, asymptomatic
What is a malformation of extension of CNS through vertebral defect in lubosacral region
Myelomeningocele
What is the absence of a brain, rostral aspect
Anencephaly
What is an encephalocele
CNS diverticulum through cranium
What spinal cord abnormality is a cavity connected to the 4th ventricle
Hydromyelia
What is a syringomyelia (syrinx)
Cyst within cord, adults
What is cerebral palsy
Perinatal brain injury of non progressive motor defects
What is an epidural abcess
Infection in the epidural space
What is a subdural empyema
Infection of the subdural space
What is meningitis
Subarachnoid inflammtion of leptomeninges
What is acute pyogenic meningitis
Bacterial meningitis with rapid onset causing HA, nuchal rigidity, photophobia
What happens in the CSF after acute pyogenic meningitis
Bacteria causes increase in pressure, increase in neutrophils and increase in protein (exudate)
What is aseptic meningitis
Viral infeciton with acute onset, pyrexia, decrease conciousness, nuchal rigidity, and edema
What does aseptic meningitis cause in the CSF
Increased lymphocytes, self limiting
What is viral encephalitis
Diffuse parenchymal infection
What is fungal encephalitis
Localized or diffuse pattern of parenchymal infection, possible granulomas
What is multiple sclerosis
Autoimmune attack on white matter with plaques causing demyelination
What is the MC myelin disorder
Multiple sclerosis (1 in 1,000)
What causes MS
Genetics: family history increase risk by 15x, uses HLA-DR2
What is episodic neurologic impairment of MS
Relapsing and remitting, gradually accumulate
Where is MS
Anywhere in CNS mostly affects optic nerve, cerebrum, cerebellum, brain stem/cord
What are some features of MS
- early = unilateral vision impairments/diplopia
- ataxia, motor/sensory impair
- bowel, bladder, sexual dysfunx
- seizures, decreased cognition, depression
What are 2 types of thiamin deficiency
- wernicke korsakoff syndrome = chronic alcoholics/ gastritis
- Beriberi = lower extremity
What is a thiamine deficiency
Vitamin B1 deficiency
What is cobalamin
B12 deficiency causing cord demyelination
What are two metabolic disorders
Hypoglycemia, hyperglycemia
What type of neurodegenerative diesease can cause personality changes and impaired memory/cognition
Dementia
What is the lethal infection of alzheimers
MC pneumonia
What does damage to dopaminergic neurons cause
Parkinsons
In parkinsons what causes lewy bodies
Alpha synuclein
What autosomal dominant disease affects huntington gene
Huntingtons disease
What are features of huntington disease
Inherited, delayed onset (30-40yrs), caudate/putamen, body wide chorea(jerking)
What is ALS
Degeneration of motor neurons causing muscle atrophy
What is associated with LMN death
Amyotrophic lateral sclerosis in cord/brainstem
What is associated with UMN death
Amyotrophic lateral sclerosis i betz cells (post frontal lobe)
Who does ALS mostly affect
Males 40-50 years
What are 3 types of gliomas
Astrocytoma, oligodendroglioma, ependymoma first two are diffuse/infiltrative
What are diffuse astrocytomas
Malignant, 80% of adult gliomas causing seizures, HA, necrotic, distort brain tissue
What do pilocytic astrocytomas do
Beningn, cystic, affect children/YA, cerebellum or spinal cord (rarely cerebral)
What is an oligodendroglioma
Benign or malignant, cerebral, prognosis = 5-20 years
What is an ependymoma
Cancer of transformed ependymal cells located at periventricular regions, MC in peds
Where are ependymoma’s in adults
Spinal canal, history of NF2 increases risk
What is a medulloblastoma
Malignant that makes up 20% of ped brain tumors, exlusively cerebellar
What has possible homer wright rosettes
Medulloblastoma
What is primary CNS lymphoma
Diffuse large B cell lymphoma
What is MC among immunosuppressed
Diffuse large B cell lymphoma
What involves transformed arachnoid cells
Meningioma
Who is affected by meningioma
MC adult females with history of cranial irradiation or NF2
Where are most metastasis from CNS from
Lung, breast, melanoma, kidney, GI
