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Basic Human Pathology 2 > Neuropathology > Flashcards

Neuropathology Flashcards

1
Q

what do glial cells do

A

regulate homeostasis
provide support and protection to neurons

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2
Q

what does an astrocyte do

A

maintain blood barrier

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3
Q

what does an oligodendrocyte do

A

myeline CNS axons

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4
Q

what does a microglial cell do

A

act as a phagocyte

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5
Q

what do ependymal cells do

A

produce CSF

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6
Q

what are the 5 changes seen in acute neural injury (red neurons)

A

1.) shrinkage of cell body
2.) pyknosis of nucleus
3.) lack of nucleolus
4.) loss of Nissl substance
5.) eosinophilia of cytoplasm

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7
Q

what is the best indicator of neuronal injury

A

reactive glial cell changes

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8
Q

what is the most important histopathologic marker of CNS injury

A

gliosis

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9
Q

what is gliosis

A

injury of astrocytes that leads to hypertrophy and hyperplasia

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10
Q

what are the two hallmarks of gliosis

A

Rosenthal fibers and corpora amylacea

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11
Q

what is corpora amylacea

A

brain sand - polyglucosan aggregates from waste products

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12
Q

what are the 4 steps of microglia response to injury

A

1.) proliferate
2.) formation of elongated nuclei (rods)
3.) formation of aggregates around tissue necrosis
4.) congregation around cell bodies of dying neurons

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13
Q

what can be seen histologically in oligodendrocyte injury

A

nuclear viral inclusions or cytoplasmic inclusions

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14
Q

what are ependymal granulations

A

small irregularities on the ventricular surfaces caused by astrocyte proliferation

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15
Q

which condition can cause ependymal injury with viral inclusions

A

cytomegalovirus (CMV)

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16
Q

what are the three main causes of increased intracranial pressure

A

1.) brain edema
2.) hydrocephalus (increased CSF)
3.) expanding masses

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17
Q

what are the two types of cerebral edema

A

1.) vasogenic edema
2.) cytotoxic edema

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18
Q

what is vasogenic edema

A

blood brain barrier disruption causes increase in extracellular fluid

only affects white matter

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19
Q

what is cytotoxic edema

A

injury to cells causes secondary increase in intraceullar fluid

common in cases of obesity and diabetes

affects white and gray matter

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20
Q

what are the three changes associated with generalized cerebral edema

A

1.) flattening of gyri
2.) narrowing of sulci
3.) compression of ventricles

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21
Q

what is the main change associated with interstitial cerebral edema

A

lateral ventricle compression

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22
Q

which structure generates the CSF

A

choroid plexus

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23
Q

what is hydrocephalus

A

accumulation of successive CSF in the ventricular system of the brain

most commonly cause by impaired flow and resorption of CSF

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24
Q

what is hydrocephalus ex vacuo

A

compensatory increase in ventricular volume secondary to loss of brain parenchyma
ex. Alzheimer’s

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25
Q

what is a subfalcine herniation

A

asymmetric expansion of cerebral hemisphere that displaces the cingulate gyrus under the falx

can cause compression of anterior cerebral artery

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26
Q

what causes a red neuron

A

lack of oxygen (hypoxia)

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27
Q

what is a transtentorial herniation

A

compression of medial temporal lobe against free margin of tentorium

can cause compression of third cranial nerve (oculomotor) or the posterior cerebral artery which would affect the eyes

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28
Q

what is a tonsillar herniation

A

displacement of cerebellar tonsils through the foramen magnum

can cause brainstem compression - most deadly

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29
Q

what are duret hemorrhages

A

secondary hemorrhagic lesions in the midbrain and pons due to progression herniation

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30
Q

what is the most common form of CNS malformation

A

neural tube defects

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31
Q

the most common neural tube defect involves what

A

the spinal cord

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32
Q

what is a well-known risk factor for a neural tube defect

A

folate deficiency

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33
Q

what is the most common type of neural tube defect

A

spina bifida occulta

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34
Q

what is a meningoencephalocele

A

neural tube defect where a large portion of the occipitoparietal brain tissue protrudes through the posterior fontanel

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35
Q

a meningoencephalocele is associated with which condition

A

Meckel-Gruber syndrome

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36
Q

what is iniencephaly

A

lack of occipital bone and cervicothoracic spinal fusion

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37
Q

what is anencephaly

A

absence of scalp, cranium, and most of brain

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38
Q

what is craniorachischisis

A

combination of ancenphaly and boney spinal defect

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39
Q

what are the three main causes of macrocephaly and microcephaly

A

1.) chromosome abnormalities
2.) fetal alcohol syndrome
3.) HIV infection in utero

