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D2 Fall > Gen Path Exam 2 - CNS Disease > Flashcards

Gen Path Exam 2 - CNS Disease Flashcards

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1
Q

What category of disease?

Hydrocephalus

A

Primary disease

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2
Q

What category of disease?

Epidermal hematoma

A

Vascular/traumatic

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3
Q

What category of disease?

Intracerebral hemorrhage

A

Vascular/traumatic

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4
Q

What category of disease?

Subarachnoid hemorrhage

A

Vascular/traumatic

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5
Q

What category of disease?

Subdural hematoma

A

Vascular/traumatic

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6
Q

What category of disease?

CVA/stroke

A

Vascular/traumatic

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7
Q

What category of disease?

MS

A

Acquired

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8
Q

What category of disease?

Alzheimer’s

A

Acquired

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9
Q

What category of disease?

Parkinson’s

A

Acquired

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10
Q

What category of disease?

Huntington’s

A

Acquired

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11
Q

What category of disease?

ALS

A

Acquired

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12
Q

What category of disease?

Brain abscess

A

Infectious

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13
Q

What category of disease?

Viral meningitis

A

Infectious

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14
Q

What category of disease?

Bacterial meningitis

A

Infectious

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15
Q

What category of disease?

Pilocytic astrocytoma

A

Neoplastic

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16
Q

What category of disease?

Glioblastoma multiforme

A

Neoplastic

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17
Q

What category of disease?

Meningioma

A

Neoplastic

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18
Q

What category of disease?

Medulloblastoma

A

Neoplastic

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19
Q

What category of disease?

Metastatic tumors

A

Neoplastic

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20
Q

Which disease?

Symptomatic increase in the volume of CSF within the cerebral ventricles of the brain

A

Hydrocephalus

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21
Q

In hydrocephalus, what does the increase in volume of CSF in the cerebral ventricles result in?

A

Expansion of ventricles due to increased CSF pressure

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22
Q

What are the causes of hydrocephalus?

A
  1. Obstructive
  2. Impaired absorption of CSF at arachnoid villi (rare)
  3. Overproduction of CSF by choroid plexus neoplasms (very rare)
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23
Q

What is the MOST COMMON form of hydrocephalus?

A

Obstructive

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24
Q

Obstructive hydrocephalus can be ___________ or __________

A

congenital; acquired

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25
Q

What can happen if hydrocephalus is left untreated?

A

Permanent brain damage
Mental impairment
Death

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26
Q

CNS trauma often directly disrupts vessel walls, leading to what?

A

Hemorrhage

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27
Q

Depending on the affected vessel, the hemorrhage and hematoma formation may be one or a combination of what areas?

A

Epidural
Subdural

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28
Q

In epidural hematomas, what vessels are vulnerable to traumatic injury?

A

Dural vessels (especially middle meningeal artery)

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29
Q

In adults with epidural hematoma, what do tears involving dural vessels almost always stem from?

A

Skull fractures

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30
Q

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

A

True!

(epidural hematomas in adults usually always stem from a skull fracture tho)

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31
Q

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

A

hematoma

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32
Q

How does a patient with an epidural hematoma appear clinically?

A

Lucid for hours btwn moment of trauma and development of neurologic signs

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33
Q

An epidural hematoma may expand rapidly and constitutes a neurosurgical ____________ necessitating prompt __________ and repair to prevent _______

A

emergency; drainage; death

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34
Q

What disease?

Caused by tearing of the middle meningeal artery

A

Epidural hematoma

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35
Q

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

A

Subdural hematoma

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36
Q

In subdural hematoma, the disruption of bridging veins that extend from cerebral hemispheres causes what to occur?

A

Bleeding into subdural space

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37
Q

Which types of people have a higher rate/are more susceptible of subdural hematomas?

A

Elderly with brain atrophy
Infants

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38
Q

Why are elderly people with brain atrophy more susceptible to subdural hematomas?

A

Bridging veins are stretched out - brain has additional space to move

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39
Q

Why are infants more susceptible to subdural hematomas?

A

Their bridging veins are thin-walled

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40
Q

When do subdural hematomas become clinically evident?

A

Within 48 hrs after injury

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41
Q

Where are subdural hematomas most commonly found?

A

Over lateral aspects of cerebral hemispheres (may be bilateral)

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42
Q

In subdural hematoma, neurologic signs are attributable to what?

A

Pressure exerted on adjacent brain

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43
Q

What are the symptoms of a subdural hematoma?

A

Headache
Confusion
Slowly progressive neurologic deterioration

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44
Q

T/F: Symptoms of subdural hematoma are most often localized

A

FALSE, they are more often non-localized

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45
Q

How are symptomatic subdural hematomas treated?

