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Pathology 3000 > CNS > Flashcards

CNS Flashcards

1
Q

Gray matter

A

Contains the cell bodies of neurons (and some fibers)

Cortex and deep grey matter

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2
Q

White matter

A

Contains myelinated axons

Below the cortex and running along tracts in the brain

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3
Q

Corpus callosum

A

Connects two hemispheres

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4
Q

Diencephalon (3)

A

Structures deep in cerebral hemisphere

  1. Hypothalamus
  2. Thalamus
  3. Basal ganglia
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5
Q

Basal ganglia

A

Has three structures

Involved in motor control - skeletal muscle contraction

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6
Q

Brainstem (3)

A
  1. Midbrain
  2. Pons
  3. Medulla
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7
Q

Cerebrum

A

4 lobes (frontal, parietal, temporal, occipital)

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8
Q

Frontal lobe

A

Controls movement, behaviour, emotions, higher intellectual functions

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9
Q

Parietal lobe

A

Integrates sensory inputs like touch and controls language

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10
Q

Temporal lobe

A

Hearing, smelling, memory and expression

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11
Q

Hippocampus

A

In control of memory

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12
Q

Occipital lobe

A

Controls vision

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13
Q

Thalamus

A

Integrates sensory stimuli like pain and touch

Controls consciousness

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14
Q

Hypothalamus

A

Connects many different parts of the brain and regulates many body functions (appetite, thirst, temperature)

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15
Q

Midbrain

A

Visual, auditory reflex centers

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16
Q

Medulla oblongata

A

Cardiac, vasomotor, respiratory centers

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17
Q

Pons

A

Bundles of axons carrying information to and from the brain

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18
Q

Cerebellum

A

Little brain
Coordinates voluntary movement
Controls the ability to stand upright without falling over
Controls muscle tone
Inputs include sensory information carried by spinal cord, vestibular organ and motor impulses form cerebral cortex

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19
Q

White matter of the spinal cord

A

Dorsal, lateral and ventral columns

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20
Q

Descending motor tracts

A

Corticospinal tracts in lateral and anterior columns
Downward extension of upper motor neurons in the brain
Contact lower motor neurons in anterior horn which stimulate contraction of skeletal muscle

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21
Q

Ascending sensory tracts

A

Carry sensory information through posterior columns

Contain axons coming from neurons in the spinal ganglia which receive sensory information from the body

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22
Q

Meninges (3)

A 
Membranous cover bathing the brain
\+BBB prevent ionization in the brain
1. Dura
2. Arachnoidea
3. Pia
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23
Q

Dura

A

Outermost meninges

Very thick

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24
Q

Arachnoidea

A

Middle layer of meninges

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25
Q

Subarachnoid space

A

Contains CSF

Bathes the brain

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26
Q

Pia

A

Innermost layer of meninges

Very molded to sulci

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27
Q

Neuron

A 
Perikaryon (body, dendrites, axon
Postmitotic cells that do not divide or multiply
Cannot be replaced
Huge nucleus
Nissle substance
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28
Q

Support cells in the brain (4)

A
  1. Astrocytes
  2. Oligodendroglia
  3. Microglia
  4. Ependymal cells
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29
Q

Brain herniation

A

Caused by raised intracranial pressure
Cingulate gyrus, cerebral tonsil, cerebral uncus
Treatment by drilling in skull

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30
Q

Developmental disorders

A

Cause is usually known

Genetic diseases, chromosomal abnormalities, intrauterine infections (TORCH syndrome)

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31
Q

TORCH syndrome

A

To: toxoplasmosis
R: rubella
C: cytomegalovirus
H: hepatitis, HIV

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32
Q

Anencephaly

A

Upper part of neural tube fails to develop - no brain

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33
Q

Meningecele

A

Vertebrae surrounding spinal cord fails to grow

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34
Q

Myelomeningocele

A

Spinal cord does not form

Born with significant paralysis

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35
Q

Spina bifida

A

Spinal cord fails to close properly, vertebrae do not fuse around it

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36
Q

Intracranial hemorrhages (4)

A

Defined by location

  1. Epidural
  2. Subdural
  3. Subarachnoid
  4. Intracerebral
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37
Q

Epidural hematomas

A 
Between skull and dura
Rupture of middle meningeal artery
Takes hours to developed and localized
Can be lethal
Coma
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38
Q

Subdural hematomas

A 
Located between dura and arachnoid
Caused by blunt trauma
Ruptured bridging veins
Venous bleeding occurs slowly, so many be asymptomatic
Can produce headache, coma, death
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39
Q

Subarachnoid hemorrhages

A

Located between arachnoid and pia layer of meninges
Caused by traumatic contusion of brain, rupture of congenital aneurysms
High mortality

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40
Q

Intracerebral hemorrhages

A

Rupture of intracerebral vessels
Common complication of head trauma, gunshot wounds
Non-traumatic forms include stroke
Common with poor clotting
Caused by arterial hypertension, or vascular malformations
Basal ganglia, cerebellum, pons

