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Pathology (Melicia) > Nervous System Pathology > Flashcards

Nervous System Pathology Flashcards

1
Q

Define Leptomeningitis

A

an inflammatory process that is localized to the interfacing surfaces of the pia and arachnoid, where CSF flows

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2
Q

Which type of meningitis is more common and related to bacteria?

A

leptomeningitis

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3
Q

Define pachymeningitis

A

inflammation of the dura, usually a consequence of contiguous infection, such as chronic sinusitis or mastoiditis.

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4
Q

What is the dura?

A

a barrier to infection

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5
Q

What kind of organism is usually responsible for bacterial meningitis in neonates?

A

e. coli and GBS

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6
Q

What kind of organism is usually responsible for bacterial meningitis in infants?

A

H. influenza

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7
Q

What kind of organism is usually responsible for bacterial meningitis in adults?

A

strep. pneumococcus

gram + diplococcus

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8
Q

What kind of organism is usually responsible for bacterial meningitis in military barracks?

A

neisseria meningitidis

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9
Q

Cerebritis

A

bacterial infection around the brain

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10
Q

encephalitis

A

viral infection inside of the brain

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11
Q

What is the definitive dx index of meningitis?

A

PMNs in the CSF

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12
Q

What is the hallmark of meningitis caused by TB, viral meningitides, and chronic fungal infections

A

lymphocytes

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13
Q

The ….. although delicate, is an effective barrier against the spread of infection and generally prevents involvement of the underlying brain

A

pia

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14
Q

common sxs of bacterial meningitis??

A

H/A, vomiting, and fever, convulsions frequently occur in children.

cervical rigidity, head retraction, +Kernig, +brudzinski

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15
Q

What is Parkinson’s disease?

A

neurologic disorder characterized by the loss of neurons in the Substantia Nigra (strips in midbrain)

tremors at rest, muscular rigidity, expressionless face and emotional lability

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16
Q

When do sxs of Parkinson’s disease usually appear?

A

6th-8th decade

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17
Q

Cause of early onset parkinson disease?

A

due to point mutation of chromosome 4

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18
Q

Main cause of parkinson disease?

A

idiopathic

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19
Q

What is found on gross pathologic association of parkinson disease? microscopic?

A

loss of pigmentation in the Substantia Nigra and Locus Ceruleus

pigmented neurons are scarce with small extracellular deposits of melanin, from necrotic neurons

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20
Q

What are Lewy bodies?

A

residual atrophic nerve cells that contain spherical, granular, eosinophilic cytoplasmic inclusions

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21
Q

What type of dementia has visual hallucinations?

A

Lewy body dementia

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22
Q

Pill rolling tremor?

A

seen in Parkinson disease

present at rest and disappears with voluntary movement

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23
Q

Parkinson disease pts have increase risk of….

A

depression and dementia

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24
Q

Therapy for early parkinson disease?

A

Levodopa, does not rectify underlying disorder and becomes ineffective

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25
Q

Other causes of Parkinson like sxs?

A
  • Drugs: Phenothiazines and Haldol
  • CO or Manganese poisoning
  • Bilateral infarcts of Basal Ganglia
  • Hydrocephalus
  • Tumors near the Basal Ganglia
  • Cerebral Trauma
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26
Q

Define Alzheimer

A

An insidious and progressive neurological disorder characterized by loss of memory, cognitive impairment, and eventual dementia

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27
Q

How can we dx Alzheimer?

A

definitive- autopsy

but can be pretty accurately dx with radiograph + clinical presentation

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28
Q

Most common cause of dementia?

A

Alzheimer

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29
Q

Are women and men affected with Alzheimer’s the same?

A

women 2x more than men

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30
Q

Cause of alzheimer’s disease

A

not fully known but thought to relate to beta-protein amyloid deposition in senile plaques

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31
Q

What occurs grossly in the brain of a pts with Alzheimer’s?

A

loss of neurons and neuritic processes, the gyri narrow, the sulci widen, and bilateral cortical atrophy becomes apparent in the frontal, temporal,parietal and hippocampal cortices

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32
Q

Alzheimers is a …..disease

A

cortical

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33
Q

microscopic pathology of Alzheimer’s disease?

A
  • Senile (neuritic) Plaques
  • Neurofibrillary tangles
  • Amyloid angiopathy
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34
Q

What are senile plaques? Where are they found?

