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Pathology Exam 6 (FINAL :)) > CNS > Flashcards

CNS Flashcards

1
Q

What is this group of cells called?

  • Perform various support functions
  • _____ cell types:
    • Astrocytes
    • Oligodendrocytes
    • Microglial cells
    • Ependymal cells
A

Glial Cells

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2
Q

What is this type of glial cell?

  • 20-40% of glial cells
  • Form BBB
  • Maintain appropriate chemical environment for neuronal signaling
  • Proliferate in response to injury (“glial scar”)
  • foot processes
A

Astrocytes

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3
Q

What is this type of glial cell?

  • Form myelin around axons in the CNS
  • A single _______ can extend its processes to 50 axons
A

oligodendrocyte

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4
Q

What is this type of glial cell?

  • 10-15% of all cells
  • Derived from circulating monocytes
  • Resident macrophages of CNS; remove cellular debris from sites of injury or normal cell turnover
    • “Scavengers of the brain”
A

Microglial cells

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5
Q

What is this type of glial cell?

  • Line the cerebral ventricles and central canal of spinal cord
  • Form choroid plexus; secrete cerebrospinal fluid
A

Ependymal Cells

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6
Q

What are two of the unique responses CNS has to injury?

A

– Liquefactive necrosis

– Gliosis

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7
Q

Why is Cerebral edema worse than edema in other parts of the body?

A

• “Enclosed space”

  • Brain and spinal cord surrounded by dura
  • Expansion is limited
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8
Q

What is this type of Cerbral edema?

• Extracellular edema

  • swelling is occuring around the cells
  • cells will look spread out
  • BBB disrupted
  • Response to trauma or tumors
A

Vasogenic Cerbral Edema

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9
Q

What is this type of Cerbral edema?

  • Intracellular edema
  • BBB intact
  • Response to ischemia or hypoxia
  • Cells themself are what swells
    • cells will look bigger and closer together
A

Cytotoxic Cerebral Edema

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10
Q

What is this type of herniation?

  • Temporal lobe has herniated across the tentorium.
  • The midbrain is displaced and compressed
A

Uncal Herniation

aka Transtentorial

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11
Q

What is this type of herniation?

  • Displacement of cingulate gyrus from one hemisphere to the other, under falx cerebri
A

Subfalcine Herniation

Aka Cingulate

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12
Q

What is this type of herniation?

Cerebellar tonsils are displaced into the foramen magnum and the medulla is compressed

  • lots of respiratory problems because the medulla has the respiratory centers
A

Cerebellar Tonsillar Herniation

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13
Q

What is the name of this hemorrhage?

  • Secondary brainstem hemorrhages in a patient with uncal herniation
  • Caudal displacement of the brainstem and stretching of its vessels
A

Duret Hemorrhages

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14
Q

What is this type of hyrodcephalus?

– Obstruction of CSF flow within ventricular system

A

Non-communicating (obstructive)

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15
Q

What is this type of hyrodcephalus?

– Impaired CSF resorption

A

Communicating (nonobstructive)

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16
Q

What is this type of hyrodcephalus?

– Dilatation of ventricles due to loss of brain tissue

A

Hydrocephalus ex vacuo

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17
Q

What is this cerebrovascular disease–type of stroke?

  • Systemic: severe hypotension/shock
    • blood is not reaching the brain
  • Hippocampus and cerebellum most sensitive areas
  • Clinical: persistent vegetative state or brain death in severe cases
A

Global Cerebral Ischemia

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18
Q

What is this general term for a cerbrovascular disease where there is neuronal damage caused by a lack of blood flow (ischemia) or bleeding?

A

Stroke

  • 3 causes
    • Thromboembolic disease
    • Hemorrhage
    • Global cerebral ischemia
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19
Q

What is this cerebrovascular disease–type of stroke?

  • Usually due to thromboembolic vascular occlusion
  • Type of ischemic stroke
  • Most common in distribution of middle cerebral artery
  • May be hemorrhagic (ischemia-reperfusion injury)
    • blood is going to build up pressure behind occlusion
A

Cerebral Infarct

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20
Q

What is this type of cerebral hemorrhage that can lead to stroke?