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41
Q

Cerebrovascular disease/stroke (3)

A 
Third most common cause of death
Most common crippling disease
Atherosclerosis of arteries supplying the brain - plaques can rupture and occlude
1. Global ischemia
2. Cerebral infarct
3. Intracerebral hemorrhage
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42
Q

Stroke

A

Sudden persistent loss of brain function from a vascular cause

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43
Q

Risk factors of cerebrovascular disease/stroke

A

Hypertension, smoking, diabetes, elevated cholesterol

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44
Q

Global ischemia

A

If many vessels are narrowed: multiple infarcts
Over time can lead to dementia
Hypoperfusion from cardiac arrest or peripheral bleeding
Watershed infarcts
Laminar necrosis

45
Q

Cerebral infarct

A

Caused by thrombotic occlusion, thromoboemboli
Pale or hemorhagic infarct (reperfusion)
Edematous: from surrounding brain tissue
Fluid filled cavity
Never heals
Clinical presentation depends on site of occlusion

46
Q

Middle cerebral territory strokes

A

Contralateral hemiplegia and sensory loss

Global aphasia in the dominant hemisphere

47
Q

Acute stroke edema

A

Can kill
Accumulation of fluid because BBB is disrupted
Raised intracranial pressure

48
Q

Concussion

A

Transient loss of consciousness

49
Q

Contusion

A

Crush brain, some bleeding

50
Q

Laceration

A

Tear

51
Q

Neck and spinal cord injuries (3)

A
  1. Hyperextenion
  2. Hyperflexion
    May transect spinal cord leading to paralysis
52
Q

Routes of infection of CNS (3)

A
  1. Direct extension
  2. Via blood
  3. Via nerves
53
Q

Bacterial infection of CNS

A

Hematogenous route or from septic emboli

Meningitis, abcesses, myelitis, encephalitis, neurosyphilis, AIDs related CNS lesions

54
Q

Meningitis in adults

A

Caused by streptococcus pneumoniae

55
Q

Meningitis in babies

A

Caused by Group B streptococci, E. coli, Listeria monocytogenes

56
Q

Meningitis in children/adolescents

A

Caused by Neisseria meningitidis

57
Q

Brain abcesses

A

Staphylococcus aureus

58
Q

Rare infections of the CNS

A

Tuberculosis, syphilis

59
Q

Viral infections of CNS

A

Hematogenous route or along nerves

Measles, rubella, adenovirus, herpes, cytomegalovirus, rabies

60
Q

Protozoal infections of the CNS

A

Hematogenous route

Toxoplasma gondii causes encephalitis in neonates and immunosuppressed patients

61
Q

Fungal infections of the CNS

A

Hematogenous route

Cadida albicans, Aspergillus flavus, Cryptococcus neoformans

62
Q

Early multiple sclerosis lesion

A

Macrophages phagocytose myelin
Exit lesion
Axons remain partially
Left with reactive astrocytes in lesions

63
Q

Late multiple sclerosis lesion

A

Astrocytes react to damage in early lesion

Cells cannot come remyelinate the axon

64
Q

Multiple sclerosis

A

Demyelinating disease, presumed autoimmune
Loss of neurons over time
Women x2 > men
Commonest neurological disease in young adults
High prevalence of certain major histocompatibility antigens
Oligoclonal T-cell population in the brain
IgG in CSF composed of oligoclonal bands
Episodes of exacerbation and remission - eventually becomes chronic

65
Q

Sensory abnormalities in MS

A

Loss of sense of touch

66
Q

Motor abnormalities in MS

A

Muscle weakness, unsteady gait, incoordination of movements, sphincter abnormalities

67
Q

Diagnosis of MS

A

2 episodes separated in space and time

Remission between, different parts of the brain

68
Q

Inborn errors of metabolism (2)

A
  1. Tay-Sachs disease
  2. Niemann-Pick disease
    Enzymes that metabolize components of lipids are lost
    Genetic
69
Q

Nutritional disease

A

Acquired
Inadequate intate of vitamins
Vit B1, B12, nicotinic acid

70
Q

Vitamin B1 deficiency

A

Wernicke-Korsakoff syndrome

71
Q

Wernicke-Korsakoff syndrome

A

Caused by B1 deficiency

Two diseases rolled into one

72
Q

Wernicke

A

Acute, abnormal eye movements

73
Q

Korsakoff

A

Chronic, short-term memory loss

74
Q

Vitamin B12 deficiency

A

Subacute combined degeneration of the cord, peripheral neuropathy
Leading to loss of sensation and motor function - demyelination of dorsal tracts
Uncoordinated movements and psychiatric symptoms

75
Q

Nicotinic acid deficiency

A

Causes pellagra

Dermatitis, diarrhea, delirium (dementia)

