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NMSP > Intro to Neuropathology part 1 > Flashcards

Intro to Neuropathology part 1 Flashcards

1
Q

What are the glial cells and what are their shapes?

A 
Astrocytes = oval 
Oligodendrocytes = round
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2
Q

Set of neurons, not necessarily located together, that share 1+ properties demonstrating response to 1 insult

A

Selective Vulnerability

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3
Q

Injury response of Neurons to ACUTE injury (12-24 hours)?

A

“Red neurons”

  • Cell shrinkage and pyknosis
  • Intense eosinophilic staining
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4
Q

Injury response of Neurons to SUBACUTE and CHRONIC injury (progressive)?

A
  • Reactive gliosis

- Cell loss and Apoptosis

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5
Q

What occurs with the Axonal Reaction of Neurons due to an injury?

A

Increased protein synthesis + Axonal sprouting

–> displaces nucleus and Nissl substance to the periphery

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6
Q

With the Axonal reaction, what is it called with the Nissl substance is pushed to the periphery?

A

Central Chromatolysis

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7
Q

Neuronal Inclusions are also a Neuron response to injury. The inclusions can be of what 2 types?

A

Intranuclear

Intracytoplasmic

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8
Q

What infection can cause Intranuclear Neuronal inclusions and which infection can cause both Intranuclear and Intracytoplasmic?

A

Intranuclear = Herpes cowdry bodies
BOTH intranuclear and intracytoplasmic = CMV
– everything else = intracytoplasmic

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9
Q

What is the most important indicator of CNS injury?

A

Gliosis

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10
Q

Gliosis

A

Hypertrophy and Hyperplasia of ASTROCYTES

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11
Q

What is the job of Astrocytes?

A

Detoxifiers in the brain

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12
Q

What are Gemistocytes?

A

Bright pink Astrocytes with displaced nucleus

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13
Q

What are Alzheimers Type 2 Astrocytes?

A

Astrocytes with a large nucleus, pale stain and intranuclear glycogen droplet
– usually arise with metabolic disorders

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14
Q

What are Rosenthal Fibers?

A

Elongated bright pink irregular structures within the Astrocytic processes

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15
Q

Where do Rosenthal Fibers usually arise?

A

In areas of longstanding gliosis!

ex. Pilocytic Astrocytoma

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16
Q

What do Rosenthal Fibers contain?

A

2 heat shock proteins: alpha B crystalline and HSP27

+ Ubiquitin

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17
Q

Elongated bright pink irregular structures within the Astrocytic processes

A

Rosenthal Fibers

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18
Q

What is Corpora Amylacea?

A

Round faint, concentrically laminated strictures adjacent to the Astrocytic end processes

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19
Q

Round concentrically laminated strictures adjacent to Astrocytic end processes

A

Corpora Amylacea

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20
Q

What does Corpora Amylacea represent?

A

Degenerative change

– Increased # with Increased age

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21
Q

What is contained within Corpora Amylacea and what marker is (+)?

A

(+) PAS

- Polyglucosan bodies, 2 heat shock proteins, Ubiquitin

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22
Q

What are Microglia and what surface markers are (+)?

A

Macrophages of the CNS

(+) CR3 and CD68

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23
Q

What are 2 possible injury responses of Microglia?

A
  1. Microglial Nodules

2. Neuronophagia

24
Q

Microglial Nodules

A

Microglia aggregate around small foci of necrosis

25
Q

Neuronophagia

A

Microglial congregate around cell bodies of dying neurons

26
Q

Where and what type of cells are Ependymal Cells?

A

Ciliated cells that line the ventricles in the brain

27
Q

What is an example of an infection that can injure Ependymal Cells and describe what occurs?

A

CMV

- Ependymal Granulations

28
Q

What is one injury response of Oligodendrocytes?

A

Demyelination

29
Q

Cerebral Edema

A

Accumulation of fluid in the brain parenchyma

30
Q

What are the 2 types of Cerebral Edema?

– Commonly occur together

A
  1. Vasogenic Edema

2. Cytotoxic Edema

31
Q

Vasogenic Edema and what causes it?