  • Most commonly results from hypertension
  • Basalganglia, thalamus, pons most common sites
  • Complications include cerebral edema and herniation
A

Cerebral Hemorrhage- Intraparenchymal

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21
Q

What is this type of cerebral hemorrhage that can lead to stroke?

  • Usually due to ruptured aneurysm “berry aneurysm”
  • Clinical: Sudden onset of severe headache, stiff neck
  • Bloody CSF
  • High morbidity and mortality
A

Subarachnoid Hemorrhage

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22
Q

What is this type of cerebral hemorrhage that can lead to stroke?

  • Malformations of one or several blood vessels
  • May cause parenchymal or subarachnoid hemorrhage
A

Vascular Malformations

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23
Q

What is this type of cerebral hemorrhage that can lead to stroke?

  • Concussion
  • Diffuse axonal injury
  • Contusions:
    • Edema and hemorrhage; cortical surface most affected
    • Coup - beneath site of trauma to an immobile head
    • Contrecoup - opposite to the site of trauma, due to a rapidly moving head that impacts an immobile surface
A

CNS Trauma

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24
Q

What is this type of traumatic CNS hemorrhage?

  • Usually due to artery laceration secondary to skull fracture
  • May develop rapidly
  • Outside dura
A

Epidural Traumatic CNS hemorrhage

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25
Q

What is this type of traumatic CNS hemorrhage?

  • Tearing of “bridging veins”
  • May become chronic
  • beneath dura
    • occurs mostly in elderly people with loss of brain tissue because brain is smaller but skull is the same size s you are at more risk to have brain move and rupture veins when you fall
A

Subdural

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26
Q

What kind of hemorrhage could occur after a large fall and blood accumulates quickly?

A

Acute Subdural Hemorrhage

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27
Q

What is this congenital malformation?

  • Most common CNS malformation
    • 1,500 per year in U.S.
  • Due to failure of closure of embryonic neural tube at caudal (lumbosacral) end
  • Symptoms
    • Sensorimotor deficits in legs
    • Bowel/bladder incontinence
A

Spina Bifida

28
Q

What is this type of spina bifida?

  • most common, least severe
  • loss of one vertebrae
  • tuft of hair at skin surface
A

Spina Bifida Occulata

29
Q

What is this type of spina bifida?

  • Fluid sac moves outside spine because of loss of one vertebrae
    • but no spinal cord actually in the sac
A

Meningocele

30
Q

What is this type of spina bifida?

  • sac of fluid outside spine with spinal cord contents
A

Myelomeningocele

31
Q

What is this neural tube defect?

– Defect of anterior end of neural tube

– Absence of the cerebrum and top of the skull

– About 1,000 per year in U.S.

– Incompatible with life- usually stillborn

A

Anencephaly

32
Q

What is this neural tube defect?

  • Herniation of brain tissue through a skull defect
    • Posterior (most common)
    • Anterior (sinonasal)
  • Maybe associated with neurologic deficits
A

Encephalocele

33
Q

What is this forebrain malformation?

– Failure of hemisphere/lobar development

– Associated with craniofacial anomalies

*one large hemisphere!

A

• Holoprosencephaly

34
Q

What is this forebrain malformation?

– Agyria, “smooth brain”

A

Lissencephaly

35
Q

What is this forebrain malformation?

Brain is small

A

Microcephaly

36
Q

What is the Most common cause of intraventricular hemorrhage in premature infants?

  • Related to hypoxia, acidosis, hypercarbia
  • May lead to fetal death or scarring leading to hydrocephalus
A

Germinal Matrix Hemorrhage

  • Perinatal Injury
37
Q

What is the perinatal injury related to poor oxygenation?

  • Seen in both term and premature infants
A

Necrosis of White Matter

38
Q

What is this infectious disease of the CNS?

