Introduction to Neuropathology- Martin (part 3 injury)

Question 1

what is cerebral palsy

Answer 1

a non progressive neurologic motor defecit due to insults in the prenatal and perinatal period

Question 2

symptoms of cerebral palsy

Answer 2

spasticity, dystonia, ataxia, paresis

Question 3

intraparenchymal hemorrhage is often seen where?

Answer 3

in the germinal matrix of premature infants

Question 4

what is the germinal matrix

Answer 4

the junction between the thalamus and caudate nucleus (hemorrhage here can cause the ventricles to swell and cause subarachnoid hemorrhage)

very delicate

Question 5

what is periventricular leukomalacia

Answer 5

infarcts in the supratentorial white matter in premature infants

Question 6

how does periventricular leukomalacia present

Answer 6

as chalky yellow plaques that are indicative of necrosis and calcifications

Question 7

what is multicystic encephalopathy

Answer 7

extensive ischemic damage of both the white and the gray matter with large cysts

perinatal injury

Question 8

what is ulegyria

Answer 8

this is perinatal ischemic lesions in the depths of the sulci

they cause the gyri to be thinned out and gliotic

Question 9

what is the long term sequelae of severe pernatal or perinatal ischemic injury

Answer 9

periventricular leukomalacia

Question 10

when you fall while awake there is usually _ contact

when you fall with LOC there is usually _ contact

skull fractures

Answer 10

occipital

frontal

Question 11

diastatic fracture

Answer 11

fracture that crosses a suture

Question 12

later fractures lines _ (do/do not) extend across previous fracture lines

Answer 12

DO NOT

Question 13

displaced/depressed skull fracture

Answer 13

bone is displaced into cranial cavity by distances greater than the thickness of the bone

Question 14

basal skull fracture

Answer 14

orbital or mastoid hematomas

“battle sign, racoon eyes)

Question 15

symptoms of a basal skull fracture

Answer 15

otorrhea/rhinorrhea resulting in CSF drainage from the ear or nose

hinge

Question 16

in raccoon eyes there is _ _ sparing

Answer 16

tarsal plate

Question 17

concussion is a clinical syndrome characterized by?

parenchymal injury

Answer 17

altered consciousness secondary to head injury typically brought on by a change in momentum of the head

Question 18

symptoms of concussion

Answer 18

transiet neurological dysfunction

transient LOC

transiest respiratory arrest

transient loss of reflexes

Question 19

in a concussion _ recover is often complete, _ of the event often persists

Answer 19

neurologic

amnesia

Question 20

a concussion is the dysregulation of the _ _ system

Answer 20

dysregulation of the reticular activating system

Question 21

what is a post concussive neuropsychiatric syndrome

Answer 21

chronic traumatic encephalopathy

Question 22

what are direct parencymal injuries

Answer 22

contusions or lacerations caused by tranmissionod kinetic energy to the brain

Question 23

direct parenchymal injury: a blow to the surface of the. brain is transmitted through the skull and leads to rapid _ displacement, disruption of _ channels and subsequent hemorrhage, tissue injury and edema

Answer 23

tissue

vascular

Question 24

most common locations for contusions

Answer 24

frontal lobes, occipital ridges, temporal lobes

Question 25

direct parenchymal injury _ _ _ most susceptible where direct force is greatest

Answer 25

crests of gyri

Question 26

contusion

Answer 26

wedge shaped injury base at the point of impact is broad

Question 27

coup

Answer 27

contusion at the point of impact

Question 28

contrecoup

Answer 28

contusion diametrically opposed to coup (sudden deceleration)

Question 29

plaque jaune

Answer 29

depressed retracted yellow brown patches that are in the crests of cyri (broken down blood) from contrecoup contusion can become an epileptic focus ## Footnote old trauma lesions

Question 30

diffuse axonal injury (DAI) timing immunostains

Answer 30

axonal swelling and hemorragic foci appear within hours of injury and persits for a long time silver stain, amyloid precursor, alpha synuclein

Question 31

late manifestation of DAI

Answer 31

increased number of microglial areas and generation of tracts

Question 32

what causes DAI

Answer 32

mechanical forces ## Footnote angula acceleration alone can produce DAI even in the absence of impact

Question 33

50% of indvidual that develop coma without cerebral contusions have _

Answer 33

DAI

Question 34

in diffuse axonal injury immunostains with antibodies to beta amyloid precurosr protein (BAPP) can detect the axonal lesions in _ hours after injury what is seen on histology of DAI

Answer 34

2-3 hrs axonal spheoids

Question 35

all shaken babies develop ?

