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NMSP > Intro to Neuropathology part 2 > Flashcards

Intro to Neuropathology part 2 Flashcards

1
Q

What type of necrosis occurs with CNS infarcts?

A

Liquefactive Necrosis

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2
Q

Describe Liquefactive Necrosis

A

Digestion of tissue into liquid viscous mass with NO architectural remnants!

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3
Q

Liquefactive Necrosis involves the loss of architectural remnants. How does that differ from coagulative necrosis that occurs in other organs besides the CNS?

A

Coagulative necrosis involves the architecture remaining!

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4
Q

Describe the general steps that occur in the CNS with an acute ischemic injury

A
  • Red neurons
  • Presence of macrophages and reactive gliosis
  • CNS infarct and liquefactive necrosis
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5
Q

What malformations/developmental disorders are the most common with the CNS?

A

Neural tube defects

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6
Q

Neural tube defects involve the failure of the tube to close or a portion reopening. What deficiency is common? When does the tube usually close?

A

Folate deficiency

– Tube closes by day 28 = before pregnancy is usually noticed

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7
Q

List some of the possible Neural Tube Defects

A

Spina Bifida – occulta/meningocele/myelomeningocele
Encephalocele
Anencephaly

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8
Q

Spina Bifida Occulta

A

Asymptomatic bony defect

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9
Q

Meningocele

A

Bony defect with meninges protruding in a pouch

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10
Q

Myelomeningocele

A

Bony defect with meninges + CNS tissue protruding in a pouch

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11
Q

Meningocele and Myelomeningocele neural tube defects may present with what symptoms?

A

LE deficits
Bowel issues
Infections

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12
Q

Encephalocele and Anencephaly neural tube defects occur in what trimester?

A

1st

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13
Q

Encephalocele

A

Disorganized brain tissue extends through a defect in the cranium
– usually posterior fossa

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14
Q

Anencephaly and when it occurs?

A

Absence of most of the brain and calvarium

– forebrain development disrupted at 28 days gestation

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15
Q

Forebrain Anomalies involve abnormalities in?

A

Generation and migration of neurons

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16
Q

List some of the possible Forebrain Anomalies

A 
Mega/microcephaly
Lissenencephaly
Polymicrogyria
Neuronal Heterotopias
Holoprosencephaly
Agenesis of corpus callosum
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17
Q

Microcephaly involves a decreased number of neurons and a small head. What is it associated with?

A

Fetal alcohol syndrome, HIV1, Zika virus

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18
Q

Lissenencephaly

A

DECREASED # of gyri = smooth or cobblestone surface of brain

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19
Q

Polymicrogyria

A

Small and numerous irregular gyri

– gray matter is < 4 layers and meningeal tissue is trapped

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20
Q

Neuronal Heterotopias

A

Collections of neurons in inappropriate locations along pathway

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21
Q

What are Neuronal Heterotopias associated with?

A

Epilepsy

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22
Q

If the X chromosome Filamen A and DCX proteins are altered, what forebrain anomalies will occur in males and females respectively?

A 
Males = lissenencephaly 
Females = Neuronal Heterotopias
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23
Q

Holoprosencephaly and its possible symptoms

A

Incomplete separation of cerebral hemispheres

- cyclopia, absent CN1, associated with trisomy 13

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24
Q

Agenesis of corpus callosum appears how?

A

Bat wing lateral ventricles

– normal or decreased IQ

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25
Q

List some of the Posterior Fossa Anomalies

A

Arnold-Chiari Malformation
Dandy-Walker Malformation
Syringomyelia/Hydromyelia
Joubert Syndrome

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26
Q

Arnold - Chiari Malformation

A

SMALL posterior fossa

27
Q

Type 1 Chiari malformation

A

Low-lying cerebellar tonsils

== Usually SILENT

28
Q

Type 2 Chiari malformation is more severe. Describe it.

A

Downward extension of cerebellar vermis through the foramen magnum
– usually with a myelomeningocele and hydrocephalus

29
Q

Dandy - Walker Malformation

A

ENLARGED posterior fossa

30
Q

What are the manifestations in the brain of the Dandy-Walker Malformation?

