Exam 2: CNS Flashcards
1
Q
Reversible neuronal injury examples
A
Swelling of soma and axons
Aka spheroid
2
Q
Spheroids can displace
A
Nissl bodies
3
Q
Irreversible neuronal injury
A
Some shrinks
Pyknosis - nucleus necrosis
Eosinophilia
4
Q
___ freq from acute hypoxia
A
Irreversible neuronal injury
5
Q
Red neurons characteristic of
A
Irreversible neuronal injury
6
Q
Astrocytes Function in
A
Gliosis
7
Q
Activated astrocytes
A
Gemistrocytic astrocyte
8
Q
Oligodendrocytes
A
Produce myelin in CNS
9
Q
Oligodendrocytes can also be site for
A
Viral inclusions
10
Q
Microglia
A
Phagocytes of CNS
11
Q
Ependymal cells line
A
Ventricles and spinal cord
12
Q
___ likes to infect ependymal cells
A
CMV
13
Q
Viral infections: disease and inclusion
A
Rabies = negri body
CMV = owl’s eye appearance
14
Q
Neurodegenerative diseases: name and inclusion
A
Parkinson’s = Lewy bodies
Alzheimer’s = beta amyloid plaques (tau protein); neurofibrillary tangles
15
Q
Lipofuscin
A
Lipid accumulations
16
Q
Increase in ICP can be due to
A
Blood
Pus
Tumor
Edema
17
Q
Vasogenic edema
A
Disrupted BBB
Extracellular edema
18
Q
Cytotoxic edema
A
Disrupted neuronal/glial membranes
Intracellular edema
19
Q
Cerebral edema cause gyri to ___, sulci to ___, ventricles ___
A
Flatten
Narrow
Compressed
20
Q
Hydrocephalus
A
Increase CSF volume in ventricles
21
Q
Hydrocephalus can be due to
A
Disturbed CSF flow or resorption
22
Q
Types of edema
A
Vasogenic
Cytotoxic
23
Q
Hydrocephalus MC from
A
Choroid plexus tumor
24
Q
Communicating hydrocephalus
A
Bilateral
Even
25
Noncommunicating hydrocephalus
Localized
| Uneven
26
Under 2, hydrocephalus causes
Cranium expansion
27
Older than 2, hydrocephalus causes
Increase ICP
| Enlarged ventricles
28
Half of all cases of hydrocephalus are
Idiopathic
29
Hydrocephalus Ex Vacuo
Due to infarction or neurodegeneration
30
Herniated brain tissue can shift where?
Across dural structures
| Through foramen magnum
31
Herniation often follows
Increase in ICP
32
Types of herniation
Subfalcine (cingulate)
Transtentorial (uncinate)
Tonsillar
33
MC type of herniation
Subfalcine (cingulate)
34
Untreated hydrocephalus can cause
Respiratory arrest
35
Subfalcine herniation
Cingulate gyrus,under falx
Abnormal posturing
Coma
36
Transtentorial herniation
Uncinate fasciculus (temporal lobe) under tentorium
37
CN3 involvement, blown pupil, and diplopia can result from
Transtentorial herniation
38
Tonsillar herniation
Cerebellar tonsils through FM
Headache, cardiorespiratory arrest
39
Duret hemorrhage
Disrupts vessels in pons
40
Flame shaped bleeds indicates
Duret hemmorrhage
41
Duret hemorrahage can result from
Transtentorial herniation
42
Types of abnormal posturing
Decorticate rigidity
Decerebrate rigidity
43
Decorticate rigidity
Brachial flexion
Injury between cortex and red nuclei
44
Decerebrate rigidity
All limbs extended, flexed wrists
Injury in brainstem between red nuclei and vestibular nuclei
45
Mydriasis
Dilation of pupil
46
Anisocoria
Unequal pupil size
47
MC chiari malformation
Type 1
48
Type 1 chiari malformation
Mild
Low lying cerebellar tonsils
Downward extension through FM
Adults
49
Arnold-Chiari malformation
Small post fossa
Misshapen midline cerebellum
Downward extension through FM
Associated with myelomeningocele
50
Type 2 chiari malformation effects
Infants or in utero
51
Chiari malformations aka
Post fossa abnormalities
52
Tx for chiari malformations
Neurosurgical decompression
53
