Chapter 23: Lecture Neuropathology part 2 Flashcards

1
Q

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

A

Meningitis and (meningo)encephalitis

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2
Q

In what area does meningitis occur?

A

Between the arachnoid and the pia

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3
Q

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

A

False! Meningitis is often bacterial, encephalitis is often viral

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4
Q

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

A

True

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5
Q

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

A

False, meningitis is always acute

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6
Q

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

A

True!

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7
Q

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?

A

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

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8
Q

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?

A

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

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9
Q

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

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

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10
Q

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

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

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11
Q

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

A

Bacterial: granulocytes / neutrophils Viral: lymphocytes

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12
Q

In what area does encephalitis occur?

A

In the cephalon/brain parenchyma

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13
Q

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

A

Microglial nodules

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14
Q

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

A

Neuronophagia

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15
Q

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?

A

Inclusion bodies

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16
Q

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

A

Add fig on p31

17
Q

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

A

White (because of the lymphocytes)

18
Q

What is progressive multifocal leukoencephalopathy (PML)?

A

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)

19
Q

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

20
Q

How is PML pathologically diagnosed?

A

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

21
Q

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

A

Secondary/metastasis, they are also the most aggressive

22
Q

Where do the metastases mostly come from?

A

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

23
Q

In what cell types do primary CNS tumors usually occur?

A

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

24
Q

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

A

Medulloblastoma (and occurs in children)

25
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)
26
Are the gliomas very infiltrative?
Yes, they spread very rapidly and thus are difficult to remove surgically
27
True/false: Because gliomas are so infiltrative, they often metastasize outside the CNS
False, they are not equipped to metastasize
28
Why is grading useful?
For prognosis
29
What will a pathologist look for when grading a brain tumor?
– Presence and number of mitoses – Endothelial proliferation – Necrosis
30
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))
31
True/false: The meningiomas grow fast
False, they grow slow
32
Is there a gender that seems to have more incidence of meningiomas?
Yes, females more often than men
33
True/false: The meningiomas are malignant
False, they are (often) benign and have few symptoms
34
True/false: The meningiomas can be excised surgically
True
35
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)
36
The meningiomas often have few symptoms, when do symptoms occur?
When they have grown to such an extent that there is compression
37
A tumor of the meninges is called: 1. Glioma 2. Carcinoma 3. Sarcoma 4. Meningioma
4. Meningioma