  • Due to trauma or spread from infections of adjacent structures
    • Abscess formation
  • Increased in patients with neural tube defects
A

Epidural/Subdural Infection

39
Q

What is this infectious disease of the CNS?

  • High fever, headache, stiff neck, confusion, skin rash (meningococcus)
  • CSF findings
    • Neutrophils
    • High protein
    • Low glucose
    • Bacteria on gram stain/culture
A

Bacterial Meningitis

40
Q

What is this type of meningitis?

  • Can be seen with any viral infection, usually self-limited
  • Clinical: similar to bacterial, but less severe
  • CSF: lymphocytes, normal glucose, slightly increased protein; PCR
A

Viral Meningitis (Aseptic Meningitis)

41
Q

What is this type of meningitis?

  • TB, Cryptococcus neoformans (AIDS), syphilis
  • Morphology is variable
  • Can cause vascular obstruction due to proliferative changes leading to infarction in underlying brain
A

Chronic Meningitis

42
Q

Identify:

  • Usually bacterial
  • Direct implantation, or local or hematogenous spread
  • Neurologic deficits, increased intracranial pressure
  • Treatment-antibiotics, surgical drainage
A

Brain Abscess

43
Q

What is the most common cause of encephalitis?

A
  • Viral encephalitis - most common cause of encephalitis
  • Common causes
    • Arbovirus: arthropodborne
      • West Nile Virus
      • Dengue
      • Zika
    • Herpes simplex: HSV Type I
      • Hemorrhagic, necrotizing, temporal lobes
    • Cytomegalovirus: CMV
      • Neonates, immunocompromised
    • HIV encephalitis: progressive neurologic disease
    • Poliovirus, Rabies virus
44
Q

Identify:

  • JC virus, a polyomavirus; attacks oligodendrocytes
  • Immunosuppressed patient
  • demylinating disease
A

Progressive Multifocal Leukoencephalopathy (PML)

45
Q

What is this type of menigoecephalitis?

  • Usually immunosuppressed patients
  • Organisms
    • Candida
    • Aspergillus
    • Mucormycosis (uncontrolled diabetes)
    • Cryptococcus
A

Fungal Meningoencephalitis

46
Q

What is this parasitic CNS disease?

  • Neonates (chorioretinitis, hydrocephalus, intracranial calcification)
  • Immunosuppressed adults
  • from cats
A

• Toxoplasmosis

47
Q

What is this parasitic CNS disease?

  • Encysted larvae of tapeworm, Tenia solium
  • Inflammatory response after organism death may worsen symptoms
  • Larvae grow in brain
A

Cysticercosis

48
Q

What is this parasitic CNS disease?

  • Organism- Naegleria fowleri- swimming in warm lakes
    • kid hurts cribiform plate while swimming organisms get into brain
    • cause necrosis
  • Usually fatal
A

Amebic meningoencephalitis

49
Q

What is this type of Encephalopathy CNS disease?

  • Prion transmission, proteins without DNA or RNA
  • Creutzfeldt-Jacob disease, Mad Cow disease, Kuru (humans in New Guinea), scrapie (animals)
  • Major infection control concern in hospitals
    • Prions are not inactivated by routine disinfectants/fixatives
      • super hard to get rid of
  • All of these prion diseases are characterized by:
    • Vacuoles in the gray matter
    • Clinical: progressive dementia and other neurologic abnormalities, death within 1 year after onset is typical
A

Spongioform Encephalopathy

Vacuoles in the gray matter (“spongiform”)

50
Q

What is this Primary CNS tumor?

  • Most common type of primary CNS malignancy
  • Arise from glial cells
    • Astrocytoma
    • Oligodendroglioma
    • Ependymoma
A

Gliomas

51
Q

What is this type of Glioma?

  • 80% of adult gliomas
  • Diffusely infiltrating
  • WHO Grade
    • Grade 2 (diffuse astrocytoma)
    • Grade 3 (Anaplastic)
    • Grade 4 (Glioblastoma Multiforme)
A

Astrocytoma

52
Q

What is this type of Glioma?

