Gen Path Exam 2 - CNS Disease Flashcards
What category of disease?
Hydrocephalus
Primary disease
What category of disease?
Epidermal hematoma
Vascular/traumatic
What category of disease?
Intracerebral hemorrhage
Vascular/traumatic
What category of disease?
Subarachnoid hemorrhage
Vascular/traumatic
What category of disease?
Subdural hematoma
Vascular/traumatic
What category of disease?
CVA/stroke
Vascular/traumatic
What category of disease?
MS
Acquired
What category of disease?
Alzheimer’s
Acquired
What category of disease?
Parkinson’s
Acquired
What category of disease?
Huntington’s
Acquired
What category of disease?
ALS
Acquired
What category of disease?
Brain abscess
Infectious
What category of disease?
Viral meningitis
Infectious
What category of disease?
Bacterial meningitis
Infectious
What category of disease?
Pilocytic astrocytoma
Neoplastic
What category of disease?
Glioblastoma multiforme
Neoplastic
What category of disease?
Meningioma
Neoplastic
What category of disease?
Medulloblastoma
Neoplastic
What category of disease?
Metastatic tumors
Neoplastic
Which disease?
Symptomatic increase in the volume of CSF within the cerebral ventricles of the brain
Hydrocephalus
In hydrocephalus, what does the increase in volume of CSF in the cerebral ventricles result in?
Expansion of ventricles due to increased CSF pressure
What are the causes of hydrocephalus?
- Obstructive
- Impaired absorption of CSF at arachnoid villi (rare)
- Overproduction of CSF by choroid plexus neoplasms (very rare)
What is the MOST COMMON form of hydrocephalus?
Obstructive
Obstructive hydrocephalus can be ___________ or __________
congenital; acquired
What can happen if hydrocephalus is left untreated?
Permanent brain damage
Mental impairment
Death
CNS trauma often directly disrupts vessel walls, leading to what?
Hemorrhage
Depending on the affected vessel, the hemorrhage and hematoma formation may be one or a combination of what areas?
Epidural
Subdural
In epidural hematomas, what vessels are vulnerable to traumatic injury?
Dural vessels (especially middle meningeal artery)
In adults with epidural hematoma, what do tears involving dural vessels almost always stem from?
Skull fractures
T/F: In infants with epidural hematoma, displacement of the easily deformable skull may tear a vessel, even in the ABSENCE of a skull fracture
True!
(epidural hematomas in adults usually always stem from a skull fracture tho)
Once a vessel is torn, blood accumulating under arterial pressure can dissect the tightly applied dura away from the inner skull surface producing, a ___________ that compresses the brain surface
hematoma
How does a patient with an epidural hematoma appear clinically?
Lucid for hours btwn moment of trauma and development of neurologic signs
An epidural hematoma may expand rapidly and constitutes a neurosurgical ____________ necessitating prompt __________ and repair to prevent _______
emergency; drainage; death
What disease?
Caused by tearing of the middle meningeal artery
Epidural hematoma
What disease?
Rapid movement of the brain during trauma can tear the bridging veins that extend from the cerebral hemispheres
through the subarachnoid and subdural space to the dural sinuses
Subdural hematoma
In subdural hematoma, the disruption of bridging veins that extend from cerebral hemispheres causes what to occur?
Bleeding into subdural space
Which types of people have a higher rate/are more susceptible of subdural hematomas?
Elderly with brain atrophy
Infants
Why are elderly people with brain atrophy more susceptible to subdural hematomas?
Bridging veins are stretched out - brain has additional space to move
Why are infants more susceptible to subdural hematomas?
Their bridging veins are thin-walled
When do subdural hematomas become clinically evident?
Within 48 hrs after injury
Where are subdural hematomas most commonly found?
Over lateral aspects of cerebral hemispheres (may be bilateral)
In subdural hematoma, neurologic signs are attributable to what?
Pressure exerted on adjacent brain
What are the symptoms of a subdural hematoma?
Headache
Confusion
Slowly progressive neurologic deterioration
T/F: Symptoms of subdural hematoma are most often localized
FALSE, they are more often non-localized
How are symptomatic subdural hematomas treated?
Surgical removal of blood and associated reactive tissue
What commonly occurs during the healing process of a subdural hematoma? What does this result in?
