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Systems Pathology Exam Two > Chapter 22 - CNS Part 1 > Flashcards

Chapter 22 - CNS Part 1 Flashcards

0
Q

What is the third leading cause of mortality in the U.S.?

A

Cerebrovascular disease (CVA)

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1
Q

What is the most common cause of neurological morbidity?

A

Cerebrovascular disease (CVA)

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2
Q

What are ways that a stroke can occur?

A

Thrombotic occlusion, embolic occlusion, vascular rupture (dissection)

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3
Q

What is the clinical term for a mini-stroke?

A

Transient ischemic attack (TIA)

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4
Q

What is a transient ischemic attack?

A

Temporary neurologic dysfunction without actual infarction or damage

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5
Q

What is the “FAST” acronym for recognizing and responding to a possible stroke situation?

A

Face drooping
Arm weakness
Speech difficulty
Time to call 911

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6
Q

Why is duration such an issue with strokes?

A

The more time that passes, the more destruction typically occurs

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7
Q

What is the number one leading cause of mortality in the U.S.?

A

Heart disease

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8
Q

What is the #2 leading cause of mortality in the U.S.?

A

Cancer

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9
Q

What condition involves the paralysis of the facial nerve results in a rapid onset of unilateral facial weakness?

A

Bell palsy

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10
Q

It is currently hypothesized that what virus is associated with Bell palsy?

A

HSV-1

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11
Q

How long does the inflammation of the facial nerve typically last in Bell palsy?

A

Self-limiting (2-8 weeks)

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12
Q

What is the most common age range for Bell palsy?

A

15-45

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13
Q

When Bell palsy is seen, what diagnoses should be considered and ruled out?

A

TIA/stroke, brain tumor, skull fracture

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14
Q

What is the treatment for Bell palsy?

A

Facial exercises, eye drops/patch

Corticosteroids, antivirals

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15
Q

Both stroke and Bell palsy cause paralysis of what part of the face?

A

Lower part

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16
Q

What part of the face has dual innervation?

A

Upper part

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17
Q

In strokes, what ability of the face is maintained that is still paralyzed with Bell palsy making it possible to distinguish the condition?

A

Wrinkling of the forehead (raising eyebrows)

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18
Q

What type of necrosis is seen with brain ischemia/hypoxia?

A

Liquefactive necrosis (infarct)

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19
Q

What are two causes of functional hypoxia?

A

Decreased oxygen partial pressure

Decreased oxygen availability

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20
Q

What can lead to decreased oxygen partial pressure (hypoxemia)?

A

High altitude

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21
Q

What can cause decreased oxygen availability?

A

Carbon monoxide (CO), anemia, cyanide

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22
Q

What is global cerebral ischemia?

A

Widespread ischemic-hypoxic injury

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23
Q

Cardiac arrest, shock, and severe hypotension’s effect on blood pressure leads to what condition?

A

Global cerebral ischemia

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24
Q

What can occur with severe global cerebral ischemia?

A

Widespread neuronal death leading to neurological impairment, coma, or death

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25
Q

What defines being in a comatose state?

A

Unconscious for more than 6 hours

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26
Q

What condition is cause by an arterial occlusion due to localized ischemia?

A

Focal cerebral ischemia

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27
Q

What type of tissue lacks a lot of collateral blood supply therefore making them more susceptible to ischemia?

A

Deep tissues (like the thalamus, basal ganglia, deep white matter)

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28
Q

What is the most common cause of focal cerebral ischemia?

A

Emboli

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29
Q

What are the most common locations of emboli that cause focal cerebral ischemia?

A

Middle meningeal artery and internal carotid artery

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30
Q

What is another name for a stroke?

A

Cerebral infarction

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31
Q

Neutrophils, red neurons, and edema are seen in what stage of a cerebral infarction?

A

First stage (roughly 12-48 hours)

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32
Q

Nuclear fragmentation (karyorrhexis) is seen in what stage of a cerebral infarction?

A

Second stage (rough to 48 hours to 2 weeks)

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33
Q

Macrophages and gliosis are most commonly seen in what stage of a cerebral infarction?

A

Third stage (roughly months to years, also cavitation)

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34
Q

What are the two types of strokes?

A

Ischemic or hemorrhagic

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35
Q

Ischemic strokes are treated with what kind of medication?

A

Thrombolytic

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36
Q

Liquefaction necrosis is seen in which type of cerebral infarction?

A

Ischemic

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37
Q

Is an intracranial hemorrhage considered a stroke?

A

No

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38
Q

How does an intracranial hemorrhage occur?

A

Due to vessel wall injury, structural malformations, or tumors

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39
Q

What is the most common cause of intracranial hemorrhage injury?

A

Hypertension

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40
Q

What are the steps of the extravasation of blood during an intracranial hemorrhage?