5th MC mortality in US
CVD
54
MC cause of neurological morbidity
CVD
55
3 mechanisms that cause CVD
Thrombotic occlusion
Embolic occlusion
Disruption of vessel wall
56
Stroke causes ___ to CNS tissues
Liquefactive necrosis
57
2 primary forms of stroke
Ischemic
| Hemorrhagic
58
Ischemia
Lack of blood to area
59
Hemorrhagic
Injure CNS tissue + disrupt BBB
60
Features of stroke
Unilateral facial drooping
Difficulty speaking
Contralateral paralysis
61
Stroke preserves
Motor to upper face
- can close eyes tightly
- can wrinkle forehead symmetrically
62
With a TIA, normal function returns in
24 hrs from time of onset
63
Paralysis of CN7
Bell’s palsy
64
MC age for Bell’s palsy
15-45 yo
65
Features of Bell’s palsy
Asymmetrical forehead weakness
Unilateral paralysis of face
66
Potential causes of hypoxia
Altitude
CO
Anemia
Cyanide
67
Global cerebral ischemia
Low blood perfusion to entire brain
68
___ provides some collateral flow to brain
Circle of Willis
69
Isolated area of low blood flow
Focal cerebral ischemia
70
Deep tissues have minimal collateral supply, which include
Thalamus
Basal ganglia
Deep white matter
71
MC cause of focal cerebral ischemia
Emboli
72
Cerebral infarction: 12-48 hrs
Neutrophils
Red neurons
Edema
73
Cerebral infarction: 48 hrs-2 weeks
```
Nuclear fragmentation (karyorrhexis)
Liquefaction
```
74
Hemorrhagic stoke involves
Reperfusion
75
Cerebral infarction: weeks-years
Macrophages
Gliosis
Cavitation
76
Causes of intracranial hemorrhage
Vascular injury
Malformations
Tumors
Trauma
77
Bleeding inside brain
Intracranial hemorrhage
78
MC cause of intracranial hemorrhage
HTN
79
Extravasation of blood will
Coagulate
| Compress parenchyma
80
HTN MC cause of _____, which involves spontaneous microbleeds
Primary brain parenchymal hemorrhage
81
Berry aneurysm aka
Saccular aneurysm
82
Saccular aneurysm occur at branch points of
Circle of Willis
83
“ Worst headache I’ve ever head” indicates
Subarachnoid hemorrhage
84
MC cause of subarachnoid hemorrhage
Ruptured saccular aneurysm
85
1st episode of subarachnoid hemorrhage results in
25-50% lethal
86
Subarachnoid Bleeding is ____, and 1/3 come from increased ICP
Non-traumatic
87
Clinical decision rule for subarachnoid hemorrhage
1. >40 yo
2. Neck pain or stiffness
3. LOC
4. Thunderclap HA
5. Limited neck flexion
88
Saccular aneurysm associated with
Polycystic kidney disease
89
Method used to evaluate potential brain bleeds
CT scan
90
Polycystic kidney disease due to
Autosomal dominant PKD1 or 2 gene
91
Asymptomatic until 30s, flank pain, hematuria, HA all describe
Polycystic kidney disease
92
PKD can also cause cysts in ___ and saccular aneurysms
Liver
93
Berry aneurysm MC in
Anterior circulation of branch points of circle of Willis
94
Saccular aneurysm may scar and produce
Hydrocephalus
95
Arteriovenous malformation (AVM)
Tangle of arteries and veins
| Fistula
96
AVM MC
Cerebrovascular malformation
97
AVM MC in ___ ages ___
Males
| 10-30 yo
98
“Worm-like” mass describes
AVM
99
___ weakens vessels walls that can easier rupture
HTN
100
Diastolic BP > 130 =
Severe ICP
101
HTN encephalopathy can break down
BBB
102
HTN encephalopathy can cause widespread
Cerebral edema
103
4 types of intracranial hemorrhages
Primary brain parenchymal
Subarachnoid
Ruptured AVM
Lacunar infarction and slit hemorrhage
104
__ 2X more likely to have CNS trauma
Males
105
CNS trauma can result in ___ and ___
Morbidity
Mortality
106
Suspected CNS injury, assess...