Answer 35

brain damage

Question 36

shakikng a child on several occasions may be like second _ _

Answer 36

concussion syndrome ## Footnote they dont die instantly

Question 37

when do shaken babies die

Answer 37

hours after brain swelling and DAI

Question 38

how do we recognize shaken impact syndrome

Answer 38

DAI/edema subdural hematomas retinal hemorrhages subgaleal hemorrhages (b/w scalp and skull) microscopic iron with a prussion blue stain | no skull fractures or impact sites ## Footnote the child is never normal again after a fatal shaking

Question 39

seqelae of brain trauma manifest _ after brain trauma of any cause

Answer 39

months to years

Question 40

what are some late complications of brain trauma

Answer 40

prost traumatic hydrocephalus and chronic traumatic encephalopathy

Question 41

what is post traumatic hydrocephalus

Answer 41

obstruction of CSF resorption due to hemorrhage in the subarachnoid space

Question 42

what is chronic traumatic encephalopathy

Answer 42

dementia pulgilistica a dementing illness from repeated head trauma

Question 43

what is CTE symptoms

Answer 43

atrophy, enlarged ventricles, tau neurofibrillary tangles in the gyral depths, perivascular regions and frontal and temporal lobes

Question 44

TBI/CTE is brain damage resulting from _ _ _ such as rapid deceleration or acceleration, impact, blast waves. There is associated diminished or altered _ . brain function is _ or _ impaired

Answer 44

external mechanical forces conciousness temporarily or permenantly ## Footnote tbi - traumatic brain injury and head injury are not the same

Question 45

CTE is a brain disease linked with _ head blows

Answer 45

repeated

Question 46

CTE can only be diagnosed by?

Answer 46

examining the brain after death

Question 47

CTS occurs due to?

Answer 47

progressive loss of normal brain matter and an abnormal builup of tau protein

Question 48

most instances of CTE occur in association with the play of _ but it also has association with _ injuries and other _. Symptoms of CTE include _ and _ changes, _ loss, cognitive impairement and dementia

Answer 48

sports blast neurotrauma behavorial and mood memory loss

Question 49

CTE is a _ characterized by the deposition of hyperphosphorylated _ protein as _ tangles, _ tangles and _ in striking clusters around small blood vessels of the cortex typically at the _ _

Answer 49

taupathy tau neurofibrillary astrocytic neurites at the sulcal depths ## Footnote increase in ventricle size decrease in parenchymal mass

Question 50

what amyloid is seen in CTE

Answer 50

b amyloid

Question 51

in CTE there is depigmentation of

Answer 51

substrantia nigra

Question 52

thoracic spinal cord injury results in

Answer 52

paraplegia

Question 53

cervical spinal cord injurly results in

Answer 53

quadriplegia

Question 54

C4 or above lesions result in

Answer 54

respiratory compromise and paralysis of the diaphragm

Question 55

micro lesions in the spinal cord do what?

Answer 55

taper above and below level of injury

Question 56

acute spinal cord injury shows

Answer 56

hemorrhage, necrosis, axonal swelling

Question 57

chronic spinal cord injury results in

Answer 57

central areas of the cord becoming cystic and gliotic

Question 58

epidural space hemorrhage of the CNS is usually associated with ? it is _ (slow/rapid)

Answer 58

skull fracture rapid ## Footnote ARTERIAL

Question 59

subdural space hemorrhage spreads _ (slowly/fast)

Answer 59

slowly ## Footnote venous

Question 60

subarachnoid space hemorrhage is associated with

Answer 60

severe onset of headache with rapid neurologic symptoms/deterioration

Question 61

CTE is in the

Answer 61

depths of the sulci

Question 62

trauma/contusions have selective involvement of the ?

Answer 62

crest of the gyri (frontal and temporal lobes too)

Question 63

hypertension is centered in the deep _ matter

Answer 63

white

Question 64

in a epidural hematoma the dura is? it is associated with _ blood what vessel is ruptured

Answer 64

peeled off skull arterial medial meningeal artery ## Footnote does not cross suture line

Question 65

in a subdural hematoma the dura is? it is associated with _ blood what vessel is ruptured?

Answer 65

still attached to the skull venous blood bridging vein ## Footnote crosses suture line