A

Expanded roofless 4th ventricle = ABSENT cerebellar vermis

– Replaced by ependymal cyst

31
Q

Syringomyelia (syrinx)

A

Fluid filled cavity in inner portion of spinal cord

32
Q

What are the symptoms of Syringomyelia (syrinx) and why?

A

Loss of pain and temperature sensation in the UE only!!

– interrupts fibers that cross the white commissure

33
Q

Hydromyelia

A

Expansion of ependymal-lined central canal of spinal cord

34
Q

Joubert Syndrome

A

Vermis hypoplasia that creates a “molar tooth” sign

35
Q

What are some Perinatal Brain Injuries that can occur?

A 
Cerebral palsy
Intraparenchymal hemorrhage
Periventricular leukomalacia
Multicystic Encephalopathy
Ulegyria
36
Q

Cerebral palsy

A

Non-progressive neurologic motor deficit attributable to insults that occurred during the prenatal/perinatal period

37
Q

Where and in who are Intraparenchymal Hemorrhages seen?

A

In the germinal matrix (between thalamus and caudate nucleus) of preemies

38
Q

Periventricular Leukomalacia

A

Infarcts in supratentorial white matter

= Chalky yellow plaques that turn into large cystic spaces in preemies

39
Q

Multicystic Encephalopathy

A

Ischemic damage –> large destructive lesions

40
Q

Ulegyria

A

Ischemic lesions in the depth of sulci –> thinned gliotic gyri

41
Q

If a person is awake and they fall, the likely direction was? If a person loses consciousness and they fall, the likely direction was?

A

Awake = occipital injury by falling back

Loss of consciousness = frontal injury by falling forwards

42
Q

Diastatic skull fracture

A

Fracture that crosses a suture

43
Q

What is unique about later skull fractures?

A

They do NOT cross previous fracture lines

44
Q

Displaced/Depressed skull fractures

A

Bone displaced into cranial cavity by a distance > bone thickness

45
Q

Basal skull fracture

A

Break of bone in the base of the skull

– orbital or mastoid hematomas

46
Q

What are the signs of a basal skull fracture?

A
  • CSF drainage from ear or nose
  • Raccoon eyes
  • Battle’s bruise behind the ear
47
Q

What are the 3 parenchymal injuries?

A
  1. Concussion
  2. Direct Parenchymal Injury
  3. Diffuse Axonal Injury
48
Q

A concussion is a _____ syndrome that is brought about by?

A

CLINICAL syndrome

– head momentum change

49
Q

Concussions involve transient neuro dysfunction. The patient will fully heal although they may have?

A

Amnesia of event

50
Q

Direct Parenchymal Injury

A

Contusions from blunt trauma and lacerations due to kinetic injury to the brain

51
Q

What area of the brain is the most susceptible to direct parenchymal injuries and what is the shape of the contusion?

A

Crests of gyri with wedge shaped contusion

52
Q

Coup

A

Contusion at the point of impact

53
Q

Countercoup

A

Contusion opposite of the site of impact – ex. deceleration

54
Q

Plaque Jaune

A

Old countercoup lesions that are depressed yellow/brown patches

55
Q

What can Plaque Jaunes become?

A

Epileptic focus

56
Q

Diffuse Axonal Injury

A

Axonal swelling +/- focal hemorrhagic lesions

57
Q

What stains can be (+) with Diffuse Axonal Injuries?

A

Silver stain
Amyloid precursor protein
Alpha Synuclein

58
Q

What constellation of injuries is usually present with Shaken Baby Syndrome?

A

Diffuse Axonal Injury/cerebral edema
Subdural hematomas
Retinal hemorrhages

59
Q

Altered state of consciousness with brain function temporarily or permanently impaired

A

Traumatic Brain Injury

60
Q

Chronic Traumatic Encephalopathy (CTE)

A

Repetitive brain trauma

61
Q

What are the signs of CTE on the brain?

A

Atrophy
Enlarged ventricles
Tau neurofibrillary tangles

62
Q

Epidural hematomas occur rapidly. What type of blood, its source and why?

A

Arterial blood from middle meningeal artery due to skull fracture

63
Q

Subdural hematomas occur slowly. What type of blood?

A

Venous blood

NMSP (28 decks)

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