Gianani Final CIS

Question 1

What is diffuse axonal injury?

a type of traumatic brain injury
a complication of herpes virus encephalitis
a symptom of parkinson disease
synonymous with  MS
The first sign of ALS

Answer 1

A type of traumatic brain injury. Seen when neurons are stretched from rapid acceleration/ deceleration.

Question 2

What do we see in Herpves virus

Answer 2

• you will see Cowdry inclusions.

Question 3

Progressive Multifocal Leukoencephalopathy

Answer 3

Jc and Bk virus –>

lesion of oligodendrocytes –> demyelination

Affects immunocompromised

inclusions are in the nucleus

Question 4

Tau deposition is related to

• ALS
• Traumatic encephalopathy
• Parkinson disease
• Cerebral Amyloid Angiopathy
• Gillan- Barre syndrome

Answer 4

Traumatic encephalopathy

repetitive mild head injury with tautopathy (deposition of tau protein)

Question 5

Guillan Barre syndrome

Answer 5

progressive demyelination of peripheral nerves

CSF protein content is high. Other disease with high protein in the CSF: meningitis

Question 6

Cerebral Amyloid Angiopathy

Answer 6

• degenerative disease
• amyloid
• in a clinical vignette, an elderly person but without HTN might be a good candidate

Question 7

protein involved in Parkinson’s disease

Answer 7

synuclein, which is also involved in Lewy Body Dementia

Question 8

ALS

Answer 8

a neuropathy of the upper and lower neurons

You would see a secondary change in the muscles

Question 9

Beta-2-transferrin testing is used in the evaluation of

• Basilar skull fracture
• Meningitis
• Hypoxic ischemic encephalopathy
• Oligodendroglioma
• Meningioma

Answer 9

Beta-2-transferrin is a protein present in the CSF but not in the serum

used to diagnose Basilar skull fracture

Question 10

Oligodendroglioma genetics

Answer 10

19q (long arm)

Question 11

worst location for meningitis

Answer 11

basilar meningitis is associated with tuberculous

CN that can be involved: VI

Question 12

issues that –> elevated protein level in CSF

Answer 12

neoplasms
bacterial meningitis
MS (oligoclonal)

Question 13

Guillan-Barre syndrom

Answer 13

viral or low-grade bacterial agent (like campylobacter)

immune response that attacks the nerve cells of the PNS and their support structures–> Guillain Barre

Question 14

vitamin deficiency in the differential dx for peripheral neuropathy

Answer 14

Vitamin B12

also can be related to dementia

Question 15

Is the ApoE genetic locus associated with AD?

Answer 15

yes

in familial forms we see AD earlier
also in trisomy 21

Question 16

most frequent site of the neurofibrillary tangles of tau are found in AD

Answer 16

medial temporal cortex

Question 17

alpha-secretase activity in AD

Answer 17

may prevent accumulation of Abeta protein

Question 18

difference between demyelinating disease and MS?

Answer 18

MS is a subset of it.

Others: Neuromyelitis Optica- Auto Abs against aquaporin-4, a water channel of astrocytes

Progressive Multifocal Leukoencephalopathy

Guillain-Barre syndrome

Question 19

intranuclear inclusion plus demyelination =

Answer 19

PML. You will see demyelination of the cerebellum and pons.

Question 20

The pathology of ALS involves

• degenerative disorder of upper and motor neurons
• Loss of substantia nigra
• autoimmunity
• necrosis of muscular tissue
• peripheral neuropathy

Answer 20

degenerative disorder of upper and motor neurons

dementia appears at the onset or develops later in a significant proportion of ALS patients

relentlessly progressive. Majority of patients die, usually from respiratory paralysis, within 2-3 years of onset.

Question 21

pilocytic astrocytoma

Answer 21

children
cerebellum/ optic nerve
good prognosis

Question 22

glioblastoma multiforme

Answer 22

grade four astrocytoma

Question 23

ependymoma

Answer 23

ependymal cells line the CSF

–> hydrocephalus

Question 24

vasculor pseudo-rosette + hydrocephalus, code word for

Answer 24

ependymoma

Question 25

Virkow-Robbins spaces are

Answer 25

associated with the subarachnoid space

Question 26

sites of CSF foration

Answer 26

1. choroid plexus of the vevntricle cavities, mostly is formed in the lateral ventricles
2. some originates from the ependymal cells lining the ventricles
3. Some from the brain substances through perivascular spaces

Question 27

Movement of the CSF inside the ventricle is controlled by the

Answer 27

1. Pulsation of the artery in the choroid plexus

2. by the aid of the cilia and microvilli of the epenymal cells

Question 28

xanthochromia of the CSF?

Answer 28

yellow discoloration of the CSF due to oxyhemoglobin which appears in 4-6 hours and bilirubin which appears in 2 days.

eliotropism is the same thing

Question 29

blood in the CSF

Answer 29

if it’s only in the first tube, it was traumatic lumbar puncture

if it’s in subsequent ones, subarachnoid hemorrhage

Question 30

first step with lady who has bad headaches?

Answer 30

rule out migraines

Question 31

ring-enhancing lesion?

Answer 31

glioblastoma multiforme, e.g.

Question 32

serpentine palisading necrosis, cellular proliferation and endothelial proliferation

Answer 32

buzzwords for glioblastoma

Question 33

Neurocysticercosis

Answer 33

commonest global parasitic infection of the CNS and leading cause of epilepsy worldwide

cystercercus cellusosae, Taenia solium larvae

Pork meat –> patients become definite host

Cysticercosis as intermediate host- muscle, other organs

Variable manifestation, some asymptomatic

There is an inflammatory reaction following the parasite’s death

eventual calcification

Question 34

CNS involvement in AIDS

Answer 34

direct: HIV encephalitis

indirect- infectious- toxoplasmosis, cryptococcus, PML

• neoplastic: lymphoma

Question 35

cells that PML affects?

Answer 35

oligodendrocytes

Question 36

Cerebral lymphoma

Answer 36

PCNSL is typically a diffuse large B-cell lymphoa (DLBCL)

the tumors that arise in immunocompromised patients are EBV-positive