Neuro I (b) Flashcards by Elyaa Saleh

HTN in the brain leads to?

1) Hyaline arterioscelrosis
2) Charcot-Bouchard Micro-Aneurysm
3) Lacunar Infarcts
4) Rupture of the small-caliber penetrating vessels
5) Acute Hypertensive Encephalopathy

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loc of Hyaline Arteriosclerosis

basal ganglia and brain stem

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———-: Small cavitary infarcts in basal ganglia, thalamus, internal capsule, pons, etc which is a result in Occlusion of a penetrating artery

Lacunar infarcts

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CF of Acute Hypertensive Encephalopathy

Sudden, sustained increase in diastolic blood pressure (>130mm Hg) –> Increased intracranial pressure –> Headaches, confusion, vomiting, convulsions

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DD of Acute Hypertensive Encephalopathy

Stroke

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Rupture of the small-caliber penetrating vessels suplying deep structures if the brain will result in?

Slit haemorrhage (slit-like cavity)

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———: Infectious arteritis of small and large vessels

Vasculitis

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cause of Vasculitis

Opportunistic infections in immunocompromised individuals

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Vasculitis

In systemic forms of Vasculitis there is Involvement of ———— (e.g. polyarteritis nodosa) –> ————

In systemic forms of Vasculitis there is Involvement of cerebral vessles (e.g. polyarteritis nodosa) –> -Multiple infarcts

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————: Form of vasculitis, affecting small- to medium-sized parenchymal and subarachnoid vessels

Primary Angiitis of the CNS

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Microscopic Findings:
* Chronic inflammatory cell infiltrates
* Multinucleate giant cells (+/- granuloma formation)
* Destruction of vessel walls
* Amyloid-β deposits
* Lumen Oblitertion

features of?

Primary Angiitis of the CNS

* Form fo Vasculitis

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———: Rapid tissue displacement –>Damage of vessels -> Haemorrhage, tissue injury and oedema

Contusion

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Contusion Will cause?

haemorrhage, tissue damage and oedema in the brain

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Loc of a Contusion

1) Orbito-frontal regions
2) Temporal lobe tips

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the 2 types of Contusion

Coup and Contre-Coup injuries

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Macroscopic Features:
* Cross-section: Wedge-shaped
* Old lesions: Depressed, yellowish-brown patches (Crests of gyri)

Microscopic Findings:
* Involvement of superficial layer
* Neuronal cell body injury (nuclear pyknosis and cytoplasmic eosinophilia) within 24 hours
* Inflammatory response: Initially neutrophils and later also macrophages
* Old lesions: Gliosis and haemo-siderophages

features of?

Contusion

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Contusion

Macroscopic Features:
* Cross-section: ———– -shaped
* Old lesions: Depressed, ————– patches (Crests of gyri)

Microscopic Findings:
* Involvement of superficial layer
* Neuronal cell body injury (————- and cytoplasmic eosinophilia) within 24 hours
* —————: Initially neutrophils and later also macrophages
* Old lesions: Gliosis and —————-

Macroscopic Features:
* Cross-section: Wedge-shaped
* Old lesions: Depressed, yellowish-brown patches (Crests of gyri)

* pyknosis: nuclear shrinking

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cause/ patho of Diffuse Axonal injury

Angular acceleration –> Axonal injury and haemorrhage

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location of Diffuse Axonal injury (DAI)

Near the angles of the lateral ventricles
Corpus callosum
Brain-Stem

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Microscopic Findings:
* Axonal swellings (“bulbs”), within hours of the injury
* Axonal Spheroids
* Immuno-histochemistry : β-APP

features of?

Diffuse Axonal injury

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Diffuse Axonal injury

Microscopic Findings:
* Axonal swellings (“——-”), within hours of the injury
* Axonal ——-
* Immuno-histochemistry : ——-

Microscopic Findings:
* Axonal swellings (“bulbs”), within hours of the injury
* Axonal Spheroids
* Immuno-histochemistry : β-APP

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Histochemical stain for diffuse Axonal Injury ?

Silver stain
(detects axonal swelling)

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Immuno-Histochemistry findings in Diffuse Axonal Injury

Amyloid Precussor ProteinAPP

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————– :Penetration of the brain by a projectile (e.g. bullet, bone fragment of the skull –> Tissue tearing, vascular disruption and haemorrhage

Laceration

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**--------**: Reversible altered consciousness from head injury in the absence of contusion

Concussion

CM of Concussions

* **Loss of consciousness** * **Temporary respiratory arrest** (Due to sever perssure ont the brain stem) * **Loss of reflexes**

CNS trauma --> Disruption of the vessel wall -> **-----------**

**Haemorrhage**

The 4 types of Haemorrahge

1) Epidural 2) Subdural 3) Subarachnoid 4) Intra-parenchymal

Cause of Epidural Haematoma

Traumatic injury of the **middle meningeal artery,** after a skull fracture

CM of Epidural Haematoma

Neurosurgical emergency; If left untreated --> Death

causes of Subdural Haematoma

**Tear of the bridging veins**, after trauma

Cause of Subdural Haematoma in Elderly?

Elderly individuals with brain atrophy, due to **stretching of the bridging veins**

patho of Subdural Haematoma

Vein disruption (tear of bridging veins) --> Bleeding into the subdural space

location of Subdural Haematoma

lateral aspects of the cerebral hemispheres

CM of Subdural Haematoma

Within **48 hrs** after injury: * Headache * Confusion * Slowly progressive neurologic deterioration

Macroscopic Features: * Collection of **freshly clotted blood**, over the brain convexity * **Flattening of the underlying brain** * **Ruprture of Bridging veins** * **star-like** invasion of Collagen fibers * Immuno-histo: Combined leukocyes-macrophage rxn, **Siderophages** features of ?