76
Q

Alcoholism

A

CNS depressant than can kill

Direct and indirect effect on CNS

77
Q

Indirect affects of alcoholism

A

Damage to liver and nutritional deficiencies

78
Q

Nutritional deficiencies caused by alcoholism (4)

A
  1. Thyamine deficiency
  2. Wernicke-Korsakoff
  3. Hepatic encephalopathy
  4. Pontine myelinolysis
79
Q

Hepatic encephalopathy

A

Too much ammonia in liver

80
Q

Pontine myelinolysis

A

Damage to myelin in pons

81
Q

Direct affects of alcoholism (5)

A
  1. Loss of neurons
  2. Cerebellar atrophy
  3. Myelopathy
  4. Neuropathy
  5. Myopathy
82
Q

Alzheimer’s disease

A

Sporadic
Increased levels of beta-amyloid - chronic ischemia in the brain
Atrophy greatest in frontal and temporal lobes
Age is factor

83
Q

Dementia

A

Progressive loss of cognitive functions

84
Q

Gross examination of Alzheimer’s

A

Brain appears atrophic
Narrowing of gyri
Widening of sulci

85
Q

Histological changes in Alzheimer’s

A

Most prominent in cortex
Neuritic plaques with beta-amyloid core
Neurofibrillary tangles

86
Q

Parkinson’s disease

A

Subcortical neurodegenerative disorder
Usually affects elferly
Causes unknown, damage to substantia nigra in brain - decreased dopaminergic neurons

87
Q

Symptoms of Parkinson’s disease

A

TRAP

Tremor, rigidity, brady or akinesia, postural instability

88
Q

Gross examination of Parkinson’s

A

Substantia nigra looks pale

89
Q

Histological characteristics of Parkinson’s

A

Loss of neuromelanin-rich neurons

Present of Lewy-bodies

90
Q

Huntington’s disease

A

Autosomal dominant
Disease only occurs when repeats reach a threshold
Involuntary, gyrating movements, progressive dementia
Atrophy of cortex, caudate, putamen
Loss of neurons, reactive gliosis

91
Q

Amyotrophic lateral sclerosis

A 
Neurodegenerative disease
Sporadic
10% have mutations in SOD-1 gene
Older men, women
Incurable
92
Q

Motor symptoms of Amyotrophic lateral sclerosis

A

Weakness, progressive wasting of muscles, fasciculations, slurred speech

93
Q

Generalized epilepsy

A

Begins in childhood, idiopathic

Generalized electrical discharges leading to aura, tonic-clonic seizures and post-ictal drowsiness

94
Q

Focal epilepsy

A

Secondary to a focus that can be detected using EEG or imaging
Causes include brain trauma, meningitis, stroke, brain tumor
May be controlled by drugs but may need surgery

95
Q

Neoplasms of CNS

A

Rare - 2% of cancer
High mortality (rapid growth, intracranial pressure)
Usually younger

96
Q

Primary CNS tumors (4)

A
  1. Glial cells
  2. Neural cell precursors
  3. Meninges
  4. Cranial and spinal nerves
97
Q

Atrocytomas

A

Solid cerebral tumors in adults
Cystic cerebellar tumors in children
Well-differentiated astrocytes
Progress into lesions

98
Q

Glioblastoma multiforme

A

Most common CNS tumor
65yo
Lateral hemispheres

99
Q

Gross appearance of glioblastoma multiforme

A 
Parts are necrotic, yellow
Parts are hemorrhagic red
Parts are white
Irregularly shaped
Poorly demarcated
Butterfly-like appearance
100
Q

Histological characteristics of glioblastoma multiforme

A

Highly anaplastic astrocytic cells
Fetal appearance to cells, enlarged, bizarre shaped, multinucleated cells with well-developed cytoplasms
Numerous mitotic figures
Proliferatie changes in blood vessels

101
Q

Oligodendrogliomas

A

Occur in cerebral hemispheres
Middle-aged adults
Well circumscribed, partially cystic, calcified
Well-differentiated oligodendroglia
Possible progression to glioblastoma multiform

102
Q

Ependymomas

A

Children: ventricles
Adults: spinal cord
Tumor cells line papillary structures or form rosettes

103
Q

Medullablastoma

A

Cerebellum
Childhood
Uncertain origin - primite neurectodermal cells
May enter CSF and metastasize in other parts of CNS
Poor prognosis

104
Q

Meningiomas

A

Arise from meninges
Dural baed
Mainly benign
Located near midline, base of brain, along spinal cord
Cause epileptic seizures or motor deficits
Excellent prognosis

105
Q

Neuromas

A

Schwannomas

Neurofibromas

106
Q

Neurofibromatosis type I

A

Produces multiple peripheral neurofibromas

107
Q

Neurofibromatosis type II

A

Produces acoustic schwannomas as well as multiple meningiomas

108
Q

Metastases to brain

A

50% of all tumors are metastases
Solitary or multiple
Lung, breast, melanoma

Pathology 3000 (14 decks)

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