A

Surgical removal of blood and associated reactive tissue

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46
Q

What commonly occurs during the healing process of a subdural hematoma? What does this result in?

A

Rebleeding

Results in chronic subdural hematoma

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47
Q

An acute subdural hematoma appears as a collection of ________ _________ blood apposed to the contour of the brain surface, ___________ extension into the depths of ________.

A

freshly clotted; without; sulci

48
Q

In subdural hematoma, what does the underlying brain look like? What does the subarachnoid space look like?

A

Underlying brain = flat
Subarachnoid space = clear

49
Q

In subdural hematoma, venous bleeding is ____________ with breakdown and organization of the hematoma taking place over time

A

self-limited

50
Q

Describe the process of breakdown and organization of subdural hematoma over time

A
  1. Hematoma organizes by lysis of clot in 1 week
  2. Granulation tissue grows from dural surface into hematoma in 2 weeks
  3. Fibrosis occurs in 1-3 months
  4. Fibrosing lesions retract, leaving a thin layer of CT (“subdural membranes”)
51
Q

What disease?

Characterized by injury to the brain as a consequence of altered blood flow

A

Cerebrovascular disease (CVD)

52
Q

What disease?

Clinical designation that applies to all the conditions of cerebrovascular disease, particularly when symptoms begin acutely

A

Stroke

53
Q

What are the 2 mechanisms of the pathophysiology of cerebrovascular disease?

A

Hypoxia/ischemia/infarction
Hemorrhage

54
Q

Which pathophysiologic mechanism of CVD?

Results from impairment of blood supply and oxygenation of CNS tissue

A

Hypoxia/ischemia/infarction

55
Q

Which pathophysiologic mechanism of CVD?

Results from rupture of CNS vessels

A

Hemorrhage

56
Q

What are the common causes of hemorrhage in CVD?

A

Hypertension
Vascular anomalies like malformation and aneurysm

57
Q

What is the common cause of hypoxia/ischemia/infarction in CVD?

A

Embolism

58
Q

T/F: In the brain, embolism is a more common etiology of hypxia/ischemia/infarction than thrombosis

A

True

59
Q

What are the 2 most common causes of cerebral infarctions?

A

Atherosclerotic thrombi
Emboli of cardiac origin

60
Q

What is the cause of atherosclerotic thrombi, leading to cerebral infarction?

A

Carotid artery atherosclerotic disease (plaque rupture) at carotid bifurcation

61
Q

What are the causes of emboli of cardiac origin, leading to cerebral infarction?

A

Valvular pathology (mitral)
MI/congestive cardiomyopathy
Cardiac arrhythmia (afib)

62
Q

What is the extent of cerebral infarction determined by?

A

Site of occlusion
Size of occluded vessel
Duration of occlusion
Collateral circulation

63
Q

What do neurologic abnormalities from cerebral infarction depend on?

A

Artery involved + area of supply

64
Q

Gross appearance of an ischemic cerebral infarct varies with ________

A

time

65
Q

What is the gross appearance of an ischemic cerebral infarct during the first 6 hrs?

A

Little change

66
Q

What is the gross appearance of an ischemic cerebral infarct during the first 48 hrs?

A

Tissue = pale, soft, swollen
Corticomedullary junction = indistinct

67
Q

What is the gross appearance of an ischemic cerebral infarct during days 2-10?

A

Brain = gelatinous, friable
Boundary btwn normal and infarcted tissue is more distinct
Edema resolves in viable adjacent tissue

68
Q

What is the gross appearance of an ischemic cerebral infarct during days 10-3 weeks?

A

Liquefactive necrosis
Fluid-filled cavity that expands until all dead tissue is gone

69
Q

What risk factor is most commonly associated with clinically significant deep brain intracerebral hemorrhages?

A

Hypertension

70
Q

Hypertension can cause vessel wall ___________, making them weaker and more vulnerable to rupture. Name 3.

A

abnormalities

  1. Accelerated atherosclerosis (large arteries)
  2. Hyaline arteriosclerosis (small arteries)
  3. Frank necrosis of arterioles
71
Q

Where does hypertensive intracerebral hemorrhage originate in?

A

Putamen (MOST COMMON)
Thalamus
Pons
Cerebellar hemispheres

72
Q

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

A

extravasation; brain

73
Q

What is the MOST COMMON cause of clinically significant subarachnoid hemorrhage?

A

Rupture of saccular aneurysm in cerebral artery

74
Q

What is the MOST COMMON type of intracranial aneurysm?

A

Saccular aneurysm

75
Q

Which vessels are most often affected by saccular aneurysms?

A

Circle of Willis vessels

76
Q

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

A

Subarachnoid hemorrhage

77
Q

Which meningitis is the most serious form?

A

Bacterial meningitis

78
Q

What disease?