A

discrete spherical masses of silver-staining neuritic processes surrounding a central amyloid core.

Found predominantly in the hippocampus and amygdala, as well as the cortex

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35
Q

What are neurofibrillary tangles? Where are they found?

A

bundles of paired, helical filaments in the cytoplasm of cortical neurons or hippocampal pyramidal cells that displace or encircle the nucleus (flame cells)

cortex, hippocampus and amygdala

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36
Q

Where is amyloid angiopathy found?

A

within cerebral blood vessels seen with congo red stains

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37
Q

Terminal stages of Alzheimer’s disease?

A

incontinent and bedridden

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38
Q

Usual cause of death of alzheimer’s disease?

A

terminal bronchopneumonia

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39
Q

What is Multiple Sclerosis?

A

chronic, demyelinating disease of the CNS in which there are numerous patches of demyelination throughout the white matter.

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40
Q

What is the most common demyelinating disorder?

A

MS

1/1000

41
Q

What does MS affect?

A

both sensory and motor functions

42
Q

Mean age of MS onset?

A

30

more common in women

43
Q

Etiology of MS?

A

unknown

possible: genetic, immune, infectious

44
Q

Hallmark of MS?

A

plaque

variable size with smooth rounded contour

usually situated in white matter

(has preference for optic nerves and chiasm, can also involve cerebellum, brain stem and spinal cord)

45
Q

how is seen MS histologically?

A

selective loss of myelin in a region of axonal preservation

perivascular inflammation of lymphocytes and macrophages with focal edema

46
Q

Course of MS?

A

usually onsets of 3rd/4th decades with periods of exacerbation and remissions

47
Q

Initial sxs of MS?

A

typically begins with symptoms related to lesions of the optic nerves, brainstem or spinal cord.

- Blurred vision, or the loss of vision in one eye, is often the presenting complaint.
- When the initial lesion is in the brainstem, the most troubling early symptoms are double vision and vertigo.
48
Q

Prognosis of MS?

A

pts usually survive 20-30 yrs after the onset

49
Q

How do MS pts typically die?

A

respiratory paralysis or UTIs in terminal coma

50
Q

Cause of berry aneurysms?

A

arterial defects that originate during embryonic development, when the bifurcation of an artery creates a Y-shaped configuration

The circumferential muscular layer of the parent vessel, may fail to interdigitate to the two branches, creating a point of congenital muscular weakness, bridged only by endothelium, the internal elastic lamina, and the slender adventitia

51
Q

Etiology of berry aneurysm?

A

congenital- embryological malformation

52
Q

Rupture of berry aneurysm causes…

A

life threatening subarachnoid hemorrhage

53
Q

initial sxs of ruptured berry aneurysm

A

sudden severe HA = onset of SAH, may be followed by coma

54
Q

Sxs of pts who survive 3-4 days after ruptured berry aneurysm

A

progressive decline in consciousness due to arterial spasm and cerebral ischemia/infarction

55
Q

What can HTN causes in the brain?

A

HTN associated aneurysms

Charcot-Bouchard aneurysms, small fusiform dilatations located on the trunk of a vessel

56
Q

What causes Charcot-Bouchard aneurysms?

A

HTN compromises cerebral arterioles by depositing lipid and hyaline in the walls

57
Q

What happens when Charcot-Bouchard aneurysms rupture?

A

hypertensive cerebral hemorrhage

58
Q

Where do hypertensive intracerebral hemorrhages occur?

A

basal ganglia-thalmus

the pons

the cerebellum (retractable n/v)

59
Q

Sxs Hypertensive Intracerebral Hemorrhage

A

abrupt onset sxs, weakness is most prominent, ataxia, occipital HA, vomiting

when hemorrhage is progressive (which it usually is) death occurs within hrs to days

60
Q

Causes of cerebral infarction

A

Atherosclerosis predisposes to vascular thrombosis > embolic events > ischemia > cerebral infarction

61
Q

What types of cerebral infarcts are more likely to be “bland?”

A

those initiated by thrombotic occlusion are largely ischemic

62
Q

Which cerebral infarcts are more likely “hemorrhagic”?

A

those caused by embolism

an embolus occludes vascular flow abruptly and then ischemic region undergoes necrosis

63
Q

What happens within months are a cerebral infarction?

A

the necrotic area is excavated by phagocytosis and a permanent cyst is formed

64
Q

Where do primary brain tumors usually metastasis?

