Introduction To Neuropathology - Dr. Martin Flashcards
1
Q
Oligodendrocytes look like what and location
A
round, scattered and aggregation aroiund the nerve cell body
2
Q
Astrocytes look like and location
A
oval shaped, around BVs and Nerves
3
Q
selective vulnerability
A
a set of neurons (not located in same area ) sharing 1 or more properties and show response to one insult
4
Q
Neuronal response looks like what in ACUTE
A
RED neurons (12-24hrs) \+ Gliosis (Cell loss, shrinking, HIGH EOSINOPHILIA)
5
Q
Neruonal responce looks like in SUBACUTE AND CHRONIC
A
degenerative and progressive disease
= gliosis (Cell loss_)
= protein accumulation
6
Q
central chromatolysis
A
when axon of neuron reacts to injury
= increase protein synthesis and
= Nissl removed from center of cell to periphery
7
Q
Intracytoplasmic Lipofuscin
A
proteins or carbs accumulation
8
Q
Intracytoplasmic Lipofuscin examples
A
- Negri bodies = Rabies
- Neurofibrillary tangles = Alzheimers
- Lewy Bodies = Parkinsons
- Vacuolization of perikaryon and neural processes = CJD
9
Q
examples of intranuclear accumulations
A
- Cowdry body = Herpes
10
Q
example of Intranuclear + cytoplasmic accumulations
A
CMV
11
Q
Chromatolysis
A
cell body reaction to cell injury
= swollen body
= loss of Nissl substance
12
Q
most important indicator that there is CNS injury
A
gliosis especially astrogliosis
13
Q
Gemistocytes
A
enlarged nuclei into vesicle and bright pink
= removes nuclei eccentically from the periphery
14
Q
ALZ type 2 astrocyte is what and 3 times it is seen
A
Grey matter cell (large nuclei, glycogen)
= hyperammonemia (chronic liver disease)
= Wilsons Dz
= Urea cycle Dzs
15
Q
What do Astrocytes do
A
- detoxifiers
- BBB foot processes
- hypertrophy and hyperplasia can happen
16
Q
Craniopharyngioma is what and what happens
A
- increasing head circumference
- slow growing tumor from Rathke’s pouch (Anterior Pituitary = keratin + SS cells + Cholesterol crystals yellow oil)—-> can make teeth*
- Astogliosis
17
Q
Rosenthal Fibers look like what and contains what
A
thick elongated, fibers within astrocyte processes
1. HSP a B-crystalline + HSP 27 + Ubiquitin
18
Q
Rosenthal Fibers found in what location
A
Grows around in 1. longlasting astogliosis IN *Pilocytic astrocytoma * = grade 1 Benign Brain Tumor 2. Alexander Dz = Leukodystrophy
19
Q
Corpora Amylacea are what and stain what
A
- round next to astrocyte foot process (periventricular, perivascular locations) = look like cut onions
- PAS +
20
Q
Corpora Amylacea happen from and contain what
A
- Glycosaminoglycan polymers, HSP, Ubiquitin
2. age, degenerative disease
21
Q
Eosinophilic granulae bodies
A
protein droplets
- Pleomorphic Xanthoastrocytoma
- Gangliogliomas
PAS +
= slow low grade favorable tumors
22
Q
microglia are what and surface markers
A
M of CNS
= CR3 + CD68
23
Q
microglial nodules are what
A
microglia that aggregate around small foci of necrosis
24
Q
Neuronophagia is what
A
microglia around cell bodies of dying neurons
25
neurosyphillis microglia
elongated rod cells
26
Oligodendrocytes respond to what injuries
1. demyelinating DOs + leukodystrophies
= progressive multifocal leukoencephalopathy (PML) INTRANUCLEAR INCLUSIONS
= (MSA) multisystem atrophy CYTOPLASMIC INCLUSIONS (a-synuclein)
27
Ependymal cells
line ventricles and ciliated columnar cells
28
Ependymal cells do what when they are disrupted
cause ependymal granulations (small irregularities on ventricular surface
= seen in children with CMV
29
Cerebral Edema
fluid in parenchyma of brain
30
vasogenic edema
high ECM Fluid from
1. BBB disruption
