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2420 Pathology > Module 12 Neurocognitive > Flashcards

Module 12 Neurocognitive Flashcards

1
Q

Medical Imaging

A
  • Skull & spine x-ray
  • CT
  • Angiography
  • MRI
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2
Q

Electrophysiological Studies

A
  • EEG
  • EMG
  • Nerve conduction
  • Evoked potential
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3
Q

Cerebrospinal Fluid (CSF) Studies

A
  • Cell count
  • Biochem
  • Microbio
  • Cytology
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4
Q

Molecular Genetics & Cytogenetics

A
  • Inherited disorders
  • Tumours
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5
Q

Biochemical Analysis

A
  • Metabolic disorders
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6
Q

Frontal Lobe

A
  • Thinking
  • Feelings/emotion
  • Speech
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7
Q

Temporal Lobe

A
  • Hearing
  • Memory
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8
Q

Parietal Lobe

A
  • Sensation
  • Speech
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9
Q

Brainstem

A
  • Eye & facial movement
  • Breathing
  • Heartbeat
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10
Q

Cerebellum

A
  • Balance
  • Coordination
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11
Q

Unique CNS Tissues

A
  • Neurons
  • Astrocytes
  • Oligodendroglia
  • Ependyma
  • Microglia
  • Choroid plexus
  • Leptomeninges
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12
Q

CNS Tissues Found Elsewhere

A
  • Dura (connective)
  • Blood vessels
  • Pericytes
  • Smooth muscle
  • Phagocytes (macrophages)
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13
Q

Neurons

A
  • Initiate & transmit impulses
  • Synapses (point of connection)
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14
Q

Astrocytes

A
  • Scaffolding
  • Insulate nerve fibres
  • Growth & nutrition of neurons
  • Maintain CNS environment (BBB)
  • Repair of injuries
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15
Q

Oligodendrocytes

A
  • Maintain myelin
  • Conduction velocity of nerve fibers
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16
Q

Microglia

A
  • Defensive (immunologic) responses
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17
Q

Neuronal Degeneration

A
  • Atrophy
  • Damage
  • Necrosis
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18
Q

Axonal Degeneration

A
  • Axonal swellings/loss
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19
Q

Glial Reaction

A
  • Astrocytic hyperplasia
  • Proliferation
  • Astrocytosis/gliosis
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20
Q

Demyelination

A
  • Damage to myelin/oligodendrocytes
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21
Q

Vascular Changes

A
  • Vasculitis & vasospasm (ischemia)
  • Vasogenic edema (BBB breakdown)
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22
Q

Cerebral Edema

A
  • Vasogenic (breakdown of BBB)
  • Accumulation of extracellular fluid (tumour, abscess, cytotoxic)
  • Intracellular swellings of neurons/glia (hypoxia, ischemia)
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23
Q

Migration of Systemic Inflammatory Cells

A
  • Neutrophils, lymphocytes, macrophages
  • To CNS
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24
Q

