Neuropath 2 Flashcards
_______________ are an inflammation of arachnoid, pia mater and CSF in the subarachnoid space
Leptomeningitis
a _____________ is a focal suppurative infection of the brain
Cerebral abscess
what is Encephalitis ?
- diffuse inflammation, infections
- usually viral
characteristics of Acute Bacterial Meningitis (ABM):
- Inflammation of leptomeninges, spreads through subarachnoid space
- Caused by pyogenic bacteria
- Fever, headache, stiff neck, common presenting complaints
what are the risk factors for ABM?
extremes of age, debilitated state, poor hygiene, crowded living conditions.
what are the microscopic characteristics of ABM?
cell types present, staining characteristics
- Meningial exudate contains large number of neutrophils and necrotic cellular debris.
- Gram stain usually shows organisms
characteristics of CHRONIC Tuberculosis Meningitis:
- clinical = > 2-3 weeks of headache,lethargy, nausea & vomiting
- Gelatinous exudate, may appear nodular
- Cranial nerve palsies, epilepsy
what are the microscopic characteristics of Tuberculosis Meningitis?
(cell types present, staining characteristics)
- Lymphocytes, macrophages, and multinucleated giant cells form GRANULOMAS
- Mycobacteria may be demonstrable by ACID FAST STAIN
Characteristics of Cryptococcal Meningitis:
SUBacute meningitis
- microbe = Spherical budding yeast, found in soil and bird excreta
- clinical = Low grade fever, debility, headache.
- Slimy exudate, capsular material
T/F: only immunocompromised individuals are likely to acquire cryptococcal meningitis
FALSE
- both healthy and immunocompromised can get it
how can bacteria spread to the brain to cause an abscess?
Hematogenous or contiguous spread
dental root or ear infections
characteristics of brain abscesses:
- cause = Usually bacterial (S.milleri), also candida
- Fever, focal neurologic deficits (mortality 20%)
- Cavity contains pus and surrounded by a thick wall of granulation tissue and fibrosis
characteristics of encephalitis:
- Diffuse inflammation of brain parenchyma
- VIRAL in origin
- Usually FATAL without treatment
- Inflammation and viral inclusion bodies
what is the most common causative agent of Encephalitis?
Herpes viruses
what is the KEY MICROSCOPIC characteristics of Encephalitis:
- PERIVASCULAR LYMPHOCYTOSIS
T/F: Demyelination disorders-interfere with the integrity of myelin sheath perturbing normal brain electrical activity
true
_____________ is the most common primary demyelinating disorder
Multiple Sclerosis
Clinical signs of multiple sclerosis:
** visual disturbances, speech and gait abnormalities **
- symptoms begin in YOUNG ADULTS
- waxing and waning of signs and symptoms
what causes MS? what are the hallmark histological signs of it in the brain?
- Probably autoimmune in origin (T-cell mediated )
- Hallmark = Irregular areas of demyelination, called MS PLAQUES.
_____________ is the most common cause of Dementia in the elderly
Alzheimer’s disease
T/F: there is a strong familial risk for Alzheimer’s disease
FALSE
- only 10% are familial linked
- most cases have unknown cause
characteristics of Alzheimers disease:
- Grossly, atrophic brain (↓ volume and weight)
- ventricular dilatation.
** Microscopically - senile or neuritic plaque
** neurofibrillary tangle
what is neurofibrillary tangle ?
filamentous aggregates within neuronal cytoplasm
what are the characteristics of the senile and neutritic plaques found in Alzheimer’s?
aggregates of thickened, tortuous processes with central amyloid deposits
what is the clinical presentation of someone with Parkinson’s disease?
- RIGIDITY
- expressionless face
- stooped posture
- fine TREMOR
what causes Parkinson’s disease?
Degeneration of dopamine secreting pigmented neurons of the SUBSTANTIA NIGRA in the midbrain.
Name the gross and microscopic characteristics of Parkinson’s disease:
- Gross: mildly atrophic brain
- Microscopic: intracytoplasmic, eosinophilic inclusions within the PIGMENTED neurons
what are the intracytoplasmic, eosinophilic inclusions of the brain called in someone with parkinson’s?
where are they found?