2. Vascular permeability
= usually after ischemic injury
31
Cytotoxic Edema
higher ICM fluid from
1. neuronal, glial, or endothelial cell membrane injury
=- hypoxia or ischemia
32
hydrocephalus
fluid build up so the ventricles grow bigger
| = frontal horn width is > then 1/2 internal skull diameter
33
Atrophy Ex vacuo or brin
parenchyma separates from the skull and shrinks in
= BVs get stretched
= fluid buildup happens to push back and reinflate parenchyma
34
Hydrocephalus increases CSF which causes what 7 things
1. absorption into nerves
2. Dilation or frontal and temporal horns
3. corpus callosum elevation
4. cerebral mantle thinning
5. septum pellucidum stretch + perforation
6. 3rd ventricle enlargement downward
7. Papilledema (from increased intracranial P)
35
Hydrocephalus increased CSF HOW CAN THIS HAPPEN
1. over production from choroid plexus
2. blood, tumor, exudate obstruction, infection, atresia/stenosis in ventricle
3. low absorption, outflow obstruction
36
Choroid Plexus Papilloma
benign and not dangerous if in children
= grows intraventricularlly and can cause hydrocephalous
= has thick fibrous core and stalk (looks like broccoli)
37
what usually causes pyogenic meningitits
TB
neurosyphilis
= exudate and injure the leptomeninges
38
5 causes of congenital hydrocephalus
1. intrauterine infection (TORCH)
2. AVM
3. agenesis, stenosis
4. Dandy Walker Syndrome
5. cranial problem
39
7 acquired reasons for hydrocephalus
1. infection
2. mass lesions neoplasm
3. inflammation
4. Post hemorrhage : In ventricle, subarachnoid, injury
5. choroid plexus over production
6. hyper VitA
7. Sagittal sinus Thrombosis = deadly
40
what absorbs CSF
dural sinuses
41
cysticercosis does what and from what
```
causes hydrocephalus
from Taeniasis (pork worm Taenia Solium) = epilepsy can also be caused
```
42
common place for stenosis in babies causing hydrocephalus
aqueductal stenosis
43
Hydrocephalus Ex Vacuo happens when
1. atrophy with age
2. stroke or injury
3. neurodegenerative dz (Huntingtons, Alzheimers
44
hydrocephalus ex vacuo is not normal hydrocephalus by what
it has normal CSF Pressure
45
Normal Pressure Hydrocephalus (NPH)
hydrocephalus usually in pt over 60yo from slow blockage of CSF absorption
= not very high P elevation
= enlarged ventricles gives Dementia like SXs
= REVERSIBLE
46
Normal Pressure Hydrocephalus (NPH) looks like
Dementia, Alzheimers, Parkinsons
47
Normal Pressure Hydrocephalus (NPH) types (where it comes from)
1. Idiopathic**
| 2. subarachnoid hemorrhage, head trauma, tumor, infection, cranial surgery complication
48
Normal Pressure Hydrocephalus (NPH) TRIAD
WET, WACKY, WOBBLY (weird walking water)
1. urinary incontinence
2. gait problem= magnetic, wide legged (can fall backward)
3. dementia
* *** no trembling or rigidity
49
how brain compensates for the Normal Pressure Hydrocephalus (NPH) and steps it takes if not caught
1. lowers venous sinuses blood
2. cerebral swelling happens eventually happens ----> herniatation
3. low cerebral BF, low cerebral perfusion , leads eventually to brain dead
50
ways herniations happen from brain swelling of NPH
1. temporal lobe pushed down the mid brain through the tentorium incisura
2. cerebral peduncles forced down the foramen magnum
51
Increased Intracranial Pressure happens usually from what 2 things
1. brain edema
2. expanding mass lesion (tumor, abscess, hemorrhage)
3. increased CSF
52
Increased Intracranial Pressure herniations
goes past the dural folds (falx and tentorium) and openings of the skull
1. subfalcine (cingulate) : cingulate gyrus goes under FALX
