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Pathology Pt. 5 > Nervous System 1 > Flashcards

Nervous System 1 Flashcards

1
Q

What cellular changes are seen after acute neuronal injury (7)?

A

Within 12-24 hours:

  1. Cell body shrinks
  2. Pyknosis (condensation of chromatin)
  3. Nucleolus is lost
  4. Nissl substance is lost
  5. Intense cytoplasmic eosinophilia (RED NEURONS)

Later:

  1. Axons swell; axonal SPHEROIDS
  2. Intracellular inclusions: Lewy bodies (protein aggregates), viral inclusions, lipofuscin pigments
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2
Q

Does myelin stain with H&E?

A

Nope

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3
Q

What is hydrocephalus?

A

Accumulation of excessive CSF in the ventricular system in the brain.

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4
Q

Most cases of hydrocephalus are a consequence of impaired ______ or ______. Rarely, an overproduction of _____ from choroid plexus tumors can cause it.

A

impaired flow or resorption. Overproduction of CSF from choroid plexus tumors can cause it

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5
Q

Enlargement of the head from hydrocephalus occurs only if…?

A

if the cranial sutures (in infancy) have not closed yet

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6
Q

What happens in the case of hydrocephalus AFTER the cranial sutures have closed?

A

Ventricles expand –> increased intracranial pressure presses on the brain; no change in head circumference

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7
Q

What is the difference between non-communicating and communicating hydrocephalus?

A

Non-communicating is when there is an obstacle to the flow of CSF in the ventricular system - one portion of the ventricles will enlarge while other portions will not.

Communicating is due to reduced CSF resorption - the entire ventricular system will enlarge.

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8
Q

How is hydrocephalus treated?

A

A shunt is placed in the ventricles which drains CSF into the abdomen.

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9
Q

What are the five general causes of a CNS infarction?

A
  1. Thrombosis
  2. Embolism
  3. Vascular rupture
  4. Hypotension
  5. Hypertension
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10
Q

What are the three most common sites of CNS thrombosis?

A
  1. Carotid bifurcation
  2. Origin of the middle cerebral artery
  3. Either end of the basilar artery
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11
Q

What is the most common site of embolic occlusion that leads to CNS infarction?

A

Middle cerebral artery

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12
Q

Infarction via hypotension usually involves the ‘watershed’ areas and the deep layers of the cortex. What is a watershed area?

A

An area of tissue that lies at the far ends of arterial supply - usually in the area of an anastomosis of two arteries.

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13
Q

Are nonhemorrhagic infarcts and hemorrhagic infarcts treated the same way?

A

No, non-hemorrhagic infarcts are treated with thrombolytic therapies and hemorrhagic infarcts are not (it makes it worse)

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14
Q

Hemorrhagic CNS infarcts occur secondary to _______ of ischemic tissue, either through collaterals or after dissolution of intravascular occlusion.

A

reperfusion

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15
Q

Describe the timeline of morphological changes seen in a nonhemorrhagic infarct.

A

0-6 hours: no obvious signs.
By 48 hours: tissue is pale, soft, swollen.
2-10 days: brain is gelatinous and friable.
10 days - 3 weeks: tissue liquefies, fluid-filled cavity is lined by dark gray tissue.

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16
Q

What microscopic changes are seen in a nonhemorrhagic infarct (5)? What additional things are seen in a hemorrhagic infarct?

A
  1. Tissue is necrotic
  2. Phagocytosis
  3. Liquefactive process
  4. Revascularization/capillary growth
  5. After months: gliosis-lined cystic cavity

Hemorrhagic infarct adds blood extravasation and resorption.

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17
Q

What is an intracerebral hemorrhage aka primary brain parenchymal hemorrhage?

A

Bleeding into the brain

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18
Q

Is intracerebral hemorrhage aka primary brain parenchymal hemorrhage always caused by trauma?

A

No, spontaneous hemorrhages can occur; peak incidence of this is at age 60.

19
Q

Most cases of intracerebral hemorrhage aka primary brain parenchymal hemorrhage are caused by rupture of a small _______ vessel.

A

intraparenchymal

20
Q

_________ is the most common cause of intracerebral hemorrhage aka primary brain parenchymal hemorrhage, often complicated by minute dilations at small artery bifurcations (called _____-_____ aneurysms)

A

Hypertension is the most common cause. Minute dilations at small artery bifurcations are called Charcot-Bouchard aneurysms.

21
Q

Specifically where in the brain does intracerebral hemorrhage aka primary brain parenchymal hemorrhage usually occur (5)?

A
  1. Basal ganglia
  2. Thalamus
  3. Pons
  4. Cerebellum
  5. Frontal lobe white matter
22
Q

What morphological changes are seen in intracerebral hemorrhage aka primary brain parenchymal hemorrhage (4)?

