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GM Systems Path > Chapter 22 > Flashcards

Chapter 22 Flashcards

1
Q

What is the selective variability within the CNS

A

Functionality, level of activity, connections, neurotransmitters, metabolic requirements

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2
Q

What is swells within a neuronal injury

A

-swelling of soma and axons (“spheroids”)

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3
Q

What is displaced within a reversible neuronal injury

A

The Nissl body (central chromatolysis)

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4
Q

What neuronal injury is associated with red neurons

A

Irreversible

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5
Q

What is an acute neuronal injury

A

Irreversible

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6
Q

What are 2 characteristics of irreversible neuronal injury

A
  • Eosinophil

- 12-24 hours

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7
Q

What neuronal injury deals with shrunken soma or “red neurons”

A

Irreversible injury

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8
Q

What performs gliosis

A

Astrocytes (astroglia)

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9
Q

What is activation of an astrocyte

A

Gemistocytic astrocyte

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10
Q

What happens to oligodendrocytes when activated

A

They get enlarged

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11
Q

What are phagocytes of the CNS

A

Microglia they perform neuronophagia

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12
Q

What lines the ventricles and spinal cord

A

Ependymal cells

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13
Q

What is it called when ependymal cells become infected

A

It is cytomegalovirus

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14
Q

What happens when ependymal cells get infected

A

Possible choroid plexus dysfunction

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15
Q

What is associated with the negri body

A

Rabies

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16
Q

What has an owl eye appearance in intracellular inclusions

A

Cytomegalovirus

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17
Q

What is associated with lewy bodies in intracellular inclusions

A

Parkinson’s disease

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18
Q

What two intracellular inclusions are associated with alzheimer’s disease

A
  • neurofibrillary tangles

- b-amyloid plaques (Tau proteins)

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19
Q

What is associated with lipofuscin in intracellular inclusions

A

Aging, lipid accumulation

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20
Q

What happens in cerebral edema

A

Fluid accumulation, limited expansion, increased intracranial pressure (blood, pus, tumor)

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21
Q

What is vasogenic edema

A

Disrupted BBB

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22
Q

What happens in cytotoxic edema

A

Disrupted neuronal/glial membrane

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23
Q

What are 3 identifiers of cerebral edema

A

Gyri are flattened, suli narrowed, ventricles compressed

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24
Q

What is hydrocephalus

A

Increased volume of CSF within ventricles

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25
Q

What causes hydrocephalus

A

Disturbed CSF flow or resorption

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26
Q

Which type of hydrocephalus is bilateral or even

A

Communicating

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27
Q

What kind of hydrocephalus is localized, unevenn

A

Noncommunicating

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28
Q

How old are you if you cranium expands in hydrocephalus

A

<2 yrs old

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29
Q

What age are you when there is an increases in ICP and enlarged ventricles with hydrocephalus

A

> 2 years old

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30
Q

What is the treatment for hydrocephalus

A

Shunting MC

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31
Q

What is hydrocephalus ex vacuo

A

Infarction or neurodegeneration

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32
Q

What happens in a herniation of the CNS

A

Shifting/protrusion of CNS tissue

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33
Q

Where does brain tissue shift during a herniation

A

Through foramen magnum

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34
Q

What is the positive feedback loop of herniation within CNS

A

Ischemia to infarction to inflammation to edema

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35
Q

What is the most common type of CNS herniation

A

Subfalcine (cingulate)

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36
Q

What happens in a subfalcine herniation

A

Displaced cingulate gyrus causing abnormal posturing/coma

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37
Q

Which type of herniationn displaces the temporal lobe

A

Transtentorial

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38
Q

What causes a duret hemorrhage

A

A transtentorial herniation

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39
Q

What happens in a tonsillar herniation

A

Cerebral tonsils through FM

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40
Q

What causes decorticate rigidity

A

Injury between the cortex and red nuclei (midbrain)

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41
Q

What causes decerebrate rigidity

A

Injury to the brainstem, between red nuclei and vestibular nucleus

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42
Q

What does a duret hemorrhage do

A

Disrupts vessels in the pons

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43
Q

Which type of Arnoldܿ-Chiari Malformations is MC

A

Type 1 it is mild

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44
Q

Who is most susceptible to type 1 Arnoldܿ-Chiari Malformations

A

Adults

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45
Q

Who is most susceptible to type 2 Arnoldܿ-Chiari Malformations

A

In utero or infants, most severe

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46
Q

What is the 5rh MC cause of mortality in USA

A

Cerebrovascular disease

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47
Q

What is the number one cause of neurologic morbidity

A

Cerebrovascular disease

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48
Q

How does a stroke happen from Cerebrovascular disease

A

Acute dysfunction, due to cerebral infarction

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49
Q

What two things cause a stroke in Cerebrovascular disease

A
  • thrombosis or embolic occlusion

- vascular rupture (dissection)