2. Transtentorial (uncinated, uncal, mesial) : Temporal lobe pressed to tentorium (CN3 = dilated and impaired eye movement)
3. Tonsillar : cerebral tonsils goes through the foramen magnum (EFFECTS RESPIRATORY AND CARDIAC)
53
SX of Increased Intracranial Pressure
1. headache, N, V
2. pupil reaction change (cant look up)
3. CN6 nerve palsy (abducens)
4. seizures
5. ataxia (bad coordination)
6. Papilledema
54
papilledema seen in adults think
brain tumor
55
Kernohan's notch Phenomenon happens from what
compression of cerebral peduncles against tentorium cerebelli = TRANSTENTORIAL HERNIATION
1. SAME side hemiparesis or hemiplegia (same side as herniation)
2. visible "notch" in cerebral peduncle = false localization sign
56
increased intracranial P causes herniation at
opposite side of brain by pushing it that way
57
Kernohan's notch Phenomenon what is compressed causing RIGTH SIDED MOTOR PROBLEMS ********
RIGHT SIDED KERNOHAN'S NOTCH
1. high intracranial P on right side ----> LEFT side herniation
2.. LEFT cerebral peduncle compressed + .... LEFT CN3 compressed (sometimes CN6)
3.. RIGHT SIDE motor weakness
4.... LEFT SIDE PUPIL DILATION
( when the condition starts compressing right peduncles ----> left motor weakness = false localization*)
58
Kernohan's notch Phenomenon type of herniation
Uncal herniation
59
duret hemorrhage
secondary hemorrhage in midbrain and pons
| from transtentorial herniation (when brain is displaced down = vessels disrupted)
60
hypoxia vs ischemia
low perfusion is what
infarct is what
1. hypoxia = low O2, ischemia = low BF or cant use O2
2. low bp
3. necrosis from sudden low BF = infarction
61
hypoxia does what to cells
shrink and lower number of them
| pyknotic
62
Liquifactive necrosis
necrosis denaturation ICM proteins and enzymes digesting
= into liquid smelly yellow mass (CNS)
= purulent material can be seen if bacterial
= no architect remains
63
CNS is to liquifactive necrosis as other orgnas like glomeruli and tubuli in renal is to
coagulative necrosis = has architecture remains left
64
when grabbing a bx or sample go
to the periphery of lesion = alive cells (no center)
65
red neurons look like
| what happens after
blurry red neurons
after 10 days foamy macrophages come
then there is tissue loss and gliosis
66
hygroma
arachnoid and dura separate from contraction of brain parenchyma from infarct
67
MCA and herniation
subfalcine/ cingulate gyrus herniation
68
most common developmental neural problem and some others
1. neural tube defect (FOLIC ACID B9, working with B12 and C), shoulud be done by day 28 gestation
2. posterior fossa anomalies, forebrain anomalies
3. syringomyelia (cysts in the spinal cord)
69
spinal dysraphism /spina bifida
bony defect
flattened disorganized segment of cord associated with meningial pouch
(type of NT defect)
= sometimes hair grows on surface
70
myelomeningocele /meningomyelocele
CNS extends through defect in vertebral column (usually lumbar)
MENINGOCELE (only meninges protrude)
= problems with motor and sensory of LExr, bowel, infections
(type of NT defect)
MYELOMENIGOCELE = both meninges and spinal cord in cysts above buttocks
71
encephalocele
brain tissue extends through defect in cranium (USUALLY POSTERIOR FOSSA)
1. nasal glioma = if extension through the cribiform plate
(type of NT defect)
72
Anencephaly
most of brain + calvarium is absent
= FOREBRAIN DEVELOPMENT disrupted at 28days gestation
(type of NT defect)
73
1st trimester brain malformation
1. Enceohalocele
2. Anencephaly
3. holoprosencephaly (Arrhinencephalia) = 1 ventricle with defective smell and optic systems + meningomyocele