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40
Q

what is the main consequence of agenesis of the corpus callousum

A

prevents both sides of brain from communicating

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41
Q

which three malformations are associated with posterior fossa anomalies (malformations of brainstem and cerebellum)

A

1.) Arnold-Chiari
2.) Chiari Type 1
3.) Dandy-Walker

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42
Q

what is Arnold-Chiari (type 2) malformation

A

abnormally small posterior fossa and misshapen midline extensions of vermis through foramen magnum

causes hydrocephalus and lumbar myelomeningocele

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43
Q

Arnold-Chiari (type 2) malformation is associated with what

A

spina bifida

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44
Q

what is Chiari type 1 malformation

A

low-lying cerebellar tonsils that extent into the vertebral canal

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45
Q

what is Dandy-Walker malformation

A

enlargement of posterior fossa leads to absence of cerebellar vermis and replacement by midline cyst

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46
Q

what Cerebral Palsy

A

neurologic motor deficit due to injury in prenatal and perinatal periods of development

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47
Q

what three things can be seen in Cerebral Palsy

A

1.) hemorrhage
2.) periventricular leukomalacia
3.) multi cystic encephalopathy

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48
Q

what is periventricular leukomalacia

A

infarcts in the periventricular white matter seen in Cerebral Palsy

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49
Q

what is multicystic encephalopathy

A

large, destructive cystic lesions in the brain caused by ischemic damage

seen in Cerebral Palsy

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50
Q

what is a displaced skull fracture

A

one that extends beyond the thickness of the cranium

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51
Q

conscious falls tend to affect which area of the skull

A

occipital fractures

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52
Q

unconscious falls tend to affect which area of the skull

A

frontal fractures

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53
Q

what is a diastatic fracture

A

skull fracture whose line transverses one or more suture of the skull and lead to its widening

most common in infants an young children

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54
Q

contusions and lacerations of the brain are most common in which two regions

A

1.) frontal
2.) temporal

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55
Q

what is a plaque jaune

A

remote contusion of the brain which is a yellow color

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56
Q

what is an epidural hematoma

A

pooling of arterial blood between the dura and periosteum

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57
Q

what is a subdural hematoma

A

pooling of venous blood between the dura and brain parenchyma

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58
Q

what is the gross appearance of an acute subdural hematoma

A

collection of freshly clotted blood along the brain’s surface that doesn’t go down into the sulci

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59
Q

what are the three steps to the breakdown of a subdural hematoma

A

1.) lysis of clot (1 week)
2.) growth of fibroblasts into hematoma (2 weeks)
3.) development of hyalinized connective tissue (1-3 months)

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60
Q

cord injury at and below the level of the thoracic vertebrae often causes what

A

paraplegia

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61
Q

cord injury at the level of the cervical vertebrae often causes what

A

quadriplegia

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62
Q

cervical lesions above C4 can often causes what

A

respiratory compromise and paralysis of the diaphragm

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63
Q

what is a stroke and what are the two types

A

sudden interruption of blood flow to the brain

types: ischemic and hemorrhagic

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64
Q

what is an ischemic stroke

A

hypoxia, ischemia, and infarction caused by impairment of blood supply

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65
Q

what is the most common cause of an ischemic stroke

A

embolism

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66
Q

which two things can cause a hemorrhagic stroke

A

1.) hypertension
2.) vascular anomalies like aneurysms

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67
Q

what is a hemorrhagic stroke

A

rupture of blood vessel leads to hemorrhage

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68
Q

the brain receives about ____% of the body’s resting cardiac output

A

15%

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69
Q

what are the three survival factors in regards to a cerebrovascular brain injury

A

1.) collateral circulation
2.) duration of ischemia
3.) magnitude of event and timeliness of onset

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70
Q

what is global cerebral ischemia (diffuse ischemic/hypoxic encephalopathy)

A

reduction of cerebral perfusion caused by cardiac arrest, shock, or severe hypotension

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71
Q

which brain cell, neurons or glial cells, are most sensitive to hypoxia

A

neurons

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72
Q

which three types of neurons are most sensitive to hypoxia

A

1.) pyramidal cells of hippocampus
2.) purkinje cells of cerebral cortex
3.) pyramidal neurons in cerebral cortex