Neoplastic Components

A
  • Gliomas
  • Metastases
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25
Infectious Components
- Bacterial - Fungal - Viral - Prion - Worm - Parasites
26
Vascular Components
- Cerebral infarcts - Hemorrhages - Ischemia - Perinatal
27
Traumatic Components
- Brain/spinal injuries
28
Neurodegenerative Components
- Dementias, Alzheimer's - Movement disorders, Parkinson's
29
Demyelinanting Components
- Multiple sclerosis - Leukodystrophies, adrenoleukodystrophy
30
Intrinsic Tumour
- Intra-axial - Gliomas (astrocytic, oligodendroglia) - 3 tiered diagnosis (histology, molecular alterations, WHO grade)
31
Extrinsic Tumour
- Extra-axial - Meningiomas, schwannomas - Secondary metastases (lung, breast, melanoma)
32
Primary Tumour (Adults)
- Astrocytoma (includes glioblastoma) - Oligodendrogliomas - 90% supratentorial
33
Primary Tumour (Children)
- Astrocytoma - Ependymomas - Medulloblastomas - 90% infratentorial
34
Histological Primary Tumour Features
- Suggest higher grade & poor prognosis - Increasing cellularity - Mitoses - Nuclear pleomorphism - Endothelial proliferation - Necrosis
35
Primary Tumour Molecular Features
- IDH mutation (better prognosis) - Chromosomal
36
Meningiomas
- Derived from meninges - Based on dura - Middle to old age - Cured by resection - Various histological patterns
37
Metastatic Tumours
- Difficult to asses prevalence - Most common CNS neoplasm in adults - Lung, breast, melanoma, renal cell carcinoma, colorectal - Commonly located in cerebral hemispheres (grey/white matter junction) - Less commonly seen in cerebellum & brainstem
38
Meningitis Types
- Bacterial (neutrophils) - Viruses (lymphocytes) - Fungi (immunocompromised, cryptococcus, candida) - Cloudy leptomeninges
39
Bacterial Meningitis
- Many pathogens - Fever - Neck stiffness - Headache - Confusion - Cloudy CSF
40
Cloudy Leptomeninges
- Purulent exudate in subarachnoid space - Abundant polymorphs in leptomeningeal spaces - May extend to vessels, ventricular wall, brain
41
Encephalitis
- Headache - Fever - Seizure - Loss of consciousness - Viruses most common (HSV, HIV, CMV)
42
Cerebral Abscesses (Direct Spread)
- (50% of cases) - Middle ear, paranasal sinus, dental infections - Mixed flora - Streptococcus milleri
43
Cerebral Abscesses Hematogenous Spread
- (25% of cases) - Bronchiectasis - Congenital heart disease - Bacterial endocarditis - Mixed flora - Streptococcus viridians - Trauma & iatrogenic
44
Cerebrovascular Disorder
- Stroke - Symptoms lasting 24+ hours - Leading to death - No apparent cause (vascular origin) - Ischemic (infractions) - Hemorrhagic (non-traumatic)
45
Cerebral Infarct
- Localized area of tissue necrosis - Supplied by vascular pattern - Neurons, glia, vessels - Causes occlusion
46
Occlusion Consequences
- Narrowing of arteries - Cerebral, vertebral, internal carotid - Middle cerebral artery distribution most common
47
Vascular Occlusion Causes
- Thrombosis - Atherosclerosis - Vasculitis
48
Vascular Occlusion Clinical Manifestations
- Dependent on size & location of infract - Transient ischemic attack (TIA) - Symptoms subside in 24hrs - Stroke - Neurological defects (24+ hrs)
49
Intracerebral Hemorrhage
- Hypertension (*Primarily)* - Leukemia - Blood disorders - Tumours - Vascular malformation - Aneurysms - Amyloid angiopathy - Vasculitis - Immune mediated - Sepsis - Medications - Anticoagulants - Drug abuse
50
Subarachnoid Hemorrhage
- Developmental - Berry aneurysm - Vasculitis - Immune mediated (nonseptic) - Inflammatory aneurysm (mycotic) - Septic vasculitis - Amyloid angiopathy - Arteriovenous malformation (AVM)
51
Hypertension Hemorrhage
- Hypertensive arteriosclerotic changes - Wall weakening of arterioles/micro vessels - Results in rupture - Treatment of hypertension to reduce incidence - Rupture into ventricles/brain swelling (Fatal)
52
Hypertension Hemorrhage Sites
- Basal ganglia - Thalamus regions - Pons - Cerebellum
53
Cerebral Amyloid Angiopathy
- Deposition of amyloid (beta) - Weakens vessel wall (subarachnoid & cortical) - Leads to rupture - Intracerebral & subarachnoid hemorrhages - Elderly (Alzheimer's)
54
Berrys (Saccular) Aneurysm