  • 5-15% of adult gliomas
  • Grading is related to prognosis
    • Grade 2 (Well differentiated)
    • Grade 3 (Anaplastic)
A

Oligodendroglioma

53
Q

What is this type of Glioma?

  • Fourth ventricle in children
  • Spinal canal in adults
A

Ependymoma

54
Q

Identify this Primary CNS tumor:

  • Well-circumscribed
  • Arises from meninges
  • WHO grades I-III
  • Location determines surgical resectability
A

Meningioma

55
Q

Identify this Primary CNS tumor:

  • Arises from Schwann cells of eighth cranial nerve
  • Well circumscribed; benign
  • Clinical: hearing loss, dizziness, mass effect
A

Schwannoma (Acoustic Neuroma)

56
Q

What is the only cancer that is more common than Primary CNS tumors in peidatrics?

A

Leukemia

57
Q

What is this Pediatric Infratentorial (Posterior Fossa) Primary CNS tumor?

  • 60% located in posterior fossa
  • Typically 5-15 years of age
  • 25 year survival (90%) after resection
  • Hair like processes
A

Pilocytic astrocytoma

58
Q

What is this Pediatric Infratentorial (Posterior Fossa) Primary CNS tumor?

  • 15-20% of pediatric brain tumors
  • Occur in 4-11 year age group
  • Located in cerebellum
  • Blue cell tumor
    • means its high grade proliferating rapidly
A

Medulloblastoma

59
Q

What is this general disease type of the CNS?

  • interferes with the transmission of impulses along nerve fibers
  • Findings are most prominent in white matter which is composed of nerve fibers & oligodendrocytes
A

Demyelinating Disease

60
Q

What is this demyelinating disease?

  • Clinical
    • Visual disturbances (optic chiasm), paresthesias, spasticity, gait disturbances, numbness/weakness
    • Symptoms distributed in time (acute vs. chronic) & location-worse than better than worse than better
    • Cause
      • Likely autoimmune with genetic susceptibility and environmental factors
      • Laboratory features
      • CSF: increased gamma globulin (IgG)
      • Oligoclonal bands of immunoglobulin
A

Multiple Sclerosis

61
Q

What is this nutritional disorder?

  • Subacute Combined Degeneration
  • Associated with pernicious anemia
  • Causes vacuolar demyelination of the long tracts of the spinal cord (corticospinal and posterior columns)
A

Vitamin B12 (Cobalamin) Deficiency

62
Q
  • Caused by thiamine (B1) deficiency
  • Commoninchronic alcoholics
    • Confusion, ataxia and abnormalities in eye movements
A

Wernicke’s Encephalopathy

  • Korsakoff syndrome
    • When memory disturbances are combined with this deficinecy!
63
Q
  • Most common cause of dementia
  • Slowly progressive memory loss, behavior changes common
  • Sporadic and familial cases
    • Increasing incidence with increasing age
    • Familial forms less common, earlier onset
  • Pathology
    • Brain atrophy, neuritic plaques and tangles that contain beta amyloid
  • Death from other causes; often infection
A

Alzheimer Disease

64
Q
  • Movement disorder
    • characterized by rigidity, tremor, and slowness of movement (bradykinesia)
  • Loss of dopamine-producing neurons in substantia nigra
  • Slow onset with progressive deficits
  • Death usually from other causes
  • Treatment
    • Drugs (L-Dopa, dopamine agonists, MAO inhibitors
    • Surgical (deep brain stimulation)
A

Parkinson’s Disease

65
Q
  • Loss of motor neurons in motor cortex, brainstem & anterior horn of spinal cord
  • Results in progressive muscle weakness
  • Usually insidious onset; most cases sporadic
  • Little dementia or cognitive decline
  • Median survival 5 years
    • because of respiratory problems
A

Amyotrophic Lateral Sclerosis

  • (ALS; Lou Gehrig’s Disease)

Pathology Exam 6 (FINAL :)) (4 decks)

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