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73
Q

which area of the brain is at most risk for watershed infarct

A

area between anterior and middle cerebral artery

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74
Q

what is the border (watershed) zone

A

regions of brain/spinal cord most distal to the anterior blood supply

damage here produces sickle-shaped band of necrosis

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75
Q

the major source of collateral flow in the brain is what

A

the circle of Willis

76
Q

which three locations have the least amount of collateral flow within the brain

A

1.) thalamus
2.) basal ganglia
3.) deep white matter

77
Q

which artery is most at risk for a cerebral infarct caused by embolus

A

middle cerebral artery

78
Q

what are the three main causes of a paradoxical emboli

A

1.) cardiac anomalies in children
2.) cardiac surgery
3.) tumor, fat, or air

79
Q

fat embolism syndrome is a common occurrence after what

A

after fractures and trauma to the bone marrow

80
Q

what are the three most common locations of a cerebral infarct caused by thrombus

A

1.) bifurcation of carotid arteries
2.) origin of middle cerebral artery
3.) end of basilar artery

81
Q

cerebral infarct caused by thrombus is often associated with which two conditions

A

1.) hypertension
2.) diabetes

82
Q

what are the two main causes of a cerebral infarct caused by inflammation of blood vessels

A

1.) infectious vasculitis
2.) non-infectious vasculitis

83
Q

what are the two main causes of infectious vasculitis

A

1.) syphilis
2.) TB

84
Q

what are the three main causes of non-infectious vasculitis

A

1.) polyarteritis nodosa
2.) primary angitis of the CNS
3.) granulomatous angitis

85
Q

what are three causes of cerebral infarcts caused by “other” things

A

1.) hypercoagulation states
2.) dissecting aneurysm of arteries in the neck
3.) drug abuse

86
Q

which two conditions can cause lacunar infarcts

A

1.) diabetes
2.) hypertension

87
Q

what is seen histologically in the beginning stages of acute ischemic injury of the brain

A

diffuse eosinophilia of shrinking neurons

88
Q

what is seen histologically 10 days after an acute cerebral infarct

A

foamy macrophages and reactive gliosis with neovascularization

89
Q

what are Charcot-Bouchard microaneurysms

A

minute aneurysms seen in an intracranial hemorrhage

90
Q

what is the most common cause of a subarachnoid hemorrhage

A

rupture of a berry aneurysm in a cerebral artery

91
Q

what is the most common type of intracranial aneurysm

A

saccular

92
Q

what is the most common location for a saccular aneurysms

A

anterior communication artery

93
Q

which two things increase your risk for a saccular aneurysms

A

1.) smoking
2.) hypertension

94
Q

what are the four main types of vascular malformations

A

1.) arteriovenous
2.) cavernous
3.) capillary telangiectasias
4.) venous angiomas

95
Q

what is an arteriovenous malformation

A

tangled network of vasculature with arteriovenous shunting

96
Q

what is the most common type of significant venous malformation

A

arteriovenous

97
Q

what is the most common site of an arterivenous malformation

A

middle cerebral artery

98
Q

what is a cavernous malformation

A

tightly packed, low flow vessels not associated with arteriovenous shunting

99
Q

what are the three most common locations for a cavernous malformation

A

1.) cerebellum
2.) pons
3.) subcortical region

100
Q

what is capillary telangiectasis

A

microscopic dilated, thin walled vascular channels within normal brain parenchyma

101
Q

what is the most common location for capillary telangiectasis

A

pons

102
Q

what is the most common spread type of a CNS infection

A

hematogenous

103
Q

what are the four spread pathways of CNS infections

A

1.) hematogenous
2.) retrograde venous
3.) direct implantation
4.) local extension

104
Q

what is retrograde venous spread

A

spread via anastomoses with veins of the face

105
Q

what is direct implantation spread

A

microorganisms gain access through traumatic opening or congenital malformation

106
Q

what causes acute pyogenic meningitis

A

bacterial infection

107
Q

what cases aseptic meningitis

A

viral infection

108
Q

what causes chronic meningitis

A

TB, spirochete, or cryptococcal infections

109
Q

what will an aseptic meningitis spinal tap reveal

A

high lymphocyte count
protein elevation
normal glucose

110
Q

which two organisms most commonly cause acute pyogenic meningitis in neonates

A

1.) E. coli
2.) group B strep

111
Q

which organism most commonly causes acute pyogenic meningitis in adolescents and young adults