- Developmental defect - Weakening of arterial wall - Anterior communicating artery most common site
55
Manifestation of Berry Aneurysm
- Local pressure - Isolated 3rd cranial nerve palsy - Rupture/hemorrhage - Subarachnoid, intracerebral, intraventricular
56
Duret's Hemorrhage
- Brain swelling - With uncal/tonsillar herniaition - Secondary brain hemorrhage
57
Infarction
- Compression necrosis/vasospasm - Constriction of vessel walls after subarachnoid hemorrhage
58
Hydrocephalus
- Blood clots - Ventricles & subarachnoid space
59
Head Injury
- Leading cause of death in people under 45 - Impact/blunt force - Focal, diffuse pattern
60
Skull Fracture
- Radiate/pass impact site - Not always associated with brain damage - Force required
61
Skull Fracture Patterns
- Linear, single line - Comminuted, multiple lines - Compound, communicates with cranial cavity - Depressed, margins pushed into cranial cavity - Hinge, across base of skull
62
Traumatic Intracranial Hemorrhage
- Bleeding inside cranium
63
Traumatic Intracranial Hemorrhage Sites
- Outside dura (epidural) - Under dura (subdural) - Under arachnoid (subarachnoid) - In brain (intracerebral) - Cerebral ventricles (intraventricular)
64
Epidural Hematoma
- Result of fracture to squamous temporal bone - Damage to middle meningeal artery/vein - Lucid interval association
65
Subdural Hemorrhage
- Acute - Associated with other brain trauma - Fall/blow to head - Various tears
66
Brain Contusion
- Hallmark of brain damage in head injury - Bruise to surface - Overlying pia matter intact
67
Topography
- Involve gyri crest - Contact with protuberance within skull
68
Coup Contusion
- Occur under site of impact - Result of blowC
69
Contre-Coup Contusion
- Opposite (at distance) from impact site - Result of fall - Occipital impact most obvious
70
Alzheimer's
- Cortical degeneration - 50-70% of dementia cases - Slow progression - Motor & sensory systems in tact
71
Alzheimer's Gross Pathology
- Atrophy - Frontal & temporal emphasis
72
Alzheimer's Mirco Pathology
- Neuronal loss in cerebral cortex - Gliosis (astrocytes proliferation & hypertrophy) - Amyloid deposits - Neurofibrillary tangles - Neuritic plaques
73
Alzheimer's Stages
- Thal (A) - Braak (B) - CERAD © - National institute on aging (NIA-AA)
74
Parkinson's
- Movement disorder - Slow progression - Unknown causes - No cure
75
Parkinson's Symptoms
- Resting tremor (shaking) - Generalized slowness (bradykinesia) - Stiffness of limbs (rigidity) - Gait/balance (postural dysfunction & frequent falls)
76
Parkinson's Neurochemistry
- Loss of dopamine (DA) - Imbalance of neurotrans in basal ganglia - Dopamine replacement relives symptoms
77
Parkinson's Pathology
- Loss of pigments in substantia nigra (midbrain) - Eosinophilic inclusions in cytoplasm (Lewy Bodies) - Increased astrocytes (gliosis)
78
Lewy Bodies
- Cortical degeneration - Cerebral cortex dementia association - Mutation of alpha synuclein gene PD early onset
79
Primary Demyelination
- Damage/breakdown of myelin - Sparing of axons - MS
80
Secondary Demyelination
- Myelin breakdown - Injured/dying axons - Neurodegenerative diseases
81
Primary Demyelination Incidence
- Common in temperate latitudes - 20-40 yrs onset - Female more common
82
Primary Demyelination Etiology
- Genetic predisposition - Environmental
83
Primary Demyelination Pathogenesis
- Autoimmune reaction against oligodendroglia - CNS myelin with T-lymphocyte sensation
84
Primary Demyelination Clinical Manifestations
- Relapsing - Intermittent chronic course - Unilateral limb weakness - Paresthesia - Optic neuritis - Charcot's tirad (nystagmus, tremor, dysarthria) - Impaired intelligence - CSF increased IgG
85
Macro Pathology of MS
- Scattered - Grey - Sharply defined plaques (demyelinated areas) - White matter, brain stem, spinal cord, optic nerve
86
Micro Pathology of MS
- Early active lesions - Perivenous demyelination - Perivascular lymphocytes (T-cells) - Oligodendroglia loss - Areas coalesce visible MS plaques with inflammation - Chronic lesions show gliosis - Axon preservation

2420 Pathology (13 decks)

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