A

Increased EXTRAcellular fluid due to BBB disruption and increased vascular permeability
– usually follows an ischemic injury

32
Q

Cytotoxic Edema and what causes it?

A

Increased Intracellular fluid due to neuronal/glial/endothelial cell injuries
– Can follow ischemic or metabolic derangement

33
Q

What changes can occur to the actual brain (gyri, sulci, ventricles) with Cerebral Edema?

A

Gyri flattened
Sulci narrowed
Ventricles compressed
– Can lead to herniation

34
Q

Hydrocephalus

A

Increased ventricular volume due to increased CSF

35
Q

“True” Hydrocephalus

A

Frontal horns > 1/2 internal skull diameter

36
Q

If “True” Hydrocephalus is not present, what is likely occuring?

A

Hydrocephalus ex-vacuo = atrophy of the brain

37
Q

Describe Hydrocephalus ex - vacuo

A

Atrophy of the brain with decreased brain substance + hydrocephalus

  • CSF pressure = NORMAL *
  • Can be caused by age, stroke, neurodegenerative disease
38
Q

What are the general 2 causes of Hydrocephalus?

A
  1. Obstruction - clot, tumors, stenosis, infections

2. Increased CSF production - Choroid Plexus Papilloma (thick fibrous stalk)

39
Q

How do TB and Neurosyphilis cause Obstructive Hydrocephalus?

A
  • Pyogenic Meningitis = suppurative exudate covering brainstem/cerebellum
  • Thickened Leptomeninges
  • Obstructive Hydrocephalus
40
Q

Communicating Hydrocephalus

A

CSF NOT properly absorbed at the dural sinus level

=> ventricles are symmetrically dilated

41
Q

With Communicating Hydrocephalus, is there a single point of obstruction?

A

NO

- CSF not properly absorbed at the dural sinus level

42
Q

What is Normal Pressure Hydrocephalus?

A

CSF drainage is blocked gradually in older people

–> Symmetric hydrocephalus

43
Q

What are the symptoms of Normal Pressure Hydrocephalus?

A

” wet, wacky, wobbly “

  • UI
  • Dementia – troubles with recall
  • Magnetic gait – feet stuck to the floor
44
Q

UI, dementia and gait disturbances could indicate?

A

Normal Pressure Hydrocephalus

45
Q

Why is it important to properly diagnose Normal Pressure Hydrocephalus?

A

It is reversible!

46
Q

As the Intracranial Volume increases, what compensates so the Intracranial pressure does not increase dramatically?

A

Venous system can compress and displace CSF

47
Q

There is a certain point where a small increase in the intracranial volume correlates with a LARGE increase in intracranial pressure. What usually occurs after that?

A

Brain tissue HERNIATION

48
Q

What things can cause Increased Intracranial Pressure?

A
  • Generalized brain edema
  • Expanding mass lesion
  • Increased CSF volume
49
Q

Subfalcine Herniation

A

Cingulate gyrus displaced under Falx

50
Q

Transtentorial Herniation

A

Medial temporal lobe compressed against Tentorium

51
Q

What are the signs of Transtentorial Hernation?

A

CN3 => Dilated pupil and impaired eye movement

52
Q

Tonsillar Herniation

A

Cerebellar tonsils displaced through Foramen Magnum

53
Q

What are the signs of Tonsillar Hernation?

A

Respiratory and Cardiac center compression

54
Q

What are the main symptoms of Increased Intracranial Pressure?

A

Papilledema
Headache
N/V
Seizures, lethargy, etc.

55
Q

Describe Kernohan’s Notch Phenomenon

A
  • Transtentorial Hernation
  • Contralateral Cerebral Peduncle compressed against tentorium which produces a “notch” in the peduncle
    => Ipsilateral hemiparesis on side of herniation
56
Q

Describe what will occur if there is Right hemisphere transtentorial herniation with the Kernohan’s notch phenomonen?

A
  • Right hemisphere transtentorial herniation
  • -> Left cerebral peduncle notch
  • -> Right sided hemiparesis (motor impairment) and possible blown pupil
57
Q

As a Transtentorial herniation progresses, what lesions may accompany it?

A

Duret Hemorrhage

– Hemorrhagic lesions in midbrain and pons

NMSP (28 decks)

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