A

neisseria

112
Q

which two organisms most commonly cause acute pyogenic meningitis in older adults

A

1.) strep. pneumo
2.) listeria

113
Q

which vaccine can lower the risk of acquiring acute pyogenic meningitis

A

flu vaccine

114
Q

what are the 5 main symptoms of acute pyogenic meningitis

A

1.) headache
2.) fever
3.) photophobia
4.) neck stiffness
5.) irritability

115
Q

which syndrome is associated with acute pyogenic meningitis

A

Waterhouse-Friderichsen syndrome

116
Q

what are the two most common organisms to cause acute focal suppurative infections (brain abscesses)

A

strep and staph

117
Q

what usually causes a subdural empyema

A

bacterial infections of skull or air sinuses like sinusitis or osteomyelitis

118
Q

an extradural abscess is most commonly associated with which condition

A

osteomyelitis

119
Q

which three organisms most commonly cause chronic bacterial meningoencephalitis

A

1.) TB
2.) syphilis (treponema)
3.) borrelia (Lyme disease)

120
Q

what is the most frequent clinical presentation of meningovascular syphilis

A

stroke

121
Q

what is Heubner arteritis

A

thickening and lymphocytic infiltration of intima seen in neurosyphilis

122
Q

how is an aseptic case of meningitis diagnosed

A

through absence of bacteria in culture

123
Q

what will a bacterial meningitis spinal tap reveal

A

high neutrophil count
high protein
low glucose

124
Q

what are the two main things seen histologically in aseptic meningitis

A

1.) perivascular cuffs of lymphocytes
2.) microglial nodules

125
Q

what is arthropod-borne viral meningoencephalitis

A

viral infections that have animal hosts and insect vectors (mosquitos and ticks)

ex. West Nile encephalitis

126
Q

which regions of the brain are most affected by HSV-1

A

inferior and medial regions of temporal lobes

orbital gyri of frontal lobes

127
Q

HSV-2 causes what in adults

A

meningitis

128
Q

HSV-2 causes what in neonates

A

severe encephalitis

129
Q

who is most affected by cytomegalovirus (CMV)

A

immunosuppressed individuals (HIV) and fetuses

130
Q

15% of those with CMV develop what

A

hearing loss

131
Q

CMV affects the brain in which three ways

A

1.) periventricular necrosis
2.) microcephaly
3.) periventricular calcification

132
Q

what is poliomyelitis

A

nervous system involvement due to infection with the poliovirus

133
Q

what are pathognomonic to rabies

A

Negri bodies - inclusions found in pyramidal neurons of hippocampus and Purkinje cells of cerebellum

134
Q

what are the three neuropathologic effects seen in HIV with antiviral therapy

A

1.) aseptic meningitis
2.) mild lymphocytic meningitis
3.) HIV encephalitis

135
Q

which two things are common to see histologically in HIV cases

A

1.) microglial nodule
2.) multinucleated giant cell

136
Q

what causes progressive multifocal leukoencephalopathy encephalitis

A

JC polyomavirus

137
Q

what is progressive multifocal leukoencephalopathy encephalitis

A

JC polyomavirus infection of oligodendrocytes causes demyelination

138
Q

which fungal infection is common in those with AIDS

A

cryptofoccus neoformans

139
Q

fungal infections most often cause which three forms of CNS injury

A

1.) chronic meningitis
2.) vasculitis
3.) parenchymal invasion

140
Q

what are two examples of protozoal diseases that can affect the nervous system

A

1.) malaria
2.) toxoplasmosis

141
Q

what are two examples of Rickettsial infections that can affect the nervous system

A

1.) typhus
2.) Rocky Mountain spotted fever

142
Q

what are two examples of Metazoal disease that can affect the nervous system

A

1.) cysticercosis
2.) echinococcosis

143
Q

which four types of pathologic processes can result in loss of myelin

A

1.) immune-mediated
2.) viral
3.) drug
4.) inherited disorders

144
Q

what is the most common demyelinating disorder

A

multiple sclerosis

145
Q

what is multiple sclerosis

A

autoimmune demyelinating disorder that mostly affects the myelin sheath and white matter

146
Q

CSF tap of multiple sclerosis would show which two things

A

1.) mildly elevated protein
2.) elevated IgG levels

147
Q

which stain is used to diagnose multiple sclerosis

A

Luxol fast blue periodic acid-Schiff stain

148
Q

what is the pathologic process of neurodegenerative diseases

A

accumulation of protein aggregates (proteinopathy)