LEWY bodies
- found inside pigmented neurons
in the substantia nigra
Huntington’s disease is characterized as a spontaneous, involuntary movement disorder known as _______.
Chorea
Characteristics of Huntington’s Disease:
- Hereditary- Autosomal dominant
- mutation on CHROMOSOME 4
- progressive
- FATAL disorder
Gross appearance of Huntington’s disease:
** ATROPHY of the BASAL ganglia
- eg., caudate nucleus, putamen
- in advanced cases, the globus pallidus
Symptoms of central nervous center tumors are a reflection of what?
Symptoms reflect their SITE OF ORIGIN rather than pathologic type
T/F: location is more important than tumor type when dealing with the CNS
true
what is a primary CNS tumor? what about a secondary?
Primary: Arise from cells of the brain, spinal cord or their coverings.
Secondary (metastatic): from lung, breast, prostate etc
what is the most prevalent type of CNS tumor?
Astrocytomas
In what region of the brain are most CNS tumors found in ADULTS?
cerebral hemisphere
describe grades 2, 3 and 4 of CNS tumors:
WHO grades
grades II (well differentiated)
grade III (anaplastic)
grade IV (glioblastoma)
characteristics of grade 2 Astrocytomas:
Mild hyper-cellularity
nuclear pleomorphism
characteristics of grade 3 Astrocytomas:
increased cellularity
mitotic figures
Characterstics of grade IV Glioblastoma s:
Necrosis
microvascular proliferation
Oligodendroglioma have what characteristics?
where are they found, what is the appearance of cells
- Cerebral hemisphere, well circumscribed
- Calcified
- Cells = uniform, round nuclei and PERINUCLEAR HALO
- perinuclear halo = FRIED EGG appearance
____________ are CNS tumors with well circumscribed lesions, arising from VENTRICULAR wall
Ependymoma
perivascular ______________ are characteristic of Ependymomas
perivascular pseudorosettes
T/F: most Ependymoma’s are fast growing
False
Slow growing (usually grade II)
what are perivascular pseudorosettes? where are they found?
= Elongated cells with processes radiating around blood vessels
found in patients with Ependymomas
_____________ are CNS tumors derived from the arachnoid matter
Meningiomas
Gross and microscopic characteristics of Meningiomas:
- Gross = Firm, lobulated lesions with a pushing border with underlying brain
- ***** Histo =
1) cellular WHORLS
2) PSAMMOMA bodies
what 2 histological features are characteristic of Meningiomas?
1) cellular whorls
2) Psammoma bodies
T/F: the brain is a common site for metastatic lesions
True
what 3 cancer types are most likely to metastasize to the CNS?
lungs, breast and cutaneous melanomas
characteristic of Pilocytic Astrocytomas:
A) PEDIATRIC CNS tumor
B) Grade I tumor
C) Usually in the cerebellum & cystic
D) Astrocytes with thin, hair like processes
___________ fibers are characteristic findings of Pilocytic Astrocytomas
Rosenthal fibers
- thin, hair like processes coming off astrocytes
characteristics of Medulloblastoma s:
A) PEDIATRIC brain tumor
B) found in cerebellum
C) grade IV tumor
D) Cells disseminate through CSF
Cells of Medulloblastomas form what characteristic shapes?
Homer-Wright rosettes
name the possible treatments for brain tumors
Contingent on location and histologic grade:
1) stereotactic radiosurgery
2) Intrathecal chemotherapy
3) Proton beam radiation
what is the term for treating brain cancer with both radiation and surgery?
stereotactic radiosurgery
Huntington’s disease is a Spontaneous, involuntary movement disorder known as _______.
Chorea
T/F: location is more important than tumor type when dealing with the CNS
true
T/F: the brain is a common site for metastatic lesions
True
“cowdry typa A inclusions” are associated with what disease?
Encephalitis caused by the HERPES virus
BOTH of the PEDIATRIC tumors that we talked about are likely to be found in what area of the brain?
cerebellum
