Chapter 23: Lecture Neuropathology part 2 Flashcards
What are the two important types of infections in the brain?
Meningitis and (meningo)encephalitis
In what area does meningitis occur?
Between the arachnoid and the pia
True/false: Both meningitis and (meningo)encephalitis are usually caused by bacterial infection.
False! Meningitis is often bacterial, encephalitis is often viral
True/false: Both meningitis and (meningo)encephalitis are (always) severe
True
True/false: Both meningitis and (meningo)encephalitis are acute
False, meningitis is always acute
True/false: Both meningitis and (meningo)encephalitis can have either a bacterial, viral, fungi or parasitic cause
True!
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?
There are many granulocytes (neutrophils) present (+++)
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?
There is a moderate higher amount of granulocytes, lymphocytes and monocytes (++)
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?
A slightly to moderate higher amount of lymphocytes (and plasma cells) (+/++)
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?
A moderate higher amount of monocytes, granulocytes and lymphocytes (++) (so the same as bacterial TBC)
What are the inflammatory cells that respond to a bacterial or viral infection in the brain?
Bacterial: granulocytes / neutrophils Viral: lymphocytes
In what area does encephalitis occur?
In the cephalon/brain parenchyma
Because encephalitis is often a viral infection, the innate immune respons, lymphocytes, are activated. They then activate microglia. What do these microglia form?
Microglial nodules
Microglia are in the CNS resident macrophages that clear up neuronal debris. How is this called?
Neuronophagia
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?
Inclusion bodies
From how an inclusion body looks in a cell in the brain, a diagnosis can be made. How does this look like?
Add fig on p31
What colour will the brain appear with an encephalitis infection after autopsy?
White (because of the lymphocytes)
What is progressive multifocal leukoencephalopathy (PML)?
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)
True/false: usually (in PML) there is inflammation of the oligodendrocytes on the border of the white and grey matter
True
How is PML pathologically diagnosed?
demyelination, bizarre astrocytes, and enlarged oligodendroglial nuclei are present, coupled with techniques showing the presence of JC virus (John Cunningham)
There are two types of CNS tumors, primary and secondary (metastases), which occurs more frequently?
Secondary/metastasis, they are also the most aggressive
Where do the metastases mostly come from?
They can come from anywhere! But in the lecture the lung (adinocarcinoma) and skin (melanoma) are described as more common
In what cell types do primary CNS tumors usually occur?
Gliomas (astrocytomas, oligodendrogliomas, and to a lesser extent ependymomas)
However, very rarely, primitive neuro epithelial tumors can occur. How is this called?
Medulloblastoma (and occurs in children)
For the diagnosis of tumors in the brain, two aspects are integrated in the process. What are they?
Morphological and molecular (genetic, by methylation profiling)
Are the gliomas very infiltrative?
Yes, they spread very rapidly and thus are difficult to remove surgically
True/false: Because gliomas are so infiltrative, they often metastasize outside the CNS
False, they are not equipped to metastasize
Why is grading useful?
For prognosis
What will a pathologist look for when grading a brain tumor?
– Presence and number of mitoses – Endothelial proliferation – Necrosis
There are also extra-axial ‘brain tumors’ (so within the skull, outside the brain), how are these calles?
Meningiomas (tumors of the meninges (consists of arachnoid, dura mater and pia mater))
True/false: The meningiomas grow fast
False, they grow slow
Is there a gender that seems to have more incidence of meningiomas?
Yes, females more often than men
True/false: The meningiomas are malignant
False, they are (often) benign and have few symptoms
True/false: The meningiomas can be excised surgically
True
What are the typical places where you can find meningiomas?
Parasagittal, olfactory groove, suprasellar, clivus, foramen magnum, cerebellar (i don’t think you have to know this by heart)
The meningiomas often have few symptoms, when do symptoms occur?
When they have grown to such an extent that there is compression
A tumor of the meninges is called: 1. Glioma 2. Carcinoma 3. Sarcoma 4. Meningioma
- Meningioma