A

they stay in the brain and spinal cord!

65
Q

all tumors….

A

increase ICP and chance of seizures

66
Q

Brain tumors in adults are…

A

usually in the front

67
Q

Brain tumors in kids are…

A

usually in occiput and cerebellum

68
Q

benign meningioma v. astrocytoma

A

can be just as deadly

69
Q

GBM

A

result in rapid growth and are fatal in a short time

70
Q

What are astrocytomas?

A

glial neoplasms derived from astrocytes

71
Q

What are astrocytes?

A

star shaped cells distributed throughout the nervous system, support neurons and respond to tissue injury

72
Q

Where are astrocytomas usually found? In what pt population?

A

in cerebral hemispheres in adults and cerebellum and pons in kids

usually see in late middle age or older

73
Q

Describe grade I astrocytoma

A

Composes 20% of primary intracranial neoplasms

poorly demarcated and infiltrates the cortex with an indistinct margin

74
Q

Life expectancy for pt with grade I astrocytoma?

A

~5 yrs

75
Q

Describe anaplastic (Grade II) astrocytoma

A

greater cellularity, cellular pleomorphism and anaplasia than well differentiated astrocytoma

rapid tumor growth

76
Q

Life expectancy for grade II astrocytoma?

A

~3 yrs

77
Q

Life expectancy for pt with glioblastoma multiforme? (GBM)

A

~18 months

78
Q

Describe GBM

A

infiltrates extensively in the cortex, freq. crossing the corpus callosum with bi extension into the white matter of both hemispheres with red (recent) and yellow (remote) hemorrhage that looks like a butterfly on gross examination

79
Q

Where do oligodendrogliomas from?

A

in the white matter, predominately in the cerebral hemispheres in adults

80
Q

Describe oligodendrogliomas

A

Well circumscribed gelatinous grey masses, often with cysts, focal hemorrhage and calcifications

slow growing = better prognosis

81
Q

Why oligodendrogliomas grow slowly?

A

due to absence of mitotic figures and necrosis

82
Q

sxs of oligodendrogliomas

A

several yrs of neurologic complaints, including seizures

83
Q

What is an ependymoma?

A

glial tumor most common in the fourth ventricle, producing obstruction and resulting in hydrocephalus

84
Q

Most common location for ependymoma’s in adults? kids?

A

spinal cord

near 4th ventricle

85
Q

Ependymoma prognosis

A

tumor generally grows slowly, but can seed the subarachnoid space with CSF dissemination

avg 4 yr survival after surgery and radiotherapy

86
Q

Where do medulloblastomas arise from?

A

exclusively from the cerebellum

87
Q

What are the small, round, blue cell tumors of childhood?

A

medulloblastoma, neuroblastoma, Ewing’s sarcoma, PNET, Burkitts lymphoma and rhabdomyosarcoma

88
Q

Describe medulloblastoma

A

tumor infiltrates the vermis of the cerebellum aggressively and frequently disseminates through the CSF

tumor is well circumscribed, gray and friable

89
Q

How do children with medulloblastoma present?

A

cerebellar dysfunction (ataxia) or hydrocephalus

90
Q

prognosis for Medulloblastoma

A

highly malignant tumor but extremely radiosensitive if dx early

with total excision and radiation, 10 yr survival rate is 50%

91
Q

What is a meningioma

A

Intracranial tumors that arise from the arachnoid villi and produce symptoms by compressing brain tissue

92
Q

When are meningiomas most commonly seen?

A

4th and 5th decades

majority arise sporadically and exhibit either a deletion or mutation of chromosome 22

93
Q

How do meningiomas appear grossly?

A

well circumscribed, firm, bosselated masses of variable size

94
Q

Sxs of meningiomas

A

tumors in olfactory groove: anosmia

suprasellar region: visual defects, HAs

seizures

95
Q

What happens if you partially excise a meningioma?

A

they recur!!

they typically double in size every 2 yrs

96
Q

What is an acoustic neuroma?

A

intracranial schwannoma restricted to the 8th CN, found in the cerebral pontine angle

97
Q

What sxs do acoustic neuromas cause?

A

tinnitus, deafness, can also compress other CN depending on its size

malignant change is rare

98
Q

How do metastatic tumors reach the brain?

A

through the blood stream

99
Q

Where do most metastatic tumors live in the brain?

A

in the gray-white junction

Pathology (Melicia) (6 decks)

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