A

Coagulation, compression of parenchyma, cavitation

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41
Q

What is the condition involving a cerebral microbleed?

A

Primary parenchymal hemorrhage

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42
Q

What is the most common age for a primary parenchymal hemorrhage?

A

Age 60

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43
Q

What is the most common cause of primary parenchymal hemorrhage?

A

Hypertension

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44
Q

What condition makes up 15% of the deaths in chronic hypertension patients?

A

Primary parenchymal hemorrhage

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45
Q

Where do primary parenchymal hemorrhages tend to occur?

A

Basal ganglia, thalamus, pons, cerebellum

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46
Q

When small, are primary parenchymal hemorrhages easy to detect?

A

No, clinically silent until large and lethal

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47
Q

What condition is so commonly associated with the phrase from patients, “This is the worst headache I’ve ever had.”?

A

Subarachnoid hemorrhage

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48
Q

What is the most common cause of a subarachnoid hemorrhage?

A

Ruptured saccular (berry) aneurysm

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49
Q

What are all of the causes of subarachnoid hemorrhages?

A

Saccular aneurysm, vessel malformation, history of head trauma, tumor

50
Q

What defect is associated with a ruptured saccular (berry) aneurysm that most commonly causes a subarachnoid hemorrhage?

A

Tunica media defect

51
Q

What is the fatality rate of a first episode of a subarachnoid hemorrhage?

A

25-50%

52
Q

A saccular (berry) aneurysm makes up what percentage of all intracranial aneurysms?

A

80-90%

53
Q

Where is the most common location in the circle of Willis for a saccular (berry) aneurysm?

A

Anterior circulation of the circle of Willis

54
Q

What is the most common type of arteriovenous malformation?

A

Cerebrovascular malformation

55
Q

What gender and age group are most at risk for arteriovenous malformation?

A

Males, age 10-30

56
Q

What rare and severe case of arteriovenous malformation is seen among newborns?

A

High-output heart failure

57
Q

What are the usual locations for hypertensive cerebrovascular disease?

A

Basal ganglia, white matter, brainstem

58
Q

What is a lacunar infarct?

A

Occlusion of a single artery resulting from hypertension

59
Q

What are the two terms used to describe the cavity left over following an intracerebral hemorrhage resulting from hypertension?

A

Lacunar infarct and slit hemorrhage

60
Q

What diastolic blood pressure is seen with acute hypertensive encephalopathy?

A

> 130 which means there is severe increased intracranial pressure

61
Q

What condition is a systemic autoimmune condition with fibrinoid necrosis involving the small cerebral arteries and heart that results from vasculitis within the CNS?

A

Polyarteriosis nodosa

62
Q

Primary angiitis of the CNS is limited to what locations?

A

Spinal cord and brain

63
Q

What is the most common gender and age group affected by primary angiitis of the CNS?

A

Males, age 30-60

64
Q

What is the treatment for primary angiitis of the CNS and polyarteritis nodosa?

A

Immunosuppression

65
Q

What gender is most likely to be involved in CNS trauma?

A

Males

66
Q

What is the ABCD assessment for CNS trauma?

A

Airway, breathing, circulation, disability

67
Q

What was the previous term for chronic traumatic encephalopathy?

A

Dementia pugilistica

69
Q

Repetitive CNS trauma can lead to what serious condition that involves dementia and neurofibrillary tangles?

A

Chronic traumatic encephalitis

70
Q

“Red neurons” is a sign present with which type of neuronal injury?

A

Irreversible

71
Q

What occurs with reversible neuronal injury?

A

Decreased axonal transport, swelling of soma, displacement of the Nissl substance (central chromatolysis)

72
Q

What occurs with irreversible neuronal injury?

A

Soma shrinkage, pyknosis, eosinophilia, “red neurons”, cerebral edema, loss of nucleolus and Nissl body

73
Q

Neuronophagia is associated with what cells of the CNS?

A

Microglia

74
Q

Where can ependymal cells be found?

A

Lining ventricles and the spinal cord

75
Q

Cytomegalovirus infection can affect what CNS cell type?

A

Ependymal cells

76
Q

What neuroglia cells produce cerebrospinal fluid?

A

Ependymal cells (choroid plexus)

77
Q

What neural viral infection produces the sign of Negri bodies?

A

Rabies

78
Q

What neural viral infection produces the sign of “owl’s eye”?

A

Cytomegalovirus

79
Q

Which neurodegenerative disease is associated with Lewy bodies?

A

Parkinson’s disease

80
Q

Which neurodegenerative disease is associated with neurofibrillary tangles, beta-amyloid plaques, and Tau proteins?

A

Alzheimer’s disease

81
Q

What is intracellular inclusion is known known as the aging pigment due to lipid accumulation?

A

Lipofuscin

82
Q

What are the two kinds of cerebral edema?

