Chapter 23: Lecture Neuropathology part 2

Question 1

What are the two important types of infections in the brain?

Answer 1

Meningitis and (meningo)encephalitis

Question 2

In what area does meningitis occur?

Answer 2

Between the arachnoid and the pia

Question 3

True/false: Both meningitis and (meningo)encephalitis are usually caused by bacterial infection.

Answer 3

False! Meningitis is often bacterial, encephalitis is often viral

Question 4

True/false: Both meningitis and (meningo)encephalitis are (always) severe

Answer 4

True

Question 5

True/false: Both meningitis and (meningo)encephalitis are acute

Answer 5

False, meningitis is always acute

Question 6

True/false: Both meningitis and (meningo)encephalitis can have either a bacterial, viral, fungi or parasitic cause

Answer 6

True!

Question 7

When a pathologist is studying a patient with a meningitis infection, the CSF cellular composition can be used to detect the cause. How can a pathologist recognize a bacterial infection?

Answer 7

There are many granulocytes (neutrophils) present (+++)

Question 8

When a pathologist is studying a patient with a meningitis infection, the CSF cellular composition can be used to detect the cause. How can a pathologist recognize a bacterial TBC infection?

Answer 8

There is a moderate higher amount of granulocytes, lymphocytes and monocytes (++)

Question 9

When a pathologist is studying a patient with a meningitis infection, the CSF cellular composition can be used to detect the cause. How can a pathologist recognize a viral infection?

Answer 9

A slightly to moderate higher amount of lymphocytes (and plasma cells) (+/++)

Question 10

When a pathologist is studying a patient with a meningitis infection, the CSF cellular composition can be used to detect the cause. How can a pathologist recognize a parasitic infection?

Answer 10

A moderate higher amount of monocytes, granulocytes and lymphocytes (++) (so the same as bacterial TBC)

Question 11

What are the inflammatory cells that respond to a bacterial or viral infection in the brain?

Answer 11

Bacterial: granulocytes / neutrophils Viral: lymphocytes

Question 12

In what area does encephalitis occur?

Answer 12

In the cephalon/brain parenchyma

Question 13

Because encephalitis is often a viral infection, the innate immune respons, lymphocytes, are activated. They then activate microglia. What do these microglia form?

Answer 13

Microglial nodules

Question 14

Microglia are in the CNS resident macrophages that clear up neuronal debris. How is this called?

Answer 14

Neuronophagia

Question 15

The virus can also be detected by a pathologist, because they accumulate in the neuron to replicate. What will this process form that is so recognizable?

Answer 15

Inclusion bodies

Question 16

From how an inclusion body looks in a cell in the brain, a diagnosis can be made. How does this look like?

Answer 16

Add fig on p31

Question 17

What colour will the brain appear with an encephalitis infection after autopsy?

Answer 17

White (because of the lymphocytes)

Question 18

What is progressive multifocal leukoencephalopathy (PML)?

Answer 18

Progressive multifocal leukoencephalopathy (PML) is a rare and often fatal viral disease characterized by progressive damage (-pathy) or inflammation of the white matter (leuko-) of the brain (-encephalo-) at multiple locations (multifocal)

Question 19

True/false: usually (in PML) there is inflammation of the oligodendrocytes on the border of the white and grey matter

Answer 19

True

Question 20

How is PML pathologically diagnosed?

Answer 20

demyelination, bizarre astrocytes, and enlarged oligodendroglial nuclei are present, coupled with techniques showing the presence of JC virus (John Cunningham)

Question 21

There are two types of CNS tumors, primary and secondary (metastases), which occurs more frequently?

Answer 21

Secondary/metastasis, they are also the most aggressive

Question 22

Where do the metastases mostly come from?

Answer 22

They can come from anywhere! But in the lecture the lung (adinocarcinoma) and skin (melanoma) are described as more common

Question 23

In what cell types do primary CNS tumors usually occur?

Answer 23

Gliomas (astrocytomas, oligodendrogliomas, and to a lesser extent ependymomas)

Question 24

However, very rarely, primitive neuro epithelial tumors can occur. How is this called?

Answer 24

Medulloblastoma (and occurs in children)

Question 25

For the diagnosis of tumors in the brain, two aspects are integrated in the process. What are they?

Answer 25

Morphological and molecular (genetic, by methylation profiling)

Question 26

Are the gliomas very infiltrative?

Answer 26

Yes, they spread very rapidly and thus are difficult to remove surgically

Question 27

True/false: Because gliomas are so infiltrative, they often metastasize outside the CNS

Answer 27

False, they are not equipped to metastasize

Question 28

Why is grading useful?

Answer 28

For prognosis

Question 29

What will a pathologist look for when grading a brain tumor?

Answer 29

– Presence and number of mitoses – Endothelial proliferation – Necrosis

Question 30

There are also extra-axial ‘brain tumors’ (so within the skull, outside the brain), how are these calles?

Answer 30

Meningiomas (tumors of the meninges (consists of arachnoid, dura mater and pia mater))

Question 31

True/false: The meningiomas grow fast

Answer 31

False, they grow slow

Question 32

Is there a gender that seems to have more incidence of meningiomas?

Answer 32

Yes, females more often than men

Question 33

True/false: The meningiomas are malignant

Answer 33

False, they are (often) benign and have few symptoms

Question 34

True/false: The meningiomas can be excised surgically

Answer 34

True

Question 35

What are the typical places where you can find meningiomas?

Answer 35

Parasagittal, olfactory groove, suprasellar, clivus, foramen magnum, cerebellar (i don’t think you have to know this by heart)

Question 36

The meningiomas often have few symptoms, when do symptoms occur?

Answer 36

When they have grown to such an extent that there is compression

Question 37

A tumor of the meninges is called: 1. Glioma 2. Carcinoma 3. Sarcoma 4. Meningioma

Answer 37

4. Meningioma