Intro Neuropathology Flashcards
Acute Neuronal Injury
Timeline, Characteristic Cell with Features (3)
12-24 hours
Red Neurons
Intense Cytoplasmic Eosinophilia
Pyknosis
Cell Body Shrinkage
Subacute and Chronic Neuronal Injury Associated Diseases (3) and Damage Characteristics (3)
Progressive, Degenerative Diseases
ALS
Alzheimer’s
Cell Loss
Reactive gliosis
Apoptosis
Axonal Reaction
Description, Characteristic Morphology
Increased protein synthesis associated with axonal sprouting
Central Chromatolysis: Nissl moved to periphery
Neuronal Inclusions
Intracytoplasmic and Intranuclear
Descriptions with Examples (4/2)
Intracytoplasmic
Lipofuscin granules
Rabies, Alzheimer’s, Parkinson, CJD
Intranuclear
Herpes Cowdry Bodies
CMV (both nuclear and cytoplasmic)
Gliosis
Characteristics (2) and Cause
Hypertrophy and Hyperplasia of astrocytes
CNS injury, regardless of the cause
Gemistocytes vs Rosenthal Fibers vs Corpora Amylacea Characteristic Descriptions (2/3/3)
Gemistocytes
Enlarged nuclei with bright pink cytoplasm
Rosenthal Fibers
Thick, elongated eosinophilic structures
In areas of longstanding gliosis
Contain heat shock proteins
Corpora Amylacea
PAS (+)
Basophilic with concentric laminations
Microglia Surface Markers (2) and Injury Responses (2)
CR3
CD68
Microglial Nodules: necrosis
Neuronophagia: dying neurons
Cerebral Edema
Main Clinical Correlation
Types with Descriptions
Vasogenic (3) Cytotoxic (2)
Can cause Herniation syndromes
Vasogenic:
Increased Extracellular fluid
From BBB disruption or vascular permeability
Follows ischemic injury
Cytotoxic:
Increased Intracellular fluid
From cell membrane injury
Hydrocephalus
Definition, Main Type Descriptions (2)
Accumulation of CSF with ventricular system
Non-Communicating
Unilateral due to no connection between ventricles and subarachnoid space
Communicating
Symmetrical enlargement of ventricles seen from dural sinuses not absorbing CSF
Hydrocephalus ex Vacuo
Description, Etiologies (3) and CSF Pressure
Dilation of ventricles secondary to loss of parenchymal tissue
Brain Atrophy with age
Stroke
Neurodegenerative diseases
CSF pressure is normal
Normal Pressure Hydrocephalus
Cause, Clinical Triad
Blocked CSF drainage
Urinary incontinence
Gait disturbance
Dementia
Herniation
Etiology, Types (3) with Defects
Increased intracranial pressure beyond the ability of the venous system to compensate
Subfalcine
Transtentorial: CN3 compression
Tonsillar: Respiratory and Cardiac center compression
Kernohan’s Notch Phenomenon
Etiology (2) Clinical Features (3)
Transtentorial herniation causing compression of cerebral peduncle
Compression of contralateral CN III causes ipsilateral hemiplegia
Compresses CN VI causing diplopia
Compression of contralateral cerebellum causes ipsilateral hemiparesis
Duret Hemorrhage
Etiology and Description (2)
Transtentorial herniation
Hemorrhagic lesions of midbrain and pons
Neural Tube Defects
Etiology, Types with Descriptions (3)
Folate deficiency prior to 28 days gestation
Myelomeningocele: cyst with CNS tissue and meninges
Encephalocele: brain tissue forming cyst near nose
Anencephaly: absence of brain and calvarium
Myelomeningocele Clinical Features (3)
Motor and sensory defects in LE
Bladder and bowel defects
Infection susceptibility
Forebrain Anomalies
Etiology, Types with Descriptions
Microcephaly (3) Lisencephaly, Polymicrogyria, Neuronal Hetertopias (2) Holoprosencephaly, Corpus Callosum Agenesis
Abnormalities in the generation and migration of neurons
Microcephaly: From fetal alcohol syndrome, HIV and Zika Virus
Lisencephaly: absence or decrease in gyri
Polymicrogyria: entrapment of meningeal tissue
Neuronal Heterotopias: collections of neurons in inappropriate places, associated with Epilepsy
Holoprosencephaly: incomplete separation of cerebral hemispheres, causes Cyclopia
Corpus Callosum Agenesis: causes bat wing lateral ventricles
Posterior Fossa Anomalies Descriptions
Arnold-Chiari (3) Dandy-Walker (3)
Arnold Chiari Malformation
Small posterior fossa
Extension of vermis through foramen magnum
Seen with myelomeningoceles commonly
Dandy-Walker Malformation
Enlarged posterior fossa
Large roofless 4th ventricle
Absent cerebellar vermis
Syringomyelia
Description and Clinical Feature (2)
Fluid filled cleft-like cavity in inner portion of spinal cord
Upper extremity loss of pain and temperature sensation
Perinatal Brain Injuries Descriptions Cerebral Palsy (4), Intraparenchymal Hemorrhage, Periventricular Leukomalacia, Multicystic Encephalopathy (2) Ulegyria (2)
Cerebral Palsy: Spasticity, Dystonia, Ataxia, Athetosis
Intraparenchymal Hemorrhage: In Germinal matrix
Periventricular Leukomalacia: chalky plaques of supratentorial white matter hemorrhage
Multicystic Encephalopathy: cystic lesions of white and gray matter, symmetric hydrocephalus
Ulegyria: ischemic lesions deep in gyri, thin gliotic gyri
Skull Fractures Features
Diastatic, Displaced, Basal Skull (3)
Diastatic: Crosses suture
Displaced: Depression in skull
Basilar Skull: Raccoon eyes, Battle’s sign, CSF drainage from ear/nose
Contusion
Definition and Terminology (3)
wedge shaped parenchymal damage with broad base at point of impact
Coup: contusion at point of impact
Contrecoup: contusion opposite impact from deceleration
Plaque Jaune: old trauma lesions
Diffuse Axonal Injury
Description (2), Etiology (2) Diagnostic Stains (3)
Axonal swelling, +/- Focal Hemorrhagic necrosis
Direct action of mechanical forces, even just angular acceleration
Shaken baby
Silver stain
Amyloid Precursor Protein
Alpha Synuclein
Traumatic Brain Injury
Description (2), Etiologies (4), Clinical Features (2)
Damage to brain caused by external mechanical force
Structure damage may not be detected
Acceleration
Deceleration
Impact
Blast waves
Diminished/altered state of consciousness with injury
Brain function temporarily or permanently impaired
Chronic Traumatic Encephalopathy
Description, Neuropathology and Symptoms (4)
Brain diseases associated with repeated TBI’s
Neurofibrillary tangles of tau proteins
Depigmentation of substantia nigra
Behavior/mood changes
Memory loss
Cognitive impairment
Dementia
Epidural Hematoma
Etiology (2), Blood Supply and Symptoms
Skull fracture, dura peeled off skull
Middle Meningeal Artery
Rapidly evolving neurologic symtpoms
Subdural Hematoma
Etiology, Blood Supply, Symptom
Mild Trauma
Venous blood
Delayed slowly evolving neurologic symptoms
Subarachnoid Hemorrhage
Etiology (2), Symptoms (2)
Vascular problems: AVM or aneurysm
Sudden onset, thunderclap, worst headache of life
Rapid neurologic deterioration
