Exam 2 (Chapter 22: CNS)

Question 1

Decreased axonal transport (spheroids), swelling of soma, displacement of Nissl bodies, and central chromatolysis are are possible signs of what type of injury?

Answer 1

Reversible Neuronal Injury

Question 2

Type of injury that results from an acute hypoxic injury resulting in soma shrinkage, pyknosis, and red neurons all within 12-24 hours

Answer 2

Irreversible Neuronal Injury

Question 3

T/F Cerebral edema, loss of nucleolus and nissl body are all found in reversible neuronal injury

Answer 3

FALSE.

All are examples of Irreversible neuronal injury

Question 4

Pattern of neuronal injury in Astrocytes

Answer 4

• CNS fibrosis
• Injury causes hypertrophy and hyperplasia enlarging the nucleus and being eosinophilic
• Causes glial filaments to sprout (

Question 5

Patterns of neuronal injury in Oligodendrocytes

Answer 5

• Produce myelin in CNS
• Causes white matter damage and potential nuclear swelling
• Enlarged nucleus present
• May produce viral inclusions

Question 6

Patterns of neuronal injury in Microglia

Answer 6

• Resident phagocytes of the CNS
• Cells proliferate and enlarge in response to injury, infection, etc. causing demyelination, infarctions, and hemorrhaging
• Neurophagia = active microglia

Question 7

Patterns of neuronal injury in Ependymal cells that line ventricles and the spinal cord

Answer 7

• Prone to infections like CMV
• Affected with irregularities of ventricular surface (possibly from viral inclusions)
• May involve the choroid plexus (fxn: produces CSF)

Question 8

Intracellular inclusion associated with Rabies

Answer 8

Negri body

Question 9

Intracellular inclusion associated with CMV

Answer 9

Owls eye (aliens head)

Question 10

Intracellular inclusion associated with Parkinson disease

Answer 10

Lewy body

Question 11

Intracellular inclusions associated with Alzheimers disease

Answer 11

Neurofibrillary tangles

Beta-amyloid plaques

Question 12

Protein that accumulates in any neurodegenerative diseases

Answer 12

Tau proteins

Question 13

Edema resulting from a blood-brain-barrier disrupton causing increased permeability leading to extracellular edema

Answer 13

Vasogenic edema

Question 14

Examples that cause localized and generalized vasogenic edema

Answer 14

Local- tumors, infarction, inflammation

General- Severe trauma

Question 15

Edema caused by neuronal/glial membrane injury causing intracellular edema

Answer 15

Cytotoxic edema

Question 16

Examples that cause Cytotoxic edema

Answer 16

Hypoxic-ischemic injury

Toxic exposure

Question 17

Physical signs of cerebral edema (post-mortem)

Answer 17

Flattened gyri
Narrow sulci
Ventricular compression

Question 18

Condition caused by an increase in CSF volume within the ventricles

Answer 18

Hydrocephalus

Question 19

T/F Hydrocephalus is most likely caused by an overproduction of CSF (like a choroidoma) instead of a disturbance in flow or resorption

Answer 19

FALSE.

Disturbance in flow/ resorption is more likely to cause hydrocephalus

Question 20

What affect would hydrocephalus have on someone < 2 years old? >2 years old?

Answer 20

• < 2 years old = cranial enlargement

- >2 years old = increased ICP and ventricular enlargement

Question 21

Intracellular inclusion caused by aging

Answer 21

Lipofuscin (lipid accumulation)

Question 22

Treatment for hydrocephalus

Answer 22

Shunting

Question 23

Compensatory hydrocephalus causing infarction and neurodegeneration

Answer 23

Hydrocephalus ex vacuo

Question 24

Herniation of the brain across the dura or through the foramen magnum causing compression on neurons and vessels

Answer 24

Cerebrum shifts

Question 25

Displaced cingulate gyrus under falx cerebri causing abnormal posturing or a coma

Answer 25

Subfalcine (cingulate) brain herniation

Question 26

Displaced temporal love under the anterior tentorium causing cranial nerve involvement, hemiparesis, and brainstem compression

Answer 26

Transtentorial (uncinate) brain herniation

Question 27

Abnormal vision and a blown pupil are symtpoms of what type of brain herniation

Answer 27

Transtentorial (uncinate) brain hernation | -Involves compromise of the oculomotor nerve (CN III)

Question 28

Displaced cerebellar tonsils through the foramen magnum. Can cause cardiorespiratory arrest, hydrocephalus, and headache

Answer 28

Tonsillar brain herniation

Question 29

T/F Transtentorial (uncinate) brain herniation is the most common type of brain herniation

Answer 29

FALSE. | Subfalcine (cingulate) brain herniation is the most common type

Question 30

When a brain herniation causes disruption of vessels that enter the pons, producing a flame shaped hemorrhage

Answer 30

Duret hemorrhage

Question 31

Malformations and types that cause herniation of the cerebellar tonsils

Answer 31

Arnold-Chiari malformations - Type I = MC, milder, present in adults - Type II = severe, present in infants

Question 32

Cerebrovascular disease causing no infarction and temporary neurological dysfunction that do not exist past 24 hours.