Rebleeding
Results in chronic subdural hematoma
An acute subdural hematoma appears as a collection of ________ _________ blood apposed to the contour of the brain surface, ___________ extension into the depths of ________.
freshly clotted; without; sulci
In subdural hematoma, what does the underlying brain look like? What does the subarachnoid space look like?
Underlying brain = flat
Subarachnoid space = clear
In subdural hematoma, venous bleeding is ____________ with breakdown and organization of the hematoma taking place over time
self-limited
Describe the process of breakdown and organization of subdural hematoma over time
- Hematoma organizes by lysis of clot in 1 week
- Granulation tissue grows from dural surface into hematoma in 2 weeks
- Fibrosis occurs in 1-3 months
- Fibrosing lesions retract, leaving a thin layer of CT (“subdural membranes”)
What disease?
Characterized by injury to the brain as a consequence of altered blood flow
Cerebrovascular disease (CVD)
What disease?
Clinical designation that applies to all the conditions of cerebrovascular disease, particularly when symptoms begin acutely
Stroke
What are the 2 mechanisms of the pathophysiology of cerebrovascular disease?
Hypoxia/ischemia/infarction
Hemorrhage
Which pathophysiologic mechanism of CVD?
Results from impairment of blood supply and oxygenation of CNS tissue
Hypoxia/ischemia/infarction
Which pathophysiologic mechanism of CVD?
Results from rupture of CNS vessels
Hemorrhage
What are the common causes of hemorrhage in CVD?
Hypertension
Vascular anomalies like malformation and aneurysm
What is the common cause of hypoxia/ischemia/infarction in CVD?
Embolism
T/F: In the brain, embolism is a more common etiology of hypxia/ischemia/infarction than thrombosis
True
What are the 2 most common causes of cerebral infarctions?
Atherosclerotic thrombi
Emboli of cardiac origin
What is the cause of atherosclerotic thrombi, leading to cerebral infarction?
Carotid artery atherosclerotic disease (plaque rupture) at carotid bifurcation
What are the causes of emboli of cardiac origin, leading to cerebral infarction?
Valvular pathology (mitral)
MI/congestive cardiomyopathy
Cardiac arrhythmia (afib)
What is the extent of cerebral infarction determined by?
Site of occlusion
Size of occluded vessel
Duration of occlusion
Collateral circulation
What do neurologic abnormalities from cerebral infarction depend on?
Artery involved + area of supply
Gross appearance of an ischemic cerebral infarct varies with ________
time
What is the gross appearance of an ischemic cerebral infarct during the first 6 hrs?
Little change
What is the gross appearance of an ischemic cerebral infarct during the first 48 hrs?
Tissue = pale, soft, swollen
Corticomedullary junction = indistinct
What is the gross appearance of an ischemic cerebral infarct during days 2-10?
Brain = gelatinous, friable
Boundary btwn normal and infarcted tissue is more distinct
Edema resolves in viable adjacent tissue
What is the gross appearance of an ischemic cerebral infarct during days 10-3 weeks?
Liquefactive necrosis
Fluid-filled cavity that expands until all dead tissue is gone
What risk factor is most commonly associated with clinically significant deep brain intracerebral hemorrhages?
Hypertension
Hypertension can cause vessel wall ___________, making them weaker and more vulnerable to rupture. Name 3.
abnormalities
- Accelerated atherosclerosis (large arteries)
- Hyaline arteriosclerosis (small arteries)
- Frank necrosis of arterioles
Where does hypertensive intracerebral hemorrhage originate in? (4)
Putamen (MOST COMMON)
Thalamus
Pons
Cerebellar hemispheres
In intracerebral hemorrhage, rupture of an artery within brain tissue leads to ____________ of blood, which displaces ________ tissue and causes increased intracranial volume until the resulting tissue compression halts the
bleeding
extravasation; brain
What is the MOST COMMON cause of clinically significant subarachnoid hemorrhage?
Rupture of saccular aneurysm in cerebral artery
What is the MOST COMMON type of intracranial aneurysm?
Saccular aneurysm
Which vessels are most often affected by saccular aneurysms?
Circle of Willis vessels
What disease?
May result from:
Extension of a traumatic hematoma,
Rupture of a hypertensive intracerebral hemorrhage into the
ventricular system
Vascular malformation
Hematologic disturbances
CNS tumors
Subarachnoid hemorrhage
Which meningitis is the most serious form?