Subdural Haematoma

# ?? not sure if we need to know this stain for Siderophages

Prussian-blue reaction

# ?? not sure if we need know this Stain used for Erythrophagocytosis

Azan

# Progression of Subdural Haematoma * **---------** of the clot (~1 week) * Development of **--------------** from dura (2 weeks) * **--------** (1-3 months) * **----------** of the fibrosing lesion -> Thin layer of connective tissue **(------------”)** * Commonly, **--------------** (chronic subdural haematoma)

* **Lysis** of the clot (~1 week) * Development of **Granulation tissue** from dura (2 weeks) * **Fibrosis** (1-3 months) * **Retraction** of the fibrosing lesion -> Thin layer of connective tissue **("Subdural membrane”)** * Commonly, **re-bleeding** (chronic subdural haematoma)

Most frequent type of CNS malformation?

Neural tube malformations

Risk factors of Neural tube defects

Folate deficiency during the initial weeks of gestation

Defects in the posterior end of the Neural Tube will result in

1) Spina Bifida Occulta 2) Meningocele and 3) Myelo-Meningocele

Defects in the anterior end of the Neural Tube

1) **Anencephaly:** Absence of the brain and the top of skull 2) **Encephalocele**

**------------**: Abnormally large brain volume

Megaloencephaly

**---------**: Abnormally small brain volume, which occurs together with a small head

Micro(en)cephaly

Risk factors of Microencephaly

Fetal alcohol syndrome, HIV infection (acquired in utero), **Zika virus**

patho of Microencephaly

**Decreased generation of neurons** that will populate the cerebral cortex

Which condition is known as **"Smooth brain"** ?

Lissencephaly

patho of Lissencephaly

**Total absence of gyration** or pachygyria (patchy involvement) --> **“Smooth brain”**

Macroscopic features: * Complete absence of Gyration --> **"Smooth brain"** * Abnormally thickened cortex * **Four cortical layers** Microscopic features: * Mylein sheath * reactive astrocytes around vessles * reticullar pattern of the deep cortical layer features of?

Lissencephaly

Patho of Polymicrogyria

Numerous **irregularly formed gyri** --> **Cobblestone-like surface**

Macroscopic features: * Numerous irregulary formed gyri --> **Cobbelstone - like surface** * Many gyri Microscopic features: * **A festooned cortex w/ fusion of Gyri** features of?

Polymicrogyria

pathophysio of Holoprosencephaly

Absence of the olfactory bulbs **(Arrhinencephaly)**

Absence of the olfactory bulb is known as ?

Arrhinencephaly | * Mild form of Holoprosencephaly

Mild form of Holoprosencephaly?

**Arrhinencephaly** - Absence of The Olfactory bulbs

sever forms of Holoprosecncephaly are associated w?

facial midline defects (e.g. **cyclopia**)

Macroscopic features: * Fused cerebral hemispheres and thalamus * Absent sulci * **Absence of Olfactory nerve** features of?

**Alobar** Holoprosencephaly

Posterior Fossa Anomalies

1) Chiari Type I malformation 2) Arnold-Chiari (Chiari Type II) Malformation 3) Dandy-Walker Malformation

CM of Chiari Type I Malformation

partial Obstruction of the CSF flow and compression of the medulla --> **Sever headaches** or **Cranial nerver deficits** | * manifested in adulthood

Macroscopic features: * Low-lying cerebellar tonsils, extending through the foramen magnum * **Protrusion of the tonsils** into the foramen magnum features of?

Chiari Type I malformation

Arnold-Chiari (Type II) Malformation Coexists w?

**hydrocephalus** and lumbar myelo-meningocele

Macroscopic features: * **Small** posterior fossa * Misshaped midline cerebellum * **Protrusion of tonsil and vermis** below the foramen magnum * **Hydrocephalus** * **Narrowing of the 4th Ventricle** * Elongation of the brain stem and Vermis features of?

Arnold-Chiari Malformation

Macroscopic features: * **Enlarged** posterior fossa * **Absence** of the cerebellar **vermis** * Large midline cyst * Cystic **dilatation of the 4th Ventricle** Microscopic features: * Agenesis of the cerebellar Vermis * **Microgyri in the cerebral cortex** features of?

Dandy-Walker Malformation

Spinal cord Abnormalities examples

1) Hydromyelia 2) Syringomyelia

Hydromyelia are associated w?

hydrocephalus or Chiary malformation type II and Dandy-Walker syndrome

Pathophysio of Hydromyelia Abnormal **---------------** of the central canal of the **--------** --> Cavity connected to the 4th ventricle, with possible build up of **----------**--> pressure on the spinal cord--> **-------------** of nerve cells and their connections

Abnormal **widening** of the central canal of the **spinal cord** --> Cavity connected to the 4th ventricle, with possible build up of **CSF**--> pressure on the spinal cord--> **Damage** of nerve cells and their connections

Syingomyelia commonly coexists w?

Chiari malformation type I or have experienced spinal cord trauma

Cerebral palsy is a non-progressive neurological motor deficit, characterized by?

1) Ataxia or Athetosis 2) Spasticity 3) Dystonia 4) Paresis (muscle weakness)

Types of Brain Injuries in the Perinatal Period

1) Haemorrhages (Eventually causes Hydrocephalus) 2) Infarcts