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PHA 512 > CNS Pathology > Flashcards

CNS Pathology Flashcards

1
Q

Leptomeningitis

A

inflammatory process

localized to interfacing surfaces of the pia and arachnoid (where the CSF flows)

more common

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2
Q

Pachymeningitis

A

inflammation of the dura

usually consequence of chronic sinusitis or mastoiditis

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3
Q

Dura

A

barrier to infection

inflammation is restricted to its outer surface

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4
Q

Bacterial Meningitis: organisms

A

majority of cases caused by suppurative bacteria

organism relates to age of patient

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5
Q

Bacterial Meningitis: neonates

A

E Coli

Group B Strept

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6
Q

Bacterial Meningitis: infant

A

(3mo-3yr)

H influenza

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7
Q

Bacterial Meningitis: adult

A

Stept pneumococcus

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8
Q

Bacterial Meningitis: crowded conditions

A

N meningitidis

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9
Q

The most definitive diagnostic index of meningitis…

A

PMN’s in the CSF

most causative organisms initiate a purulent/suppurative response

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10
Q

LYMPHOCYTES are the hallmark of meningitis caused by …

A

tuberculosis

viral meningitis

chronic fungal infections (cryptococcal meningitis)

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11
Q

Bacterial Meningitis: gross presentation

A

exudate of PMN’s and fibrin which opacifies the arachnoid

creamy gray or white appearance

(exudate passes freely bt intracranial and intraspinal subarachnoid space)

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12
Q

Pia

A

delicate, effective barrier against the spread of infection

prevents involvement of the underlying brain

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13
Q

Bacterial Meningitis: H influenza

A

dense leukocytic exudate - rich in fibrin

exudate becomes loculated - creating a barrier to antibiotics

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14
Q

Bacterial Meningitis: clinical presentation

A

headaches
vomiting
fever
convulsions (children)

untreated: coma, death

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15
Q

Classic Signs of Meningeal Infection

A

cervical rigidity
head retraction
Kernig sign
Brudzinski sign

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16
Q

Kernig Sign

A

pain in the knee when the hip is flexed

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17
Q

Brudzinski Sign

A

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

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18
Q

Parkinson’s Disease: pathological characteristics

A

loss of (pigmented, dopaminergic) neurons in the substantia nigra

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19
Q

Parkinson’s Disease: clinical characteristics

A

tremors at rest (pill rolling)

muscular rigidity (hypertonia)(cog wheel)

expressionless face

emotional lability (depression, dementia)

slowness of all voluntary movements

diminished spontaneous movement (akinesia)

stooped posture

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20
Q

Parkinson Disease

A

neurologic disorder

appears in 6th to 8th decade

suggested as an acceleration of normal age related changes

  • loss of neurons in substantia nigra
  • reduction in the dopamine content
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21
Q

Parkinson Disease: etiology

A

rare autosomal dominant early onset form (point mutation of chromosome 4)

idiopathic

  • after viral encephalitis
  • after intake of a toxic chemical
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22
Q

Substantia Nigra

A

relays information to the basal ganglia through dopaminergic synapses

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23
Q

von Economo Encephalitis

A

resulted in injury to the substantia nigra (gross loss of pigmentation)

