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Pathophys Exam 1 > CNS pathology- 2 > Flashcards

CNS pathology- 2 Flashcards

1
Q

What are astrocytomas?

A

glial neoplasms derived from astrocytes

75-80% of adult primary brain tumors

usually middle age or older

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2
Q

Where are Astrocytomas usually found?

A

Adults- in the cerebral hemispheres

Peds- Cerebellum and the pons

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3
Q

Grade I Astrocytoma

A

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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4
Q

What is the life expectancy for a Grade I Astrocytoma?

A

~5 years

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5
Q

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

A
  • Greater cellularity
  • Cellular pleomorphism
  • Anaplasia

*distribution parallels that of Grade I

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6
Q

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

A

growth is rapid

life expectancy= ~3yrs

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7
Q

Glioblastoma Multiforme (GBM)–> AKA grade III astrocytoma

A
  • 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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8
Q

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

A

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

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9
Q

What differentiated oligodendrogliomas from other tumors?

A
  • 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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10
Q

What is the most common presentation of Epenymomas?

A

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

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11
Q

What chromosomal aberration is seen in meningiomas?

A

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

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12
Q

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

A

Lewy Bodies

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13
Q

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

A
  • 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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14
Q
A
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15
Q

What is the number one etiology of why strokes occur?

A

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

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16
Q

What is are meningiomas?

A
  • intracranial tumors that arise from the arachnoid villi and produce sxs by compressing brain tissue.
  • 20% of intracranial tumors
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17
Q

What is the peak incidence of meningiomas?

A

4th-5th decades

Slightly more common in females (60:40)

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18
Q

Where are meningiomas most commonly located?

A

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

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19
Q

What do meningiomas have a propensity to do?

A

erode contiguous bone

20
Q

Other than chromosomal abberations, what else can cause meningiomas?

A

Cranial radiation (related to dosage)

21
Q

How do meningiomas appear grossly

A

well-circumscribed, firm, bosselated masses of variable size

-cut sections show a gray, fibrous patter

22
Q

What is the clincial presentation of meningiomas?

A

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)

23
Q

Clinical presentation of meningiomas

A

tumors in the olfactory groove produce ansomnia

Tumors in suprasellar region- visual defects

HA’s common

24
Q

What is Kernig sign?

A

Pain in the knee when the hip is flexed

–> sign of bacterial meningitis

25
Q

What is the Brudzinski Sign?

A

Spontaneous flexion of the knees and hips when the neck is flexed

–> sign of bacterial meningitis

26
Q

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

A

Kernig and Brudzinski signs

+= bacterial meningitis

27
Q

What is an Acoustic Neuroma?

A
  • Intracranial Schwannoma that is restricted to CN8
  • Malignancy is rare
28
Q

Symptoms of Acoustic Neuroma

A
  1. tinnitus
  2. Deafness

Can also compress other Cranial nerves

29
Q

Where are Acoustic Neuromas usually found?

A
  • Found in the cerebellar pontine angle
  • restricted to CN8
30
Q

What is Multiple Sclerosis?

A

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
31
Q

What is the prevalence of MS?

A

Most common demyelinating disorder

1 in 1000

32
Q

What is the etiology of MS?

A

unknown

experimental studies point to possible genetic, immune and infectious etiology

33
Q

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

A
  • blurred vison or unilateral vision loss
  • double vision
  • vertigo
34
Q

Who is most likely to get MS?

A
  • 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
35
Q

Genetic factors associated with MS

A

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

36
Q

What are immune factors related to MS?

A

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

37
Q

What viruses are associated with MS?

A

measles

mumps

rubella

herpes

*no direct evidence exists for this involvement

38
Q

What is the hallmark of MS?

A

the plaque

-variable in sz w/ smooth rounded contour

39
Q

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

A

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)
40
Q

What happens as the plaque in MS ages?

A
  • it becomes more discrete and the edema regresses
  • Astrocytes traverse the aging plaque and the tissue becomes dense with glial processes
41
Q

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

A
  • weakness of one or both legs
  • numbness in the lower extremities
42
Q

Are the initial sxs of MS reversible?

A

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

43
Q

What is the degree of functional impairment in MS?

A

variable.

Ranges from minor disability–> sever incapacity with widespread paralysis, dysarthria, severe visual defects, incontinence and dimentia

44
Q

How do patients with MS usually die?

A

usually die of respiratory paralysis or UTIs in terminal coma

45
Q

What is the prognosis of MS?

A

Most patients survive 20-30 years after onset of sxs

Pathophys Exam 1 (14 decks)

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