(NT formation)*
74
2nd trimester brain malformations
1. Lissencephalia = smooth brain (no gyri) or no corpus collosum (from defected neuronal migration)
2. Microgyria
3. microcephaly = decrease neurons, megalencephaly = increase neurons
4. Hydranencephaly = cystic sac fills cranial cavity (remnants of brain parts there) from cerebral BF in uterus problem
(neuronal proliferation+ migration)*
75
3rd trimester brain malformations
(neuronal organization and myelination)*
76
Spinal Dysraphism
fusion of spinal cord at a level
= spinal bifida occulta ----> OR Meningomyelocele
= hydrocephalus (ARNOLD- CHIARI MALFORMATION ----> hindbrain posterior fossa downward displacement into spinal cord ---> X absorption and circulation of CSF)****
77
severe sx in spinal dysphism can cause
paraplegia and loss of bowel movements + hydrocephalus (90%)
78
Arnold Chiari malformation
hindbrain posterior fossa displaced downward to spinal canal interfering with circulation + CSF absorption (due to small posterior fossa)
= hydrocephalus
79
megalocephaly and microcephaly
| and main causes for microcephaly
```
1. too big brain
2 .too small brain
= fetal alcohol syndrome,
= HIV-1 in uterus,
= ZIKA virus
```
80
Lissenencephaly
decrease gyri = smooth brain or cobblestone looking (Agyria = no gyri)
81
Polymicrogyria
small + many irregular convolutions (grey matter is small and entrapped meningeal tissue) = too many and too small gyri
82
Neuronal heterotopias what happens and associated with
1. neurons are not in the right place , abnormal migration
| 2. FEMALES --> epileptic , MALE --> smooth surface lissenencephaly = X chr associated
83
Neuronal heterotopias proteins encoded by CHR X that are not right
Filamin A, DCX
84
Holoprosencephaly what happens and associated with what 2 conditions
cerebral hemispheres are not separated
= cyclopia + arrhinencephaly (olfactory Ns)
= Trisomy 13
85
Agenesis of corpus callosum what happens and imaging looks like
common
= BATWING on xray
= normal or intellectual problems
86
Chiari type 2 (Arnold chiari malformation)
severe
= cerebellum vermis downward displacement through foramen magnum
= hydrocephalus + myelomeningocele
87
Chiari type 1 (Arnold chiari malformation)
cerebellum tosills are displaced down vertebral canal
= usually no sx only if csf flow disturbed
= or headaches + migranes
88
Dandy Walker malformation
enlarges posterior fossa + NO Roof on 4th ventricle
= cerebellum vermis is missing or replaced by cyst continuous with Leptomeninges
= hydrocephalus
89
Joubert syndrome what happens and imaging looks like
1. Hypoplasia of cerebellum vermis
2. cerebellum peduncles elongation
3. altered brainstem
(MOLAR TOOTH SIGN)
90
Syringomyelia (Syrinx) what happens and what is the result of this
fluid filled cleft- like cavity in spinal cord (in anterior spinal commissural fibers)
= loss of pain and temperature or upper extremities
91
cerebral palsy
```
motor deficit from injury during prenatal or perinatal period
= not progressive
= spasticity
= dystonia
= ataxia
= paresis
```
92
Intraparenchymal hemorrhage = Germial Matrix Hemorrhage (GMH)
premature infants
= bleeding in thalamus and caudate nucleus junction
= becomes SAH and ventricles bleed
= hydrocephalus can happen
93
periventricular leukomalacia
infarcts in supratentorial white matter
= premature infants
= yellow necrosis + calcifications
94
Multicystic encephalopathy
extensive ischemia of both WHITE + GREY matter
| = cystic lesions happen
95
Ulegyria
ischemic lesions in the depths of sulci