Bacterial meningitis
What disease?
This is infection of the leptomeninges (pia and arachnoid mater), and the CSF, which diffusely affects the whole
meninges and subarachnoid space
Bacterial meningitis
What are the most common organisms that cause bacterial meningitis?
Neisseria meningitidis
Strep pneumoniae
How quickly do symptoms of bacterial meningitis develop?
24 hrs to 7 days
What are the following classic symptoms associated with?
Headache
Stiff neck
Fever/chills
Vomiting
Photophobia
Confusion
Seizures
Recent URI
Bacterial meningitis
Meningitis caused by ___________ may progress to a meningococcemia with multiple organ involvement, and may be associated with maculopapular, petechial, or purpuric _______ ______
N. meningitidis; skin rash
Meningococcemia is sometimes complicated by which syndrome?
Waterhouse-Friderichsen syndrome
What disease?
Complications include ventriculitis, intracerebral abscess, cerebral infarction, subdural empyema (pus in subdural space)
Meningitis
How is bacterial meningitis diagnosed?
Cloudy CSF due to increased neutrophils
Increase in CSF proteins
Decrease in glucose
What is the tx for bacterial meningitis?
Vigorous IV antibiotics
How is bacterial meningitis caused by N. meningitidis prevented?
Vaccine
What disease?
Mortality ranges from 3% for H. influenzae to 60% for Strep pneumoniae; highest in very young and elderly
Bacterial meningitis
What disease?
Serious complications occasionally are
observed including:
Nerve deafness
Cortical blindness
Paralysis
Muscular hypertonia
Ataxia
Complex seizure disorders
Learning disabilities
Obstructive hydrocephalus
Cerebral atrophy
Bacterial meningitis
What is the most common cause of meningitis?
Viral meningitis
What type of meningitis?
Benign and self-limiting, usually less severe
Viral meningitis
Viral meningitis may occur as a complication of what?
A viral infection (ex: mumps, measles)
What are the common causative organisms of viral meningitis?
Enteroviruses
Mumps virus
What disease?
Clinically presents with acute onset of headache, fever, nuchal rigidity; irritability, and rapid development of
meningeal irritation
Viral meningitis
How is viral meningitis diagnosed?
CSF = clear/colorless
Increased lymphocytes and protein
Normal glucose
How is viral meningitis treated?
Control symptoms (palliative)
What disease?
Severe focal infection of the brain and is typically 1 to 2 cm across
Brain abscess
What disease?
Starts as an area of cerebritis and develops into a pus-filled cavity walled off by gliosis and surrounded by cerebral edema
Brain abscess
What does a brain abscess often result in?
Increased intracranial pressure
What are the 6 causes of brain abscesses?
Middle ear infection (60%)
Frontal sinusitis infection (20%)
Bacteremia/septicemia (10%)
Penetrating skull trauma
Meningitis
Odontogenic infection
Which cause of brain abscess?
Due to temporal lobe and cerebellar abscesses
Middle ear infection
Which cause of brain abscess?
Due to frontal lobe abscess
Frontal sinusitis infection
Bacteremia/septicemia
What are the common causative organisms of brain abscesses?
Strep viridans
Staph aureus
Klebsiella
Fungus
What disease?
Clinical presentation is similar to that of acute bacterial meningitis but focal neurological signs, epilepsy, and fever are common manifestations
Brain abscess
How are brain abscesses treated?
Aggressive antibiotics
Surgical aspiration or excision
What is the overall mortality of a brain abscess?
10%
What are the 4 complications of brain abscess?
Meningitis
Intracranial herniation
Focal neurological deficit
Epilepsy
What disease?
Characterized by destruction of myelin with relative preservation of axons
Demyelinating diseases
What disease is by far the MOST COMMON of the demyelinating diseases?
MS
When does MS begin? Is it more common in males or females?
20-30 yrs old; females
What disease?
Characterized by relapsing and remitting episodes of immunologically mediated demyelination within the CNS
MS
What disease?
Recovery from each episode of demyelination is usually
incomplete, leading to progressive deterioration
MS
What is MS caused by?
Unknown
Could be immune/viral/environmental/genetic
What disease?
Characterized by irregularly scattered, focal areas of demyelination in the brain and spinal cord
MS