Exam 2 Ch. 22 Flashcards by Austin Gunderson

What is a irreversible neuronal injury?

Acute neuronal injury
“Red neurons”
Frequently from acute hypoxia

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What is it called when the soma becomes shrunken?

Red neurons

Irreversible injury

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What do astrocytes do?

Perform gliosis

Activation from gemistocytic astrocyte

They become enlarged and eosinophilic

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What do oligodendrocytes do

Produces myelin in the CNS, enlarge when activated

This is the site for viral inclusions

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What are microglia

Are phagocytes of the CNS

Perform neuronophagia

Proliferate and enlarge after injury

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what are ependymal cells

Line ventricles and spinal cord

May become infected from cytomegalovirus

May cause choroid plexus dysfunction

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What produces Negri body

Rabies

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What is CMV

Owl’s eye appearance

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WHat disease produces levy bodies

Parkinson’s disease

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What are symptoms of Alzheimer’s

Neurofibrillary tangles

B-amyloid plaques (tau) proteins

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What is lipofuscin

Aging and lipid accumulation

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What can increase intra cranial pressure

Blood, pus, tumor, edema

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What is vasogenic edema

Blood-brain-barrier disruption

Results in extracellular edema

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What can cause vasogenic edema

Severa trama

Can be localized due to tumors, infection, inflammation

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What is cytotoxic edema

Nueronal/glial membrane injury

INTRACELLULAR EDEMA

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What causes cytotoxic edema

Hypoxic-ischemic injury or toxic exposure

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What are three symptoms of cerebral edema

Flattened gyri

Narrowed sulci

Ventricular compression

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What causes an increase in CSF within the ventricles

Hydrocephalus

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What is the most common cause of hydrocephalus

Choroid plexus tumor which increases production of CSF

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What is the cutoff for hydrocephalus in age

< 2 years old= cranial enlargement

> 2 years old=increased ICP and enlarged ventricles

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How is it caused and treated hydrocephalus

Unknown incidence 50% idiopathic

Treatment is shunting; aka ventriculoatrial shunt

If untreated results in respiratory arrest and death

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What is a herniation in the CNS

Shifting/protrusion of CNS tissue following a increase in ICP

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What is the process of herniation

Vessels compress
Displacement of CSF
Cerebrum shifts(herniation)- across the dura or through foramen magnum

Results in ischemia then leads to infarction

IS A POSITIVE FEEDBACK LOOP

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What is the most common herniation?

Subfalcine (cingulate)

Displaced cingulate gyrus, under falx cerebri

Abnormal posturing, coma

Transtentorial herniation is

Aka uncinate, displaced temporal lobe under anterior tentorium CN III- oculomotor, "blown pupil" / abnormal vision Hemiparesis, brainstem compression Duret hemorrhage

What is a tonsillar herniation

Cerebellum tonsilis through Foramen Magnum Results in cardiorespiratory arrest, hydrocephalus, and headache

What are two types of abnormal posturing

Decorticate rigidity Decerebrate rigidity

Decorticate rigidity results in

Brachial flexion Extension of legs along with internal rotation Injury between the cortex and red nuclei

Decerebrate rigidity results in

Extension of all 4 limbs Pronation of arms, plantar flexion Injury to brainstem- between red nuclei and vestibular nuclei

What is a duret hemorrhage cause by

Transtentorial (uncinate) herniation Disrupts the vessels in the pons Aka "flame shaped"

What is mydraisis

Dilation of a pupil Indicates compression of CN III

What causes mydriasis

A transtentorial herniation

What is anisocoria

Unequal pupil size

Which from of Arnold chiari malformations are worse?

Type II is the sever form

What is the most common Arnold chiari malformations

Type I Found mainly in ADULTS Low lying cerebellar tonsils

WHich type of chiari occurs in infants

In utero or infants

What is the 5th most common cause of mortality in the USA

Cerbrovascular disease #1 cause of neurological morbidity Ex. Stroke

What is a stroke?

Acute dysfunction due to cerebral infarction Thrombosis or emboli occlusion Vascular rupture

What is mini stroke

Transient ischemic attack

What is the difference between a stroke and a transient ischemic attack

A Transient ischemic attack no infarction occurs Neurological dysfunction lasts less than 24 hrs

What are the signs of a stroke

Face drooping Arm weakness Speech difficulty Time to call 911

Bell's palsy occurs ___________ and affects paralysis of what CN ____

Unilateral facial weakness CN VII

What causes Bell's palsy

Viral association HSV-1 Inflammation of the facial nerve self limited within 2-8 weeks

Stoke vs. Bell's Palsy

Stroke-contralateral lower facial weakness. Weak smile (dysarthria). Preserves upper face motor function Bell's Palsy- asymmetrical forehead weakness

What are the brain requirements

2% of body mass, 15% of cardiac output 20% of O2

FUnctional hypoxia occurs from

Increase in altitude and anemia, cyanide, CO

Different types of Ischemia

Hypotension, occculsion aka clot Transient=TIA Permanent=stroke

What is global cerebral ischemia

Widespread ischemic hypoxia injury Cardiac arrest, sever hemorrhage Mild confusion its TIA, severe is a stroke

WHen severe what causes neuronal death

Global cerebral ischemia Cerebral edema, red neurons, gliosis results in coma, impairment, death Mechanic ventilation=aka autolysis

What causes Focal Cerebral Ischemia

A localized arterial occlusion

What protects against focal cerebral ischemia

Circle of wills will provide some collateral flow

What is the most common Focal Cerebral Ischemia

MC Emboli-cardiac mural thrombi, valve disease, arrhythmia Thrombi- atherosclerotic plaques (carotid arteries)

What occurs during non hemorrhagic cerebral infarction aka stroke

Red neurons Liquefaction necrosis Thrombocytic meds

What is the mc cause of intracranial hemorrhage

HTN Injury to vessel walls Tumors Trauma

What is a microbleed?

Spontaneous intraparenchymal bleed HTN is the most common cause Average age 60 years old Clinically silent or lethal, 15% of deaths in chronic HTN patients Bleed-Clot-Cavitation

What causes a subarachnoid hemorrhage

1/3 from increased ICP, straining and orgasm Often described as the "worst headache ive ever had" nausea and vomiting 25-50% lethal, commonly re occur

What is the MC cause of subarachnoid hemorrhage

MC-Ruptured Saccular aneurysm Malformed vessel or a tumor

What is also known as a Berry aneurysm

Saccular Aneurysm It is 80-90% of all intracranial aneurysms

What is berry aneurysm is associated with

Polycystic Kidney Disease