A
  1. Extravasation of blood –> compression of adjacent parenchyma.
  2. Early lesions have a central core of clotted blood surrounded by a rim of brain tissue with anoxic neuronal and glial changes and edema.
  3. Old hemorrhages show a cavity of destruction with a rim of brown discoloration.
  4. Resolution of edema –> pigment and lipid-laden macrophages and reactive astrocytes appear.
23
Q

A subarachnoid hemorrhage is characterized by bleeding into the _______ space.

A

subarachnoid

24
Q

Subarachnoid hemorrhage is frequently associated with rupture of a _______ _________, especially in the circle of Willis. The initial rupture is ______ in 1/3 of patients.

A

rupture of a saccular (berry) aneurysm. Initial rupture is lethal in 1/3 of patients

25
Q

Do patients that suffer from a subarachnoid hemorrhage often suffer from recurrent bleeding, with the prognosis worsening with each episode?

A

Yeah

26
Q

Name four arteries where cerebral aneurysms most commonly occur.

A
  1. Anterior cerebral
  2. Internal carotid
  3. Middle cerebral
  4. Basilar
27
Q

Describe the morphology of a saccular (berry) aneurysm. Where are they usually found?

A

Outpouching of an artery: the endothelium and intima punch through the muscular wall and internal elastic membrane and expand the adventitia on the outside.

85% are found in the anterior circulation (circle of Willis).

28
Q

What usually causes an epidural hematoma? What artery is most often ruptured

A

Trauma. Middle meningeal artery is most often involved.

29
Q

Once a vessel has been broken in the case of an epidural hematoma, accumulation of blood under arterial pressure can cause separation of the _____ from the inner surface of the skull.

A

dura separates from the inner surface of the skull

30
Q

Describe how the clinical signs of an epidural hematoma progress.

A

Patients are ok for several hours after the traumatic event. If not treated, patients can die.

31
Q

What does an epidural hematoma look like in a CT scan (2)?

A
  1. Fusiform (tapered at each end)

2. LENTICULAR (lens shaped)

32
Q

What is Babinski’s sign? What does it tell you?

A

When poking the bottom of a person’s foot results in a big toe extension and abduction reflex rather than flexion. Indicative of pyramidal tract compression from an epidural hematoma.

33
Q

If you punch or kick someone in the temporal region of the skull, you might damage the _______ ______ artery, resulting in an epidural hematoma.

A

middle meningeal artery

34
Q

What is meningitis?

A

Inflammation of the leptomeninges (the pia and arachnoid mater) and CSF.

35
Q

How is infectious meningitis classified?

A
  1. Acute pyogenic (bacterial)
  2. Aseptic (viral)
  3. Chronic (TB, spirochetal, or cryptococcal)

-classified on the basis of characteriestics of inflammatory exudate in the CSF and clinical signs

36
Q

In what ages is acute pyogenic meningitis most often seen?

A

Highest incidence in children, second high incidence in elderly

37
Q

What are the clinical features of acute pyogenic meningitis (7)?

A
  1. Fever
  2. Headache
  3. Photophobia
  4. Irritability
  5. Prostration
  6. Nuchal rigidity
  7. Increased CSF pressure

Easier: patients feel really crappy and have stiff neck with increased CSF pressure

38
Q

Name some characteristics of the CSF from someone with acute pyogenic meningitis (4).

A
  1. Lots of neutrophils (purulent exudate)
  2. Elevated protein
  3. Reduced glucose (bacteria eat it up)
  4. Bacteria can be seen on a smear or can be cultured
39
Q

Meningococcemia can also be associated with purpuric skin lesions and is sometimes complicated by Waterhouse-Friderichsen syndrome. What characterizes this syndrome (5)?

A
  1. Hemorrhagic destruction of the adrenal cortex
  2. Acute hypocorticism
  3. Circulatory collapse
  4. Disseminated intravascular coagulation
  5. Purpuric skin
40
Q

Is bacterial meningitis associated with brain abscesses?

A

Yeah

41
Q

Early treatment of bacterial meningitis can result in little evidence of the disease after ______.

A

resolution

42
Q

How can bacteria invade the CNS?

A

Hematogenous, direct implantation, local extension, or via peripheral nerves

NOT lymphatics

43
Q

What are the morphological differences between bacterial meningitis and aseptic (viral) meningitis?

A

Pyogenic (bacterial) will have a lot of neutrophils, fibrin, and engorged blood vessels in the subarachnoid space. Viral will have lymphocytes (not neutrophils) and fewer cells overall.

Pathology Pt. 5 (7 decks)

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