| = thinned out gliotic gyri happen
96
athetosis is what and from injury where
SX in cerebral palsy
= slow involuntary writhing movements of fingers, hands, toes, arms, legs neck, tongue
= lesion to corpus striatum
97
falls awake vs from LOC
```
AWAKE = Backwards (occipital)
LOC = Forwards (frontal)
```
98
diastatic fracture and timing of them
fracture that crosses a suture
| = a later fracture does not cross a preexisting fracture line
99
displaced or depressed skull fracture is what
bone pushed into cranial cavity more then the thickness on skull
100
basal skull fracture is what and what happens
orbital or mastoid hematomas (raccoon eyes, rhinorrhea /otorrhea, hemotypanium, Battles sign (bruised behind ear)
101
concussion causes what
short term nerologic dysfunction , LOC, temporary respiratory arrest , loss of reflex
cant remember the event
= post concussion ----> chronic traumatic encephalopathy
102
Direct Parenchymal Injury
something penetrating into the brain
= blunt trauma contusion / laceration
= edema, hemorrhage, displaced tissue
(most common frontal, orbital, temporal)
103
ischemia vs contusion injury
```
ISCHEMIA = starts small and branches out
CONTUSION = starts big and gets smaller due to lower force farther away
```
104
Diffuse Axonal Injury
like shaken baby syndrome
= axonal swelling + focal hemorrhages
= B-AMYLOID PRECURSOR PROTEIN APP****, + Alpha synuclein with silver stain
= angular acceleration can cause this
105
75%-80% of shaken baby syndrome
dont die, only get brain damage
| = brain swells and they get Diffuse axonal injury
106
all injuries that point to shaken baby syndrome
1. Diffuse Axonal injury
2. subdural hematoma
3. retinal hemorrhages
107
Direct Parenchymal injury
1. most susceptible to injury
2. contusion happens when
3. coup
4. contrecoup
5. plaque jaune
1. most susceptible to injury = cresr of gyri
2. contusion happens when = wedge shaped impact
3. coup = head hits something causing contusion
4. contrecoup = head hits something causing brain to snap back or bounce and hit something causing contusion
5. plaque jaune= depressed yellowbrown in gyri crests ( old trauma, usually countercoup inferior frontal cortex, temporal, occipital)
108
post- traumatic hydrocephalus
Chronic traumatic encephalopathy CTE
1. CSF resorption obstruction from SAH
2. Dementia pugilistical = from repeated head trauma (atrophy + enlargement of ventricels + TAU tangles in deep gyri in frontal and temporal lobes)
109
TBI/ CTE **** BOARDS + EXAM
Traumatic Brain Injury TBI : rapid deceleration / acceleration , impact, blast waves
= state of consciousness altered, brain is temporary or permanently impaired
= can lead to CTE
= imaging can not always see however axonal damage
110
CTE is similar to what
DAI
= tau buildup + B- amyloid
= depigmentation of substantia nigra
111
what happen if injury is on this level of spine
1. thoracic and down
2. cervical
3. C4 and up
1. thoracic and down : paraplegia
2. cervical : Quadriplegia
3. C4 and up : respiratory + paralysis of diaphragm
112
epidural hemorrhage usually from and nature
1. skull fracture, dura pealed off
2. ARTERIAL , rapid progressing
= Middle Meningeal Artery
113
subdural hemorrhage usually from and nature
1. mild truma , direct contact to brain, dura is intact
| 2. VENOUS, slow progressing
114
Subarachnoid hemorrhage usually from and nature
1. AVM, vascular problem, trauma contusion
| 2. sever headache sudden, Rapid deterioration
115
htn causing hemorrhage location in brain it effects and nature
1. deep white matter, thalamus, BG, brainstem, can go to ventricles
