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Pathology > CNS > Flashcards

CNS Flashcards

1
Q

____ are the monocyte/macrophage of the CNS

A

Microglia

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2
Q

What cells make up the myelin sheath in CNS?

A

Oligodendrocytes

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3
Q

_________:defined as a mean
CSF pressure of more than 200 mm of water
(15 mm of mercury) as measured in the lateral
decubitus position.

A

Intracranial hypertension:

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4
Q

T/F: IH and brain edema commonly occur together

but do not necessarily coexist

A

True

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5
Q 
• Penetrating wounds and non penetrating 
injuries
• Skull Fractures
• Brain disruption/destruction
• Closed head injury –Blunt head trauma
– Concussion
– Contusion
A

Trauma

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6
Q 
\_\_\_\_\_ injuries
– Scalp lacerations
– Skull fractures
– Contusions
– Intracranial 
hemorrhages/hematoma
– Lesions secondary to 
raised intracranial 
pressure
A

• FOCAL INJURIES

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7
Q 
\_\_\_\_\_\_\_\_ injuries
– Global ischemia
– Diffuse traumatic axonal 
injury
– Brain edema and 
swelling
A

• DIFFUSE INJURIES

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8
Q

clinical syndrome of altered
consciousness secondary to head injury-
sudden disruption of neurologic function.

A

Concussion:

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9
Q

direct parenchymal injury of the

brain (similar to bruising).

A

Contusion:

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10
Q

____ injury is caused by the force of the blow to the specific area of brain

A

Coup injury

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11
Q

____ injury of brain is caused on the opposite portion of the brain as the blow due to the movement of brain

A

Contre coup injury

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12
Q

______: skull fracture and middle meningeal
artery injury (short period of consciousness
followed by rapidly developing signs of cerebral
compression)

A

– Epidural hematoma

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13
Q

_______: venous bleeding from bridging veins
(gradual signs of cerebral compression-hours-
days-weeks)

A

– Subdural hematoma

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14
Q

– Characterized by the widespread but often
asymmetric axonal swellings that appear within
hours of the injury and may persist for much
longer.
– The mechanical forces associated with trauma
are believed to damage the integrity of the axon
at the node of Ranvier, with subsequent
alterations in axoplasmic flow and function.

A

Diffuse axonal injury (DAI)

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15
Q

______ diseases: They rank as the third major cause of death in
the US after heart disease and cancer

A

Cerebrobascular diseases

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16
Q

The 4 most common cerebrovascular disorders

are?

A

global ischemia, embolism, hypertensive
intraparenchymal hemorrhage and ruptured
aneurysm.

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17
Q

____ is the common clinical designation
that applies to relatively acute
cerebrovascular damage of the CNS due to
different disorders.

A

“Stroke”

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18
Q

_______: destruction and dissection of the
tissue, mass effect. Secondary effects are
frequently necrosis and anoxic/ischemia of the
brain.

A

Hemorrhage:

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19
Q

What are the 3 CNS diseases involved in Impairment of blood supply and oxygenation:

A

– Hypoxia, ischemia and infarct (necrosis) of the

brain

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20
Q

______: brief
generally reversible episodes of impaired
neurological function (last <24 hours) –
considered to be precursors of more serious
occlusive events.

A

Transient ischemic attacks (TIA)-

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21
Q

______: tissue necrosis more frequent than
hemorrhage (75-80%).
• Thrombosis (atherosclerosis) most frequent carotid
bifurcation and middle cerebral artery.
• Embolism: middle cerebral artery most frequent.
• Small infarcts: lacunar strokes (small arteries)

A

Infarcts:

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22
Q 
\_\_\_\_\_\_\_: (20-25%) associated with 
arterial hypertension, atherosclerosis, vascular 
malformations, berry aneurysms, trauma, 
coagulopathy
– Intracerebral (arterial hypertension)
– Subarachnoid hemorrhage (berry aneurysm of the 
circle of Willis). 
– Intraventricular hemorrhage (neonates)
A

Hemorrhages:

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23
Q

______- Subarachnoid and

intraparenchymal hemorrhages

A

Berry aneurysms

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24
Q

The brain receives ____% of the cardiac output and consumes

__% of the total body consumption.

A

15%; 20%

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25
Q

Unlike other organs of

the body, the adult brain burns only _____ as fuel.