This is infection of the leptomeninges (pia and arachnoid mater), and the CSF, which diffusely affects the whole
meninges and subarachnoid space

A

Bacterial meningitis

79
Q

What are the most common organisms that cause bacterial meningitis?

A

Neisseria meningitidis
Strep pneumoniae

80
Q

How quickly do symptoms of bacterial meningitis develop?

A

24 hrs to 7 days

81
Q

What are the 8 classic symptoms of bacterial meningitis?

A

Headache
Stiff neck
Fever/chills
Vomiting
Photophobia
Confusion
Seizures
Recent URI

82
Q

Meningitis caused by ___________ may progress to a meningococcemia with multiple organ involvement, and may be associated with maculopapular, petechial, or purpuric _______ ______

A

N. meningitidis; skin rash

83
Q

Meningococcemia is sometimes complicated by which syndrome?

A

Waterhouse-Friderichsen syndrome

84
Q

What disease?

Complications include ventriculitis, intracerebral abscess, cerebral infarction, subdural empyema (pus in subdural space)

A

Meningitis

85
Q

How is bacterial meningitis diagnosed?

A

Cloudy CSF due to increased neutrophils
Increase in CSF proteins
Decrease in glucose

86
Q

What is the tx for bacterial meningitis?

A

Vigorous IV antibiotics

87
Q

How is bacterial meningitis caused by N. meningitidis prevented?

A

Vaccine

88
Q

What disease?

Mortality ranges from 3% for H. influenzae to 60% for Strep pneumoniae; highest in very young and elderly

A

Bacterial meningitis

89
Q

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

A

Bacterial meningitis

90
Q

What is the most common cause of meningitis?

A

Viral meningitis

91
Q

What type of meningitis?

Benign and self-limiting, usually less severe

A

Viral meningitis

92
Q

Viral meningitis may occur as a complication of what?

A

A viral infection (ex: mumps, measles)

93
Q

What are the common causative organisms of viral meningitis?

A

Enteroviruses
Mumps virus

94
Q

What disease?

Clinically presents with acute onset of headache, fever, nuchal rigidity; irritability, and rapid development of
meningeal irritation

A

Viral meningitis

95
Q

How is viral meningitis diagnosed?

A

CSF = clear/colorless
Increased lymphocytes and protein
Normal glucose

96
Q

How is viral meningitis treated?

A

Control symptoms (palliative)

97
Q

What disease?

Severe focal infection of the brain and is typically 1 to 2 cm across

A

Brain abscess

98
Q

What disease?

Starts as an area of cerebritis and develops into a pus-filled cavity walled off by gliosis and surrounded by cerebral edema

A

Brain abscess

99
Q

What does a brain abscess often result in?

A

Increased intracranial pressure

100
Q

What are the 6 causes of brain abscesses?

A

Middle ear infection (60%)
Frontal sinusitis infection (20%)
Bacteremia/septicemia (10%)
Penetrating skull trauma
Meningitis
Odontogenic infection

101
Q

Which cause of brain abscess?

Due to temporal lobe and cerebellar abscesses

A

Middle ear infection

102
Q

Which cause of brain abscess?

Due to frontal lobe abscess

A

Frontal sinusitis infection
Bacteremia/septicemia

103
Q

What are the common causative organisms of brain abscesses?

A

Strep viridans
Staph aureus
Klebsiella
Fungus

104
Q

What disease?

Clinical presentation is similar to that of acute bacterial meningitis but focal neurological signs, epilepsy, and fever are common manifestations

A

Brain abscess

105
Q

How are brain abscesses treated?

A

Aggressive antibiotics
Surgical aspiration or excision

106
Q

What is the overall mortality of a brain abscess?

A

10%

107
Q

What are the 4 complications of brain abscess?

A

Meningitis
Intracranial herniation
Focal neurological deficit
Epilepsy

108
Q

What disease?

Characterized by destruction of myelin with relative preservation of axons

A

Demyelinating diseases

109
Q

What disease is by far the MOST COMMON of the demyelinating diseases?

A

MS

110
Q

When does MS begin? Is it more common in males or females?

A

20-30 yrs old; females

111
Q

What disease?

Characterized by relapsing and remitting episodes of immunologically mediated demyelination within the CNS

A

MS

112
Q

What disease?

Recovery from each episode of demyelination is usually
incomplete, leading to progressive deterioration

A

MS

113
Q

What is MS caused by?

A

Unknown
Could be immune/viral/environmental/genetic

114
Q

What disease?

Characterized by irregularly scattered, focal areas of demyelination in the brain and spinal cord

A

MS

115
Q

What are the favored sites for demyelination in MS?

A

Optic nerve
Brain stem
Periventricular areas

116
Q
A

D2 Fall (16 decks)

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