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50
Q

What is a mini stroke

A

TIA =transient ischemic attack

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51
Q

What 3 results of ischemia in CNS

A

Hypotension, TIA, stroke = permanent

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52
Q

What is indicative of a global cerebral ischemia

A

Widespread ischemic-hypoxic injury

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53
Q

What happens in a severe global cerebral ischemia

A

Widespread neuronal death

  • cerebral edema, red neurons, gliosis
  • neurological impairment, coma
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54
Q

What provides some collateral flow

A

Circle of willis

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55
Q

What is the purpose of the circle of willis

A

Limits ischemia injury, deep tissues have minimal collateral supply

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56
Q

What are the two types of focal cerebral ischemia

A

Emboli MC, thrombi (plaques)

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57
Q

What is common in non-hemorrhagic stroke

A

Liquefactive necrosis

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58
Q

What is common in a hemorrhagic stroke

A

Reperfusion

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59
Q

What happens secondly in a cerebral infarction

A

Nuclear fragmentation (karyorrhexis), liquefaction

60
Q

What is a primary brain parenchymal hemorrhage

A

Spontaneous intraparenchymal bleed, cerebral microbleed

61
Q

What is the MC cause of Primary Brain Parenchymal Hemorrhage

A

HTN

62
Q

What is the average age of Primary Brain Parenchymal Hemorrhage

A

About 60

63
Q

What is a silent Primary Brain Parenchymal Hemorrhage

A

Small

64
Q

What is a lethal Primary Brain Parenchymal Hemorrhage

A

Large

65
Q

What is subarachnoi hemorrhage

A

Bleeding into subarachnoid space

66
Q

Within the first episode what is the % of death in a subarachnoid hemorrhage

A

25-50%

67
Q

What are 3 causes of a subarachnoid hemorrhage

A
  • ruptured saccular aneurysm MC
  • malformed vessel
  • tumor
68
Q

What is another name for saccular aneurysm and when is it MC

A

Berry aneurysm, and MC in anterior circulation arteries

69
Q

What might a saccular aneurysm produce

A

A scar and produce hydrocephalus

70
Q

What contains a vascular fistula

A

Ateriovenous malformation (AVM)

71
Q

What was the percentage of headacches in an ateriovenous malformation

A

50%

72
Q

Who is more likely to have an ateriovenous malformation

A

Males (2x) age= 10-30 yares

73
Q

What causes a hypertensive cerebrovascular disease

A

HTN weakens vessel walls producing a rupture

74
Q

What is a lacunar infarct in hypertensive cerebrovascular disease

A

Occlusion of a single artery

75
Q

What is a slit hemorrhage in a hypertensive cerebrovascular disease

A

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

76
Q

What is a hypertensive ecephalopathy in hypertensive cerebrovascular disease

A

Global cerebral disfunction, diastolic BP>130 = severe ICP

77
Q

What is vasculitis

A

Vessel wall inflammation

78
Q

What is primary angiitis of the CNS

A

Chronic inflammation of Multiple parenchymal and subarachnoid vessels injury produces diffuse encephalopathy

79
Q

What is polyarteritis nodosa associated with

A

Vasculitis

80
Q

Who is more common in CNS trauma

A

males 2x

81
Q

What are the ABCD’s and what are they for

A

for CNS trauma

Airway, breathing, circulation, disability

82
Q

What is a contusion

A

Brain bruise = trauma disrupts vessels producing hemorrhage and injury to parenchyma

83
Q

What is a coup injury

A

Contusion at impact site

84
Q

What is a contrecoup injury

A

Contusion at opposite site of impact

85
Q

What is a laceration in traumatic parenchymal injury

A

Tearing of cerebral parenchyma, disrupts vasculature producing hemorrhage

86
Q

What is a diffuse axonal injury

A

Movement of one brain region to another

87
Q

What does a diffuse axonal injury produce

A

Angular acceleration/shaking, diffuse white matter damage

88
Q

What produces 50% of post traumatic comas

A

Diffuse axonal injury

89
Q

What can be used in a concussion to rule out hemorrhage

A

CT

90
Q

What assesments are used to evaluate a concussion

A
  • cognitive assesment of attention and memory

- neurological assesment

91
Q

What causes a concussion most

A

Upper limb contact to head

92
Q

What is indicative of a traumatic vascular injury

A

Confusion, HA, progressive neuro. Dysfunx, coma

93
Q

What is an epidural hematoma

A

Dural artery damage, compresses brain tissue, may be lucid during bleeding

94
Q

What happens in a subdural hematoma

A

Rapid movements tear veins, subdural bleed compresses the brain

95
Q

What is MC involved in an epidural hematoma

A

Middle meningeal artery, is very aggressive, can be lethal in hours

96
Q

What is common in subdural hematoma

A

Venous bleeds are MC, self limited, but still a medical emergency

97
Q

What is spina bifida occulta

A

Bony defect, asymptomatic

98
Q

What is a malformation of extension of CNS through vertebral defect in lubosacral region