A

glucose

26
Q 
\_\_\_\_: 
– Low partial pressure of oxygen (PO2)
– Impairment of the blood ‘s oxygen-carrying 
capacity
– Inhibition of oxygen use in the tissue
A

Hypoxia:

27
Q

_____: transient or permanent interruption of
the normal circulatory flow. Reduction in
perfusion (hypotension), vascular obstruction or
both.

A

Ischemia:

28
Q

____ cerebral ischemia: generalized
reduction of cerebral perfusion (cardiac arrest,
shock, severe hypotension)

A

Global cerebral ischemia:

29
Q

_______ cerebral ischemia:: localized reduction
or cessation of blood flow to a defined portion
of the brain.

A

Focal cerebral ischemia:

30
Q

• Most are intracranial; spinal cord tumors are less
frequent
• Adults: supratentorial
• Children: infratentorial
• Children: second most common malignancy
(leukemia is first)
• Primary CNS tumor rarely metastasizes
• Location important in clinical consequences
• Metastasis to CNS are more frequent than primary in
the general population

A

CNS Tumors

31
Q

What is most common CNS tumor in adult?

A

Metastatic tumor

32
Q

What are the 4 Main microscopic features in grading (WHO):

A

– Cellular atypia - A
– Mitosis- M
– Endothelial proliferation E
– Necrosis - N

33
Q

What is the most common adult primary tumor?

A

Glioblastoma

34
Q

• 25% of primary adult tumors –most common adult primary
tumor
• Histologic Features
– Anaplasia, pseudopalisading necrosis, vasc proliferation
• Imaging Characteristics
– Ring-enhancement on MRI
• Average survival < 1 year without treatment; with treatment
only 15 months

A

Glioblastoma (diffuse)

35
Q

Are CNS tumors in children more commonly infra or supratentorial?

A

Infratentorial

36
Q
  • Children
  • Infratentorial > supratentorial
  • Cystic, contrast-enhancing
  • Rosenthal fibers and EGBs (eosinophilic granular bodies)
  • Localized tumor
  • Generally favorable outcome (WHO 1)
A

Pilocytic astrocytoma (Localized)

37
Q
  • Adults (4th-5th decades)
  • WHO grades II, III
  • Diffuse
  • White matter
  • Calcification
  • Better prognosis than astrocytoma
A

Oligodendroglioma

38
Q 
• Childhood/adolescence
• Intracranial in children (often fourth ventricle)
• Spinal cord in adults
• Ependymal rosettes and perivascular 
pseudorosettes
• WHO grade I –III, grade II most common
A

Ependymoma

39
Q

• Pediatric, WHO grade IV neoplasm
• Small round blue cell tumor
• Located in the cerebellum
• Despite the WHO grade IV designation, this tumor
has a very favorable prognosis in many cases

A

Medulloblastoma

40
Q

• Second most common primary intracranial tumor in
adults > 30 years > Female
• Benign behavior, slowly growing
• Convexities of the cerebral hemispheres and
parasagittal region; other falx cerebri, sphenoid
ridge, olfactory area, suprasellar region

A

Meningioma

41
Q
  • Cranial nerve VIII (cerebellopontine angle)
  • Antoni A, Antoni B
  • Verocay bodies
  • Benign
  • Neurofibromatosis type 2
A

Schwannoma

42
Q 
• Gray-white junction
• Often multiple lesions
• Older adults
• 25-30% of all CNS tumors
• Most common:
– Lung
– Breast
• Often hemorrhagic
– Kidney
– Melanoma
– Choriocarcinoma
A

Metastases CNS tumor

43
Q

____ is the 3rd most common intracranial primary tumour in adults

A

Schwannoma

44
Q

inflammation of the brain

A

Encephalitis:

45
Q

inflammation of the meninges

A

Meningitis:

46
Q

inflammation of the brain and

meninges

A

Meningoencephalitis:

47
Q

inflammation of the meninges,

brain and spinal cord

A

Meningoencephalomyelitis:

48
Q

inflammation of the spinal cord and its

membranes

A

Meningomyelitis:

