CNS

Question 1

define leptomeningitis

Answer 1

an inflammatory process that is localized to the interfacing surfaces of the PIA & ARACHNOID where CSF flows

-most common and related to bacteria

Question 2

pachymeningitis (elephant- strong)

Answer 2

inflammation of the DURA usually a consequence of contagious infection (sinusitis or mastoiditis)

Question 3

Whats the difference between septic vs a septic meningitis?

Answer 3

septic- bacterial

aseptic- viral

Question 4

What is the most common bacterial meningitis in neonates?

Answer 4

E. Coli & Group B strep, Listeria

Question 5

What is the most common bacterial meningitis in an infant?

Answer 5

H. influenza

Question 6

What is the most common bacterial meningitis for adults?

Answer 6

Strept. pneumococcus

Question 7

What is the most common bacterial meningitis in military barracks/dorms?

Answer 7

N. meningitidis (harbored in peoples sinuses)

Question 8

What is a definitive dx tool to dx bacterial meningitis?

Answer 8

PMN’s in CSF

Question 9

What is the hallmark indicator of TB, viral meningitides, chronic fungal infections?

Answer 9

lymphocytes

Question 10

in bacterial meningitis the brain discloses an exudate of __________ & __________. This opacifies the arachnoid giving a _______ or ______ appearance over the _______ and ________ of the brain

Answer 10

fibrin and PMN’s

creamy gray or white

convexities and base

Question 11

intracranial and intraspinal subarachnoid space are _________ so the exudate passes _______ between the compartments

Answer 11

connected

freely

Question 12

What type of exudate does H. Influenza elicit?

What is the result of this?

Answer 12

dense leukocytic exudate that is rich in fibrin over the convexities

As a result, exudate becomes loculated making a barrier to abx

Question 13

What are common sxs in a peds pt for bacterial meningitis?

Answer 13

HA, vomiting, fever, convulsions.

-note: if untx= coma & death

Question 14

What are the classical signs of meningeal infection?

Answer 14

cervical rigidity, head retraction, Kernig sign (pain in knee when hip flexed) & Brudzinski sign ( flex of knees & hip when flex neck)

Question 15

Define Parkinson’s disease?

Answer 15

a neuo d/o characterized by loss of neurons in the Substantia Nigra (in midbrain)

Question 16

What are signs & sxs of Parkinson’s disease?

Answer 16

• tremors @ rest
• pill rolling (tremors in the distal extremities that is present at rest & stop with voluntary movement)
• muscular rigidity/ hypertonia (cog wheel rigidity)
• mask face (mouth open, fixed expression, eyes not blinking)
• emotional lability (depression, dementia)
• slowness of voluntary movements
• reduced rate of swallowing
• diminished spontaneous movement (akinesia)
• posture is char. stooped

Question 17

Genetic mutation of what chromosome can cause an early onset of parkinsons?

Answer 17

Chromosome 4

Question 18

What causes Parkinsons?

Answer 18

NOTHING IT IS TYPICALLY IDIOPATHIC!!!

Also noted after pt has h/o VIRAL ENCEPHALITIS or intake of toxic chemical

Question 19

What does the Substantia Nigra so ?

Answer 19

relays info to basal ganglia through dopaminergic synapses

Question 20

What does the SN and Locus Cerules of the brain look like in Parkinsons?

Answer 20

it has a loss of pigmentation (melanin)

Question 21

What are Lewy Bodies?

Answer 21

atrophic nerve cells that contain spherical granular eosinophilic cytoplasmic inclusions

Question 22

What is used for substitution therapy during early Parkinsons?

Answer 22

Levodopa

Question 23

What are other causes of Parkinson-like sxs?

Answer 23

• Drugs: Phenothiazine, Haldol
• CO or Mag posioning
• Bilat infarct of basal ganglia
• hydrocephalus
• Tumors near basal ganglia -Cerebral trauma

Question 24

Define Alzheimer’s Dz

Answer 24

insidious and progressive neuro d/o characterized by:

• memory loss
• cognitive impairment
• eventual dementia

Question 25

women are twice affected compared to men in what dz?

Answer 25

MS and alzheimers

Question 26

What is the cause of Alzheimers?

Answer 26

not fully been found. but relates to beta protein amyloid deposition in senile plaques in the cerebral cortex and are linked to intellectual funx

Question 27

Where are beta protein amyloid also found?

Answer 27

cerebral blood vessels

Question 28

What are neurofibrillary tangles?

Answer 28

paired helical filaments that consists of abnl form of normally occurring microtubule associated protein

Question 29

What does the neurofibrillary tangles cause?

Answer 29

destabilizes microtubules causing axonal degeneration and the paired helical filaments which occupy the cytoplasm of pyramidal cells in AD

Question 30

What does a brain with AD look like?

Answer 30

narrow gyri, sulci widen, bilat cortical atrophy is apprent in frontal, temporal, parietal & hippocampal cortices

Question 31

What are microscopic characteristics of AD?

Answer 31

1. Senile plaques 2. Neurofibrillary tangles 3. Amyloid angiopathy

Question 32

Define senile plaques

Answer 32

discrete spherical masses of silver staining neuritic processes surrounding a central amyloid core -found in hippocampus, amygdala, cortex

Question 33

Where are amyloid angiopathy found?

Answer 33

found in cerebral blood vessels seen with congo red stains

Question 34

What is the usual cause of death in AD pts?

Answer 34

bronchopneumonia

Question 35

Define multiple sclerosis

Answer 35

chronic, demyelinating dz of CNS in which a number of patches are demyelinated in white matter

Question 36

What functions does MS affect?

Answer 36

sensory and motor functions -note: at beginning there are long remissions and short exacerbation. as progresses it is opposite

Question 37

What age is MS aquired? at what age is it rare?

Answer 37

30's rare before 14 and after 60

Question 38

What is the etiology of MS?

Answer 38

unknown. studies show possibly: - genetic: 2nd and 3rd degree relatives, monozygotic twins - immune: perivascular lymphocytes & macroph. with CD4 & CD8 T cells - infectious etiology

Question 39

What are the hallmarks of MS?

Answer 39

plaques with smooth rounded contour in white matter (occasionally gray white junction). preference for optic chiasm and periventricular white matter

Question 40

What are the histological steps of MS

Answer 40

1. loss of myelin in region of axonal perservation 2. perivascular inflammation of lymphocytes and macrophages with focal edema 3. plaques age and edema regresses 4. astrocytes traverse aging plaque and tissue becomes dense with glial processes

Question 41

What are sxs of MS?

Answer 41

lesions of optic n. : - blurred vision, loss of vision in one eye lesion of brainstem: - double vision - vertigo plaques in spinal chord: - weakness in extremities - numbness in lower extremities Other sxs: -paralysis, dysarthria, severe visual defects, incontinence, dementia

Question 42

How do pt's with MS usually die?

Answer 42

respiratory paralysis or UTI's in terminal coma

Question 43

How long do pt's survive after onset of sxs?

Answer 43

20-30 yrs

Question 44

What causes berry aneurysms?

Answer 44

arterial defects that originate during embryonic development when bifurcation of an artery creates a Y-shape configuration because when the parent vessel splits the muscular layer doesnt integrate with the branches causing a weakness

Question 45

What are the 3 rules about CNS tumors?

Answer 45

1. CNS is susceptible to tumors (melanoma, breast, lung) 2. Primary tumors in adults are frontal. Kids are pons and cerebellum 3. benign or malignant tumors increase intracranial pressure and can cause seizures

Question 46

What do malignant tumors do to the brain?

Answer 46

it destroys the tissue resulting in rapid growth => fatal