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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
Q

Parkinson Disease: microscopic presentation

A

pigmented neurons are scarce with small extracellular deposits of melanin

lewy bodies

26
Q

Lewy Bodies

A

spherical granular eosinophilic cytoplasmic inclusions in residual atrophic nerve cells

27
Q

Pill Rolling

A

course tremor of the distal extremities

28
Q

Expressionless Face

A 
mask like
mouth: open
reduced rate of swallowing --> drooling
fixed expression
eyes: unblinking, staring
29
Q

Parkinson Disease: treatment

A

Levodopa

  • early stage
  • substitution therapy (artificial dopamine)
  • does NOT rectify underlying disorder
  • eventually becomes ineffective
30
Q

Causes of Parkinson Like Symptoms

A

drugs (phenothiazines, haldol)

CO or manganese poisoning

bilateral infarcts of basal ganglia

hydrocephalus

tumors near basal ganglia

cerebral trauma

31
Q

Alzheimer Disease

A

insidious and progressive neurological disorder

characterized by:

  • loss of memory
  • cognitive impairment
  • eventual dementia

F>M

sporadic (MC)
familial variant (chromosome 21)
32
Q

Alzheimer Disease: gross presentation

A

narrow gyri
widened sulci
bilateral cortical atrophy (frontal, temporal, parietal, hippocampal cortices)

33
Q

Alzheimer Disease: microscopic presentation

A

senile (neuritic) plaques

neurofibrillary tangles

amyloid angiopathy

(located in areas of the cerebral cortex linked to intellectual function)

34
Q

Senile Plaques

A

discrete spherical masses of silver staining neuritic processes

surround a central amyloid core

hippocampus, amygdala, cortex

35
Q

Neurofibrillary Tangles

A

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
Q

Amyloid Angiopathy

A

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
Q

Alzheimer Disease: diagnosis

A

80-90%

  • clinical assessment
  • radiologic methods

(pathologic exam for definitive diagnosis)

38
Q

Alzheimer Disease: cause of death

A

bronchopneumonia

he mentioned something about UTIs

39
Q

Multiple Sclerosis

A

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
Q

JC Virus

A

role in initiating demyelination in the CNS

agent causing progressive multifocal leukoencephalopathy

41
Q

Plaque

A

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
Q

Multiple Sclerosis: histology

A

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
Q

Multiple Sclerosis: clinical presentation

A

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
Q

Multiple Sclerosis: functional impairment

A 
paralysis
dysarthria
severe visual defects
incontinence
dementia
45
Q

Multiple Sclerosis: cause of death

A

respiratory paralysis

UTI’s in terminal coma

46
Q

Berry Aneurysm

A

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
Q

Berry Aneurysm: risk

A

rupture causes life threatening subarachnoid hemorrhage

48
Q

Berry Aneurysm: clinical presentation

A

sudden severe headache
coma

progressive decline in consciousness

  • arterial spasm
  • cerebral ischemia and infarction

survivors: rebleed (worse prognosis)

49
Q

Hypertension Associated Aneurysm

A

integrity of cerebral arterioles is compromised by HTN

deposition of lipid and hyaline material in their walls (lipohyalinosis)

50
Q

Charcot Bouchard Aneurysm

A

small fusiform dilations located on the trunk of a vessel

predisposed to rupture –> hypertensive cerebral hemorrhage

HT aneurysm

51
Q

Hypertensive Intracerebral Hemorrhage: location

A
  1. basal ganglia thalamus (75%)
  2. pons (15%)
  3. cerebellum (!)%)
52
Q

Hypertensive Intracerebral Hemorrhage: cause of death

A

transtentorial herniation

rupture –> massive intraventricular hemorrrhage

53
Q

Intraventricular Hemorrhage: cause of death

A

distention of the 4th ventricle and the compression of vital centers in the medulla

54
Q

Cerebellar Hemorrhage

A

causes:

  • abrupt ataxia
  • severe occipital headache
  • vomiting

threatens life through compression of medulla

55
Q

Cerebral Infarction

A

cerebrovascular occlusive disease

atherosclerosis predisposes to vascular thrombosis and embolic events –> localized ischemia and subsequent cerebral infarction

56
Q

Cerebral Infarction: classification

A

hemorrhagic

bland

57
Q

Cerebral Infarction: hemorrhagic

A

caused by embolization

58
Q

Cerebral Infarction: bland

A

caused by thrombotic occlusion (largely ischemic)

PHA 512 (5 decks)

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