A

Myelomeningocele

99
Q

What is the absence of a brain, rostral aspect

A

Anencephaly

100
Q

What is an encephalocele

A

CNS diverticulum through cranium

101
Q

What spinal cord abnormality is a cavity connected to the 4th ventricle

A

Hydromyelia

102
Q

What is a syringomyelia (syrinx)

A

Cyst within cord, adults

103
Q

What is cerebral palsy

A

Perinatal brain injury of non progressive motor defects

104
Q

What is an epidural abcess

A

Infection in the epidural space

105
Q

What is a subdural empyema

A

Infection of the subdural space

106
Q

What is meningitis

A

Subarachnoid inflammtion of leptomeninges

107
Q

What is acute pyogenic meningitis

A

Bacterial meningitis with rapid onset causing HA, nuchal rigidity, photophobia

108
Q

What happens in the CSF after acute pyogenic meningitis

A

Bacteria causes increase in pressure, increase in neutrophils and increase in protein (exudate)

109
Q

What is aseptic meningitis

A

Viral infeciton with acute onset, pyrexia, decrease conciousness, nuchal rigidity, and edema

110
Q

What does aseptic meningitis cause in the CSF

A

Increased lymphocytes, self limiting

111
Q

What is viral encephalitis

A

Diffuse parenchymal infection

112
Q

What is fungal encephalitis

A

Localized or diffuse pattern of parenchymal infection, possible granulomas

113
Q

What is multiple sclerosis

A

Autoimmune attack on white matter with plaques causing demyelination

114
Q

What is the MC myelin disorder

A

Multiple sclerosis (1 in 1,000)

115
Q

What causes MS

A

Genetics: family history increase risk by 15x, uses HLA-DR2

116
Q

What is episodic neurologic impairment of MS

A

Relapsing and remitting, gradually accumulate

117
Q

Where is MS

A

Anywhere in CNS mostly affects optic nerve, cerebrum, cerebellum, brain stem/cord

118
Q

What are some features of MS

A
  • early = unilateral vision impairments/diplopia
  • ataxia, motor/sensory impair
  • bowel, bladder, sexual dysfunx
  • seizures, decreased cognition, depression
119
Q

What are 2 types of thiamin deficiency

A
  • wernicke korsakoff syndrome = chronic alcoholics/ gastritis
  • Beriberi = lower extremity
120
Q

What is a thiamine deficiency

A

Vitamin B1 deficiency

121
Q

What is cobalamin

A

B12 deficiency causing cord demyelination

122
Q

What are two metabolic disorders

A

Hypoglycemia, hyperglycemia

123
Q

What type of neurodegenerative diesease can cause personality changes and impaired memory/cognition

A

Dementia

124
Q

What is the lethal infection of alzheimers

A

MC pneumonia

125
Q

What does damage to dopaminergic neurons cause

A

Parkinsons

126
Q

In parkinsons what causes lewy bodies

A

Alpha synuclein

127
Q

What autosomal dominant disease affects huntington gene

A

Huntingtons disease

128
Q

What are features of huntington disease

A

Inherited, delayed onset (30-40yrs), caudate/putamen, body wide chorea(jerking)

129
Q

What is ALS

A

Degeneration of motor neurons causing muscle atrophy

130
Q

What is associated with LMN death

A

Amyotrophic lateral sclerosis in cord/brainstem

131
Q

What is associated with UMN death

A

Amyotrophic lateral sclerosis i betz cells (post frontal lobe)

132
Q

Who does ALS mostly affect

A

Males 40-50 years

133
Q

What are 3 types of gliomas

A

Astrocytoma, oligodendroglioma, ependymoma first two are diffuse/infiltrative

134
Q

What are diffuse astrocytomas

A

Malignant, 80% of adult gliomas causing seizures, HA, necrotic, distort brain tissue

135
Q

What do pilocytic astrocytomas do

A

Beningn, cystic, affect children/YA, cerebellum or spinal cord (rarely cerebral)

136
Q

What is an oligodendroglioma

A

Benign or malignant, cerebral, prognosis = 5-20 years

137
Q

What is an ependymoma

A

Cancer of transformed ependymal cells located at periventricular regions, MC in peds

138
Q

Where are ependymoma’s in adults

A

Spinal canal, history of NF2 increases risk

139
Q

What is a medulloblastoma

A

Malignant that makes up 20% of ped brain tumors, exlusively cerebellar

140
Q

What has possible homer wright rosettes

A

Medulloblastoma

141
Q

What is primary CNS lymphoma

A

Diffuse large B cell lymphoma

142
Q

What is MC among immunosuppressed

A

Diffuse large B cell lymphoma

143
Q

What involves transformed arachnoid cells

A

Meningioma

144
Q

Who is affected by meningioma

A

MC adult females with history of cranial irradiation or NF2

145
Q

Where are most metastasis from CNS from

A

Lung, breast, melanoma, kidney, GI

GM Systems Path (4 decks)

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