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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
Other causes of Parkinson like sxs?
- Drugs: Phenothiazines and Haldol - CO or Manganese poisoning - Bilateral infarcts of Basal Ganglia - Hydrocephalus - Tumors near the Basal Ganglia - Cerebral Trauma
26
Define Alzheimer
An insidious and progressive neurological disorder characterized by loss of memory, cognitive impairment, and eventual dementia
27
How can we dx Alzheimer?
definitive- autopsy but can be pretty accurately dx with radiograph + clinical presentation
28
Most common cause of dementia?
Alzheimer
29
Are women and men affected with Alzheimer's the same?
women 2x more than men
30
Cause of alzheimer's disease
not fully known but thought to relate to beta-protein amyloid deposition in senile plaques
31
What occurs grossly in the brain of a pts with Alzheimer's?
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
32
Alzheimers is a .....disease
cortical
33
microscopic pathology of Alzheimer's disease?
- Senile (neuritic) Plaques - Neurofibrillary tangles - Amyloid angiopathy
34
What are senile plaques? Where are they found?
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
35
What are neurofibrillary tangles? Where are they found?
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
36
Where is amyloid angiopathy found?
within cerebral blood vessels seen with congo red stains
37
Terminal stages of Alzheimer's disease?
incontinent and bedridden
38
Usual cause of death of alzheimer's disease?
terminal bronchopneumonia
39
What is Multiple Sclerosis?
chronic, demyelinating disease of the CNS in which there are numerous patches of demyelination throughout the white matter.
40
What is the most common demyelinating disorder?
MS 1/1000
41
What does MS affect?
both sensory and motor functions
42
Mean age of MS onset?
30 more common in women
43
Etiology of MS?
unknown | possible: genetic, immune, infectious
44
Hallmark of MS?
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
how is seen MS histologically?
selective loss of myelin in a region of axonal preservation perivascular inflammation of lymphocytes and macrophages with focal edema
46
Course of MS?
usually onsets of 3rd/4th decades with periods of exacerbation and remissions
47
Initial sxs of MS?
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
Prognosis of MS?
pts usually survive 20-30 yrs after the onset
49
How do MS pts typically die?
respiratory paralysis or UTIs in terminal coma
50
Cause of berry aneurysms?
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
Etiology of berry aneurysm?
congenital- embryological malformation
52
Rupture of berry aneurysm causes...
life threatening subarachnoid hemorrhage
53
initial sxs of ruptured berry aneurysm
sudden severe HA = onset of SAH, may be followed by coma
54
Sxs of pts who survive 3-4 days after ruptured berry aneurysm
progressive decline in consciousness due to arterial spasm and cerebral ischemia/infarction
55
What can HTN causes in the brain?
HTN associated aneurysms Charcot-Bouchard aneurysms, small fusiform dilatations located on the trunk of a vessel
56
What causes Charcot-Bouchard aneurysms?
HTN compromises cerebral arterioles by depositing lipid and hyaline in the walls
57
What happens when Charcot-Bouchard aneurysms rupture?
hypertensive cerebral hemorrhage
58
Where do hypertensive intracerebral hemorrhages occur?
basal ganglia-thalmus the pons the cerebellum (retractable n/v)
59
Sxs Hypertensive Intracerebral Hemorrhage
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
Causes of cerebral infarction
Atherosclerosis predisposes to vascular thrombosis > embolic events > ischemia > cerebral infarction
61
What types of cerebral infarcts are more likely to be "bland?"
those initiated by thrombotic occlusion are largely ischemic
62
Which cerebral infarcts are more likely "hemorrhagic"?
those caused by embolism an embolus occludes vascular flow abruptly and then ischemic region undergoes necrosis
63
What happens within months are a cerebral infarction?
the necrotic area is excavated by phagocytosis and a permanent cyst is formed
64
Where do primary brain tumors usually metastasis?
they stay in the brain and spinal cord!
65
all tumors....
increase ICP and chance of seizures
66
Brain tumors in adults are...
usually in the front
67
Brain tumors in kids are...
usually in occiput and cerebellum
68
benign meningioma v. astrocytoma
can be just as deadly
69
GBM
result in rapid growth and are fatal in a short time
70
What are astrocytomas?
glial neoplasms derived from astrocytes
71
What are astrocytes?
star shaped cells distributed throughout the nervous system, support neurons and respond to tissue injury
72
Where are astrocytomas usually found? In what pt population?
in cerebral hemispheres in adults and cerebellum and pons in kids usually see in late middle age or older
73
Describe grade I astrocytoma
Composes 20% of primary intracranial neoplasms poorly demarcated and infiltrates the cortex with an indistinct margin
74
Life expectancy for pt with grade I astrocytoma?
~5 yrs
75
Describe anaplastic (Grade II) astrocytoma
greater cellularity, cellular pleomorphism and anaplasia than well differentiated astrocytoma rapid tumor growth
76
Life expectancy for grade II astrocytoma?
~3 yrs
77
Life expectancy for pt with glioblastoma multiforme? (GBM)
~18 months
78
Describe GBM
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
Where do oligodendrogliomas from?
in the white matter, predominately in the cerebral hemispheres in adults
80
Describe oligodendrogliomas
Well circumscribed gelatinous grey masses, often with cysts, focal hemorrhage and calcifications slow growing = better prognosis
81
Why oligodendrogliomas grow slowly?
due to absence of mitotic figures and necrosis
82
sxs of oligodendrogliomas
several yrs of neurologic complaints, including seizures
83
What is an ependymoma?
glial tumor most common in the fourth ventricle, producing obstruction and resulting in hydrocephalus
84
Most common location for ependymoma's in adults? kids?
spinal cord near 4th ventricle
85
Ependymoma prognosis
tumor generally grows slowly, but can seed the subarachnoid space with CSF dissemination avg 4 yr survival after surgery and radiotherapy
86
Where do medulloblastomas arise from?
exclusively from the cerebellum
87
What are the small, round, blue cell tumors of childhood?
medulloblastoma, neuroblastoma, Ewing's sarcoma, PNET, Burkitts lymphoma and rhabdomyosarcoma
88
Describe medulloblastoma
tumor infiltrates the vermis of the cerebellum aggressively and frequently disseminates through the CSF tumor is well circumscribed, gray and friable
89
How do children with medulloblastoma present?
cerebellar dysfunction (ataxia) or hydrocephalus
90
prognosis for Medulloblastoma
highly malignant tumor but extremely radiosensitive if dx early with total excision and radiation, 10 yr survival rate is 50%
91
What is a meningioma
Intracranial tumors that arise from the arachnoid villi and produce symptoms by compressing brain tissue
92
When are meningiomas most commonly seen?
4th and 5th decades majority arise sporadically and exhibit either a deletion or mutation of chromosome 22
93
How do meningiomas appear grossly?
well circumscribed, firm, bosselated masses of variable size
94
Sxs of meningiomas
tumors in olfactory groove: anosmia suprasellar region: visual defects, HAs seizures
95
What happens if you partially excise a meningioma?
they recur!! they typically double in size every 2 yrs
96
What is an acoustic neuroma?
intracranial schwannoma restricted to the 8th CN, found in the cerebral pontine angle
97
What sxs do acoustic neuromas cause?
tinnitus, deafness, can also compress other CN depending on its size malignant change is rare
98
How do metastatic tumors reach the brain?
through the blood stream
99
Where do most metastatic tumors live in the brain?
in the gray-white junction

Pathology (Melicia) (6 decks)

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