49
Q 
• Hematogenous spread is most common
• Trauma
• Local spread from paranasal sinuses, dental 
infections, skin (facial) infections
• Peripheral nerves (viruses)
A

Infections

50
Q

• Meningitis: peak incidence in children (75% of
cases)
• Etiology:
– Neonates and infants: group B strep, E. Coli, Listeria
– Older infants and young adults: Strep Pneumoniae
(pneumococcus) and Neisseria meningitides
– Older adults: S Pneumoniae and Gram negative bacilli

A

Bacterial meningitis

51
Q

• Penetrating skull injuries
• Spread of infection from other sources: Para nasal
sinuses, middle ear (most common source), infective
endocarditis, bronchopulmonary infections, and
other sources
• May be bacterial or fungal in origin

A

Cerebral abscess

52
Q 
• Multiple necrotizing 
abscesses, some 
hemorrhagic, in basal 
ganglia and cortico-
subcortical junction
• Look for free tachyzoites at 
periphery of necrotic 
lesions
A

Toxoplasmosis

53
Q 
\_\_\_\_\_\_ encephalitis
• Arbovirus: St Louis Encephalitis, western equine encephalitis, 
West Nile
• Herpes Simplex
• Cytomegalovirus (CMV)
• HIV infection (progressive dementia, vacuolar myopathy)
• Poliomyelitis
• Rabies
A

Viral Meningitis-Encephalitis

54
Q

_______ encephalitis
• Lytic and hemorrhagic process distributed in an
asymmetric fashion throughout the medial temporal
and inferior frontal lobes
• Untreated is progressive and often fatal in 7-14
days

A

Herpes simplex encephalitis

55
Q

• Rare in adults, typically immunocompromised
• Important in pregnancy and early postnatal period
• One of the TORCH infections
• Causes periventricular calcifications
• Viral particles in brain and persist for decades after fetal
infection

A

CMV

56
Q

• Opportunistic demyelinating disease caused by the JC
polyomavirus (JCV)
• Most common in immunocompromised patients
• Classical histopathology is that of a multifocal white matter
disease with demyelination secondary to extensive involvement
of oligodendrocytes by JCV infection
• Diagnostic hallmark = presence of oligodendrocytes with
enlarged nuclei containing intranuclear amphophilic inclusions,
as well as astrocytes with bizarre, malignant appearing nuclei in
areas of demyelination

A

PML

57
Q

______ are abnormal forms of a cellular protein that causes
transmissible neurodegenerative disorders.
• Creutzfeldt-Jakob disease (CJD)
• Scrapie in sheeps and goats
• Bovine spongiform encephalopathy

A

Prions

58
Q

Normal ___ is a 30 kD protein present in neurons.

A

PrP

59
Q

Disease occurs when the PrP undergoes modification
to an abnormal b-pleated sheet isoform termed
______

A

PrPsc

60
Q

______ is characterized by more than one episode of neurologic
deficits separated in time, attributable to CNS white matter lesions
that are separated in space.
▪ Lesions initially involve destruction of myelin; axonal damage may
occur later in the process.
• On MRI, findings of multifocal lesions of various ages, especially
those involving the periventricular white matter, brainstem,
cerebellum, and/or spinal cord white matter, support the clinical
impression
▪ Gross pathology: Multiple areas of demyelination
(plaques) in white matter of the brain and spinal
cord (NOT the peripheral nervous system),
frequently located adjacent to lateral ventricles
(periventricular).

A

Multiple sclerosis

61
Q

• MC neurodegenerative disease causing dementia
• Pathologic findings are though to develop well in advance of
significant clinical deficits and may be seen in younger
patients
• Pathologic hallmarks = neuritic plaques and neurofibrillary
tangles in combination with neuronal loss
• Onset before age 50 should raise the possibility of a familial
form of disease

A

Alzheimer disease

62
Q

• Neurodegenerative disorder characterized by the presence of
Lewy bodies in neurons of various cortical structures
• Characterized by severe loss of substantia nigra (SN)
dopaminergic neurons, visible in brain sections as
depigmentation of the substantia nigra in the midbrain.

A

Parkinson disease

Pathology (26 decks)

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