149
Q

what is a prion

A

type of abnormally formed cellular protein that can trigged normal proteins in the brain to fold abnormally

150
Q

what is the most common prion disease

A

Creutzfeldt-Jakob disease (CJD)

151
Q

what is seen histologically in someone with Creutzfeldt-Jakob disease (CJD)

A

Kuru plaques (deposits of abnormal PrP)

may have halo of spongiform change in mad cow disease variant

152
Q

what is the most common cause of dementia in older adults

A

Alzheimer disease

153
Q

what are the two key features of Alzheimer’s

A

accumulation of Amyloid beta and tau proteins

154
Q

what is seen grossly in an Alzheimer brain

A

cortical atrophy of frontal, temporal, and parietal lobes

155
Q

what are the two key microscopic features of Alzheimer’s

A

1.) neuritic (senile) amyloid plaques
2.) neurofibrillary tangles (contain Tau)

156
Q

what is the main cause of Parkinson disease

A

loss of dopaminergic neurons from the substantia nigra

157
Q

what is the histologic hallmark of Parkinson disease

A

alpha-synuclein that forms Lewy bodies and Lewy inclusions

158
Q

what is the main cause of Huntington disease

A

degeneration of striatal neurons in basal ganglia

159
Q

what is seen grossly in someone with Huntington disease

A

atrophy of caudate nucleus and putamen

160
Q

what is the most common form of motor neuron disease

A

amyotrophic lateral sclerosis (ALS)

161
Q

what is amyotrophic lateral sclerosis (ALS)

A

loss of upper and lower motor neurons with evidence of toxic protein accumulation

162
Q

what is seen grossly in the brain of someone with chronic carbon monoxide poisoning

A

ischemic or hemorrhage necrosis in globus pallidus

demyelination in white matter that doesn’t affect arcuate fibers

163
Q

what is seen grossly in the brain of someone with ethanol poisoning (chronic alcoholism)

A

1.) cerebral dysfunction
2.) atrophy and loss of granule cells in vermis

164
Q

what is the most important factor in the outcome of a patient with a CNS tumor

A

location of tumor

165
Q

which lobe of the brain is most commonly affect by tumor

A

frontal

166
Q

what is the most common type of primary brain tumor in adults

A

grade 4 glioblastoma multiforme

167
Q

what is the most common primary glioma

A

astrocytoma

168
Q

what are the two main types of astrocytomas

A

1.) diffusely infiltrating
2.) localized

169
Q

what is the most common type of localized astrocytoma

A

pilocytic

170
Q

what is the most common location of a diffusely infiltrating astrocytoma

A

cerebral hemispheres

171
Q

which types of glial tumor has the best prognosis

A

oligodendroglioma

172
Q

what is the gross appearance of an oligodendroglioma

A

gelatinous with cysts, focal hemorrhage, and calcification

173
Q

what is the histologic appearance of an oligodendroglioma

A

anastomosing capillaries resembling chicken wire and granular chromatin

174
Q

chicken wire appearance is associated with which condition

A

oligodendroglioma

175
Q

what are the three main histologic features of a pilocytic astrocytoma

A

1.) hairlike processes
2.) Rosenthal fibers
3.) mulberry like granular bodies

176
Q

which stain is used for the hairlike processes seen in a pilocytic astrocytoma

A

GFAP+

177
Q

what is the microscopic feature of an ependymoma

A

perivascular pseudorosettes

178
Q

what is the most common type of embryonal neoplasm of the brain

A

medulloblastoma within the cerebellum

179
Q

what is the most common neoplasm in immunocompromised patients

A

primary CNS lymphoma

180
Q

what is seen histologically in primary CNS lymphoma

A

malignant cells around vessels and necrosis

181
Q

what is a risk factor for the development of a meningioma

A

radiation therapy to head and neck

182
Q

what is the most common genetic abnormality to cause a meningioma

A

loss of chromosome 22

183
Q

what is the gross appearance of a meningioma

A

rubbery and bosselated

184
Q

what is seen histologically in a meningioma

A

psammoma bodies

185
Q

what are the 5 most common primary metastasis sites of brain tumors

A

1.) lung
2.) breast
3.) skin
4.) kidney
5.) GI

Basic Human Pathology 2 (14 decks)

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