20% of primary intracranial neoplasms - poorly demarcated - infiltrates the cortex - indistinct margin - can also be seen in the pons/cerebellum in peds and cervical spinal cord in young adults

CNS pathology- 2 Flashcards by Megan Jacobson

What are astrocytomas?

glial neoplasms derived from astrocytes

75-80% of adult primary brain tumors

usually middle age or older

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Where are Astrocytomas usually found?

Adults- in the cerebral hemispheres

Peds- Cerebellum and the pons

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Grade I Astrocytoma

20% of primary intracranial neoplasms

poorly demarcated
infiltrates the cortex
indistinct margin
can also be seen in the pons/cerebellum in peds and cervical spinal cord in young adults

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What is the life expectancy for a Grade I Astrocytoma?

~5 years

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How do you distinguish Anaplastic (Grade II) Astrocytoma from a well-differentiated astrocytoma?

Greater cellularity
Cellular pleomorphism
Anaplasia

*distribution parallels that of Grade I

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What is the growth and life expectancy of an Anaplastic (Grade II) Astrocytoma?

growth is rapid

life expectancy= ~3yrs

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Glioblastoma Multiforme (GBM)–> AKA grade III astrocytoma

40% of primary intracranial neoplasms
life expectancy= 18mo
Infiltrates extensively into cortex, often crossing the corpus callosum w/ bilateral extension into the white matter of both hemispheres

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What is seen on gross examination of Glioblastoma Multiforme (GBM)?

-Both bottled red (recent hemorrhage) and yellow (remote hemorrhage) likened to a butterfly on gross examination

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What differentiated oligodendrogliomas from other tumors?

well-circumscribed, gelatinous, grey masses, often with cysts, focal hemorrhage and calcification
Slow growth is reflected by absence of mitotic figures and necrosis (so better prognosis than astrocytomas)
common complaint: seizures

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What is the most common presentation of Epenymomas?

-hydrocephalus secondary to progressive obstruction of the 4th ventricle (whee they are commonly located) x

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What chromosomal aberration is seen in meningiomas?

Majority arise sporadically and exhibit either a deletion or mutation of chromosome 22

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What is the characteristic cell that is seen in Parkinsons disease?

Lewy Bodies

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What is the number 1 etiology as to why Hypertensive bleeds occur that are related to HTN?

Charcot-Bouchard aneurysms (formed from the weakening of the walls of cerebral arterioles) are predisposed to rupture and cause hypertensive cerebral rupture
Have a graphic distribution

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What is the number one etiology of why strokes occur?

Artherosclerosis- predisposes to vascular thrombosis and embolic events –> both result in ischemia and subsequent cerebral infarction

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What is are meningiomas?

intracranial tumors that arise from the arachnoid villi and produce sxs by compressing brain tissue.
20% of intracranial tumors

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What is the peak incidence of meningiomas?

4th-5th decades

Slightly more common in females (60:40)

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Where are meningiomas most commonly located?

In the parasagittal areas, convexities of the cerebral hemispheres, the olfactory groove and the lateral wing of the sphenoid

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What do meningiomas have a propensity to do?

erode contiguous bone

Other than chromosomal abberations, what else can cause meningiomas?

Cranial radiation (related to dosage)

How do meningiomas appear grossly

well-circumscribed, firm, bosselated masses of variable size

-cut sections show a gray, fibrous patter

What is the clincial presentation of meningiomas?

depending on location, seizures rather than neuro deficits characterize the pt (due to lesions positioned in the parasagittal and over the convexities of the hemispheres)

Clinical presentation of meningiomas

tumors in the olfactory groove produce ansomnia

Tumors in suprasellar region- visual defects

HA’s common

What is Kernig sign?

Pain in the knee when the hip is flexed

–> sign of bacterial meningitis

What is the Brudzinski Sign?

Spontaneous flexion of the knees and hips when the neck is flexed --\> sign of bacterial meningitis

What are two special physical exam tests you can perform on a patient to test for bacterial meningitis?

Kernig and Brudzinski signs += bacterial meningitis

What is an Acoustic Neuroma?

- Intracranial Schwannoma that is restricted to CN8 - Malignancy is rare

Symptoms of Acoustic Neuroma

1. tinnitus 2. Deafness Can also compress other Cranial nerves

Where are Acoustic Neuromas usually found?

- Found in the cerebellar pontine angle - restricted to CN8

What is Multiple Sclerosis?

A chronic, demyelinating dz of the CNS which there are numerous patches of demyelination throughout the white matter - Affects both sensory and motor functions - Characterized by exacerbations and remissions over several yrs

What is the prevalence of MS?

Most common demyelinating disorder 1 in 1000

What is the etiology of MS?

unknown experimental studies point to possible genetic, immune and infectious etiology

What are early symptoms of MS? What is often the presenting complaint?

- blurred vison or unilateral vision loss - double vision - vertigo

Who is most likely to get MS?

- Usually occurs in temperate climates (rare in tropics) - Acquired at mean age of 30. Rare \<14y/o and \>60 - Women afflicted 2x more than men

Genetic factors associated with MS

suggest a familial aggregation of the dz w/ an increased risk in 2nd and 3rd degree relatives

What are immune factors related to MS?

Immune factors are related to the histologic appearance of lesions: perivascular lymphocytes and macrophages with numerous CD4+ and CD8+ T-cells

What viruses are associated with MS?

measles mumps rubella herpes \*no direct evidence exists for this involvement

What is the hallmark of MS?

the plaque -variable in sz w/ smooth rounded contour

Where is the plaque, that is a hallmark of MS, located?

Usually situated in the white matter occasionally breech the gray-white junction - shows a preference for optic nerves and chiasm and uniformly localizes to the periventricular white matter - Can also involv the cerebellum brainstem and SC (but mainly around the ventricles)

What happens as the plaque in MS ages?

- it becomes more discrete and the edema regresses - Astrocytes traverse the aging plaque and the tissue becomes dense with glial processes

What symptoms are seen in a patient with MS if the plaques are within the spinal cord?

- weakness of one or both legs - numbness in the lower extremities

Are the initial sxs of MS reversible?

many of the initial sxs are partially reversible w/in a few months

What is the degree of functional impairment in MS?

variable. Ranges from minor disability--\> sever incapacity with widespread paralysis, dysarthria, severe visual defects, incontinence and dimentia

How do patients with MS usually die?

usually die of respiratory paralysis or UTIs in terminal coma

What is the prognosis of MS?

Most patients survive 20-30 years after onset of sxs