immediate or delayed postencephalitic parkinsonism

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24
Q

Parkinson Disease: gross presentation

A

loss of pigmentation in the substantia nigra and locus ceruleus

25
Parkinson Disease: microscopic presentation
pigmented neurons are scarce with small extracellular deposits of melanin lewy bodies
26
Lewy Bodies
spherical granular eosinophilic cytoplasmic inclusions in residual atrophic nerve cells
27
Pill Rolling
course tremor of the distal extremities
28
Expressionless Face
``` mask like mouth: open reduced rate of swallowing --> drooling fixed expression eyes: unblinking, staring ```
29
Parkinson Disease: treatment
Levodopa - early stage - substitution therapy (artificial dopamine) - does NOT rectify underlying disorder - eventually becomes ineffective
30
Causes of Parkinson Like Symptoms
drugs (phenothiazines, haldol) CO or manganese poisoning bilateral infarcts of basal ganglia hydrocephalus tumors near basal ganglia cerebral trauma
31
Alzheimer Disease
insidious and progressive neurological disorder characterized by: - loss of memory - cognitive impairment - eventual dementia F>M ``` sporadic (MC) familial variant (chromosome 21) ```
32
Alzheimer Disease: gross presentation
narrow gyri widened sulci bilateral cortical atrophy (frontal, temporal, parietal, hippocampal cortices)
33
Alzheimer Disease: microscopic presentation
senile (neuritic) plaques neurofibrillary tangles amyloid angiopathy (located in areas of the cerebral cortex linked to intellectual function)
34
Senile Plaques
discrete spherical masses of silver staining neuritic processes surround a central amyloid core hippocampus, amygdala, cortex
35
Neurofibrillary Tangles
bundles of paired helical filaments located in cortical neurons or hippocampal pyramidal cells displace/encircle the nucleus (flame cells) cortex, hippocampus, amygdala (abnormal form of a normally occurring protein responsible for proper axonal transport)
36
Amyloid Angiopathy
within cerebral blood vessels seen with congo red stains beta protein amyloid: -found in walls of cerebral blood vessels -may be origin of deposits in the brain
37
Alzheimer Disease: diagnosis
80-90% - clinical assessment - radiologic methods (pathologic exam for definitive diagnosis)
38
Alzheimer Disease: cause of death
bronchopneumonia | he mentioned something about UTIs
39
Multiple Sclerosis
chronic demyelinating disease of the CNS numerous patches of demyelination throughout the white matter affects sensory and motor functions exacerbations and remissions temperate climates F>M unknown etiology (genetic, immune, infectious)
40
JC Virus
role in initiating demyelination in the CNS agent causing progressive multifocal leukoencephalopathy
41
Plaque
hallmark of MS variable size, smooth rounded contour located in white matter, near ventricles preference for optic nerves and chiasm can involve cerebellum, brain stem, spinal cord
42
Multiple Sclerosis: histology
selective loss of myeline in a region of axonal preservation perivascular inflammation of lymphocytes and macrophages with focal edema astrocytes --> dense with glial processes
43
Multiple Sclerosis: clinical presentation
blurred vision/loss of vision in one eye brainstem: - double vision - vertigo plaques in spinal cord: - weakness of one or both legs - numbness in LE
44
Multiple Sclerosis: functional impairment
``` paralysis dysarthria severe visual defects incontinence dementia ```
45
Multiple Sclerosis: cause of death
respiratory paralysis UTI's in terminal coma
46
Berry Aneurysm
point of congenital muscular weakness bridged only by endothelium, the internal elastic lamina and slender adventitia arterial defect originating during embryonic development - bifurcation 90% at circle of willis bloodstream from parent vessel exerts relentless pressure on the crotch --> membrane degenerates/fragments --> saccular aneurysm evolves
47
Berry Aneurysm: risk
rupture causes life threatening subarachnoid hemorrhage
48
Berry Aneurysm: clinical presentation
sudden severe headache coma progressive decline in consciousness - arterial spasm - cerebral ischemia and infarction survivors: rebleed (worse prognosis)
49
Hypertension Associated Aneurysm
integrity of cerebral arterioles is compromised by HTN deposition of lipid and hyaline material in their walls (lipohyalinosis)
50
Charcot Bouchard Aneurysm
small fusiform dilations located on the trunk of a vessel predisposed to rupture --> hypertensive cerebral hemorrhage HT aneurysm
51
Hypertensive Intracerebral Hemorrhage: location
1. basal ganglia thalamus (75%) 2. pons (15%) 3. cerebellum (!)%)
52
Hypertensive Intracerebral Hemorrhage: cause of death
transtentorial herniation rupture --> massive intraventricular hemorrrhage
53
Intraventricular Hemorrhage: cause of death
distention of the 4th ventricle and the compression of vital centers in the medulla
54
Cerebellar Hemorrhage
causes: - abrupt ataxia - severe occipital headache - vomiting threatens life through compression of medulla
55
Cerebral Infarction
cerebrovascular occlusive disease atherosclerosis predisposes to vascular thrombosis and embolic events --> localized ischemia and subsequent cerebral infarction
56
Cerebral Infarction: classification
hemorrhagic bland
57
Cerebral Infarction: hemorrhagic
caused by embolization
58
Cerebral Infarction: bland
caused by thrombotic occlusion (largely ischemic)

PHA 512 (5 decks)

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