Answer 32

Transient Ischemic Attack (TIA a.k.a. Mini-stroke)

Question 33

Cerebrovascular disease caused by an infarction that produces acute function. Results from either an occlusion or a rupture

Answer 33

Stroke

Question 34

Types of stroke

Answer 34

Thrombotic occlusion Embolic occlusion Vascular rupture (dissection)

Question 35

T/F The top 3 leading causes of mortality in the U.S. are: 1) Heart disease 2) Cancer 3) Stroke

Answer 35

True

Question 36

Ischemia/hypoxia causes what type of necrosis in the CNS?

Answer 36

Liquefactive necrosis

Question 37

A decrease in oxygen partial pressure or oxygen availability to the brain causes this type of hypoxia

Answer 37

Functional hypoxia

Question 38

A decrease in oxygen to the brain caused by a occlusion, TIA, or stroke

Answer 38

Ischemic hypoxia

Question 39

Widespread ischemic-hypoxic injury to the brain severe enough to cause widespread neuronal death leading cerebral edema,gliosis, and red neurons. Results in neurological impairment or coma.

Answer 39

Global cerebral ischemia

Question 40

Condition where a person has been unconscious for more than 6 hours

Answer 40

Comatose

Question 41

What can limit injury caused by cerebral ischemia?

Answer 41

Collateral circulation (from circle of Willis)

Question 42

What parts of the brain have minimal collateral circulation and are therefore more susceptible to damage from ischemia?

Answer 42

Deep brain structures | -Thalamus, basal ganglia, deep white matter

Question 43

T/F Emboli are more common to cause focal cerebral ischemia than thrombi

Answer 43

True

Question 44

What blood vessels are emboli and thrombi more likely to originate from in focal cerebral ischemia?

Answer 44

Emboli- carotid artery or middle meningeal artery | Thrombi- carotid artery, aortic arch, middle cerebral artery

Question 45

Spontaneous hemorrhage of small intraparenchymal vessels causing a cerebral microbleed that can range from clinically silent to lethal. Most commonly caused by hypertension in people over the age of 60.

Answer 45

Primary brain parenchymal hemorrhage

Question 46

Accumulation of blood in the suparachnoid space. Most commonly results from a rupture of a berry aneurysm originating from a defect in the tunica media of the vessel.

Answer 46

Subarachnoid hemorrhage

Question 47

Your patient comes into your office complaining of the worst headache they have ever had. Their history shows no history of headaches. What life threatening condition should you always rule out first?

Answer 47

Subarachnoid hemorrhage

Question 48

Condition caused by a tangle of arteries or veins with at least 1 fistula present. Most common in males (2x) 10-30 years old and increases a persons risk of developing seizures or hemorrhaging

Answer 48

Arteriovenous malformations (AVM)

Question 49

Hypertensive cerebrovascular disease caused by a single artery occlusion.

Answer 49

Lacunar infact

Question 50

Hypertensive cerebrovascular disease caused by a ruptured small cerebral vessel that hemorrhages, it resorbed, and leaves a slit-like cavity

Answer 50

Slit hemorrhage

Question 51

Hypertensive cerebrovascular disease that causes global cerebral dysfunction. Biastolic BP > 130 causing increased intercranial pressure, headache, confusion, coma, vomiting, and convulsions

Answer 51

Acute hypertensive encephalopathy

Question 52

Vessel wall inflammation

Answer 52

Vasculitis

Question 53

Systemic autoimmune vasculitis causing fibrinoid necrosis in the small cerebral arteries and heart

Answer 53

Polyarteritis nodosa

Question 54

Condition causes chronic inflammation in multiple parenchymal and subarachnoid vessels. Idiopathic, but more common in males and is associated with diffuse encephalopathy (like decreased cognition)

Answer 54

Primary Angiitis of the CNS

Question 55

T/F There is no sexual preference for male or females to develop CNS trauma

Answer 55

FALSE | Males are 2x as likely as females to have CNS trauma