A

Vasogenic and cytotoxic

83
Q

What is disrupted enabling increased permeability with vasogenic edema?

A

Blood-brain-barrier

84
Q

What can cause localized vasogenic edema?

A

Tumors, infection, inflammation

85
Q

What can cause generalized vasogenic edema?

A

Severe trauma

86
Q

Which is associated with extracellular edema: vasogenic or cytotoxic edema?

A

Vasogenic

87
Q

Which is associated with intracellular edema: vasogenic or cytotoxic edema?

A

Cytotoxic

88
Q

What kind of injury is the cause of cytotoxic edema?

A

Neuronal/glial membrane injury (hypoxic-ischemic injury, toxic exposure)

89
Q

What is hydrocephalus?

A

Increased cerebrospinal fluid volume within ventricles

90
Q

What specific structure produces cerebrospinal fluid?

A

Choroid plexus

91
Q

What resorbs the CSF produced by the choroid plexus?

A

Arachnoid granulations (villi)

92
Q

What does hydrocephalus most commonly result from?

A

Disturbed flow/resorption

93
Q

What rare condition can cause overproduction of CSF?

A

Choroid plexus tumor

94
Q

What is the effect of hydrocephalus in those under two years of age?

A

Cranial enlargement

95
Q

What is the effect of hydrocephalus in those above two years of age?

A

Increased cranial pressure, ventricular enlargement

96
Q

What is the frequency for congenital hydrocephalus?

A

3/1,000 live births

97
Q

Lethal tonsillar herniation (and eventually respiratory failure) occurs when what condition is left untreated?

A

Hydrocephalus

98
Q

What is the most common treatment for hydrocephalus?

A

Shunting (ventriculoatrial shunt)

99
Q

What condition involves compensatory hydrocephalus accompanied by infarct and neurodegeneration?

A

Hydrocephalus ex vacuo

100
Q

Explain the dangerous feedback loop of brain herniation?

A

Cerebrum shifts (herniations) —> compression of neurons & vessels —> decreased blood supply —> infarction —> swelling

101
Q

What are the three types of brain herniations?

A

Subfalcine (cingulate), transtentorial (uncinate), tonsillar

102
Q

What is the most common type of brain herniation?

A

Subfalcine (cingulate)

103
Q

Which type of brain herniation involves a displaced cingulate gyrus (located under falx cerebri)?

A

Subfalcine (cingulate)

104
Q

What can result from subfalcine herniation?

A

Abnormal posturing, coma

105
Q

What type of brain herniation involves a displaced temporal lobe (under the anterior tentorium)?

A

Transtentorial (uncinate)

106
Q

Which cranial nerve can suffer from compression from a transtentorial brain herniation, and what is the result?

A

Cranial nerve III (oculomotor) resulting in abnormal vision (“blown pupil”)

107
Q

What is the secondary hemorrhage associated with transtentorial brain herniations?

A

Duret hemorrhage

108
Q

Which type of brain herniation is associated with brainstem compression and hemiparesis?

A

Transtentorial (uncinate)

109
Q

Which type of brain hemorrhage involves displaced cerebellar tonsils through the foramen magnum?

A

Tonsillar

110
Q

What form of abnormal posturing involves brachial flexion, extension of the legs along with internal rotation?

A

Decorticate rigidity

111
Q

What is the location of injury associated with decorticate rigidity?

A

Between the cortex and red nuclei (midbrain)

112
Q

What form of abnormal posturing involves extension of all 4 limbs, pronation of arms, and plantar flexion?

A

Decerebrate rigidity

113
Q

What is the location of injury associated with decerebrate rigidity?

A

Between red nuclei & vestibular nuclei (brainstem)

114
Q

What type of hemorrhage is also known as the “flame-shaped” hemorrhage?

A

Duret hemorrhage

115
Q

What type of hemorrhage occurs when vessels that enter the pons are disrupted by herniation?

A

Duret hemorrhage

116
Q

What is the more common type of Arnold-Chiari malformation?

A

Type I

117
Q

Which type of Arnold-Chiari malformation is more severe?

A

Type II

118
Q

Which type of Arnold-Chiari malformation is more mild?

A

Type I

119
Q

Type I Arnold-Chiari malformation occurs among what population?

A

Adults

120
Q

Type II Arnold-Chiari malformation occurs among what population?

A

Infants

121
Q

Which Arnold-Chiari malformation involves the low-lying cerebellar tonsils and downward extension through the foramen magnum?

A

Type I

122
Q

Which Arnold-Chiari malformation involves the small posterior fossa, misshaped midline cerebellum, and downward extension through the foramen magnum?

A

Type II

123
Q

What is the treatment for Arnold-Chiari malformations?

A

Neurosurgery (decompression)

Systems Pathology Exam Two (6 decks)

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