Airway
Breathing
Circulation
Disability
107
Chronic traumatic encephalopathy (CTE)
Dementia pugilistica
Repetitive trauma
108
Confusion
Cerebral hemorrhage
109
Laceration
Tears in cerebral parenchyma
110
__ more susceptible to contusion
Gyri (frontal and temporal)
111
Coup injury
At impact site
112
Contrecoup injury
Opposite site of impact
113
Laceration can be caused by
Bullet
Knife
Nail
114
Traumatic parenchymal injuries include
Contusions
Lacerations
Diffuse axonal injury
115
Diffuse axonal injury
Movement of one brain region, relative to another
116
DAI can cause
Diffuse white matter damage
Widespread edema
Coma
Death
117
DAI can be caused by
Angular acceleration
118
Shaken baby syndrome components
Subdural hematoma
Cerebral edema
Bilateral retinal bleeding
119
Shaken baby syndrome can cause
```
Severe brain damage
Blindness
Reduced cognition
Motor impairment
25% fatal
```
120
In concussion, MRI and CT are
Normal
121
Concussion
Reversible alteration in consciousness from head injury
122
Post concussive syndrome
Prolonged symptoms of concussion, weeks to months
123
__ of concussions result in post concussive syndrome
15-20%
124
___ may be lethal, so concussion excludes return to play
Second impact syndrome
125
____ associated with skull fracture
Epidural hematoma
126
Subdural hematoma MC occur in
Infants
| Geriatrics
127
Dural artery damage that compresses brain tissue and may cause lucidity during bleed
Epidural hematoma
128
Rapid movements tear veins, subdural bleeding that compresses brain
Subdural hematoma
129
Epidural hematoma MC involves
Middle meningeal A
130
Epidural hematoma is ___ within hours
Lethal
131
____ more common than subdural hematoma
Epidural hematoma
132
Neural tube fails to close
Neural tube defects
133
MC CNS malformation
Neural tube defects
134
Risks for neural tube defect
Low folate
| Previous child
135
Types of neural tube defects
Spina Bifida Occulta
Myelomeningocele
Anencephaly
Encephalocele
136
Myelomeningocele
Extension of CNS through vertebral defect (lumbosacral)
137
Anencephaly
Absence of brain, rostral aspect
138
Encephalocele
CNS diverticulum, cranial
139
Encephalocele involves what characteristics
Craniofacial abnormalities
Larger = more severe
140
Hydromyelia
Extended 4th ventricle
141
Syringomyelia aka
Syrinx
142
Syrinx
Cyst within cord in adults
143
Syrinx can cause
Loss of pain/temperature sensation (shawl-like distribution)
Possible tissue atrophy or areflexia
144
Syrinx associated with
Type 1 chiari
145
Intraparenchymal hemorrhage
Deep (near ventricles)
146
Perinatal brain injuries
Intraparenchymal hemorrhage
Infarct
Cerebral palsy
147
Forms chalky plaques
Infarct
148
Non-progressive motor defects
Cerebral palsy
149
Things that can infect CNS
Bacteria
Viruses
Fungi
150
Epidural abscess
Infection in epidural space
151
Subdural empyema
Infection of subdural space
