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SP16- Gen Path Exam 3 > Neuropathology > Flashcards

Neuropathology Flashcards

1
Q

The brain parenchyma consists of neurons supported by a framework of _____ cells.

A

glial

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2
Q

What are three types of glial cells?

A
  1. astrocytes
  2. oligodendrocytes
  3. ependymal cells
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3
Q

What are the “functional units” of the brain?

A

neurons

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4
Q

Are neurons larger in the cerebellum or the cerebral cortex?

A

cerebral cortex

more importantly…just note that neurons have varying sizes throughout the brain ~5 to 100 micrometers

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5
Q

_____ bodies are granules of rough endoplasmic reticulum (RER) with free ribosomes and are the sites of protein synthesis within the neuron

A

Nissl

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6
Q

What is a common change in neurons that is associated with hypoxic/ischemic injury of the brain?

A 
Cytoplasmic Eosinophilia (red neurons)
-loss of ribonucleoproteins and denaturation of cytoskeletal proteins
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7
Q

What are astrocytes?

A

the major supporting cells of the brain

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8
Q

How do astrocytes respond to brain injury?

A

they produce a dense network of cytoplasmic processes surrounding the area of injury (similar to a fibrous scar that occurs elsewhere in the body) = REACTIVE GLIOSIS

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9
Q

Injury to _______ results in demyelinating disorders such as MS.

A

oligodendrocytes

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10
Q

What is the purpose of oligodendrocytes?

A

formation and maintenance of central myelin

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11
Q

_____ cells line the ventricles of the brain.

A

Ependymal

cells vary in shape/size…columnar or cuboidal

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12
Q

_______, such as phagocytes and macrophages, are derived from ______.

A

microglia

circulating monocytes

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13
Q

What purpose do microglia serve?

A
  • they act as antigen presenting cells in inflammatory conditions
  • they appear as ROD CELLS in some infections
  • they act as scavengers during tissue necrosis
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14
Q

How quickly do neurons respond to CNS injury?

A

within 12 hours

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15
Q

______ are primarily responsible for repair and scar formation after CNS injury and will form Rosenthal fibers

A

astrocytes (star-like)

“the STAR players come in to save the day”

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16
Q

Where is CSF produced?

A

choroid plexus

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17
Q

True or False: Cerebral edema is a common form of secondary brain damage.

A

True

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18
Q

How often does cerebral edema cause brain damage secondary to initial brain injury?

A

75% of the time

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19
Q

In cerebral edema, the blood brain barrier is disrupted and the ________ is increased.

A

vascular permeability

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20
Q

Secondary to glial or endothelial injury, there is an increase in ______ associated with cerebral edema.

A

water

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21
Q

Cerebral edema = Swollen _____ + Narrowed _____ + brain _____ toward the area of less pressure.

A

swollen gyri
narrowed sulci
shifting

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22
Q

What are three classical indications of increased intracranial pressure?

A
  1. headache
  2. vomiting
  3. papilledema (swelling of the optic disc)
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23
Q

What is a “brain herniation” and what are the three main types?

A

displacement of brain tissue from one intracranial compartment to another (consequence of brain edema)

  1. Transentorial (uncinate)
  2. Subfalcine (cingulate)
  3. Tonsilar (displaces cerebellar tonsils)
24
Q

What is the danger associated with a subfalcine herniation?

A

Subfalcine = cingulate
(“i SUck at CINGing…it’s not AN ART for me”)

uni or bilateral expansion of the cerebral hemisphere displaces the cingulate gyrus under the falx cerebri = may compress the ANTERIOR CEREBRAL ARTERY

25
Q

What is the danger associated with an uncinate herniation?

A

Uncinate = Transtentorial
(“my UNCle is color BLIND”)

medial temporal lobe compression may affect CN III or Posterior Cerebral Artery and cause VISUAL DISTURBANCES

26
Q

What is the danger associated with a tonsillar herniation?

A

displacement of the cerebral tonsils through the foramen magnum could be LIFE THREATENING as the brain stem becomes compromised (breathing/cardiac regulatory centers are in the medulla oblongata)

27
Q

What is hydrocephalus?

A

accumulation of excess cerebrospinal fluid within the ventricular system due to decreased reabsorption or increased production by the choroid plexus

-results in increased intracranial pressure

28
Q

True or False: In an infant, hydrocephalus will result in head expansion.

A

True, the skull is still flexible

for adults…results in intracranial pressure because the cranium is hard/stable

29
Q

True or False: Increased intracranial pressure results in higher perfusion rates.

A

False, increased pressure = decreased perfusion = displacement/damage

30
Q

Cerebrovascular diseases are the ____ leading cause of death in the US.

A

3rd

1 = heart, 2 = cancer

31
Q

What is a stroke?

A

an acute, non-epileptic neurologic deficit lasting longer than 24 hours

32
Q

A stroke results from ____ major processes. What are they?

A

TWO

  1. Hypoxia (ischemia, infarction)
  2. Hemorrhage (vessel rupture)
33
Q

What are the pathogenic MECHANISMS of cerebrovascular disease?

A
  • thrombus occludes vessel
  • “moving thrombus” occludes vessel
  • rupture of blood vessel
34
Q

A brain ______ is a circumscribed lesion caused by local interruption of blood flow.

A

infarction

35
Q

What is the most common underlying cause of brain infarction?

A

atherosclerosis

36
Q

Which blood vessel is most frequently affected by brain infarction due to atherosclerosis?

A

the MIDDLE CEREBRAL ARTERY

37
Q

Describe the evolution of a brain infarction.

A

~12 hours: grossly/histologicallly normal
24-36 hours (acute): red neurons, neutrophil infiltrate
Day 3 (subacute): macrophage infiltration
1 month: softened, irregular, cavitation
6 months (chronic): smooth walled cavity with gliosis

38
Q

What would you expect to see 30 hours after a brain infarction?

A

neurons that are red (eosinophilic)

neutrophils in the parenchyma

39
Q

What would you expect to see on day 3 or 4 after a brain infarction?

A

foamy macrophages in the cytoplasm

punctate hemorrhage

40
Q

An intraparenchymal brain hemorrhage is most likely due to _____ and the most common site is the _______.

A 
hypertension
basal ganglia (and the pons)
41
Q

Where do most subarachnoid hemorrhages occur?

A

at arterial bifurcations of the CIRCLE OF WILLIS
(rupture of “berry aneurysms”)

“WILL likes SUBs and BERRYs”

42
Q

Vascular malformations are most commonly from abnormal ______ in the developing brain.

A

angiogenesis

43
Q

What type of vascular malformation is most common?

A

AVMs (arteriovenous malformation)

44
Q

Traumatic brain injury accounts for ____% of accidental deaths.

A

25

45
Q

Epidural hematomas are _____ bleeds.

A

arterial
usually the middle meningeal artery

(vowel with vowel: E with A)

46
Q

Subdural hematomas are _______ bleeds.

A

venous

consonant with consonant: S with V

47
Q

Which is more aggressive, an epidural or subdural hematoma?

A

Epidural (more aggressive)

48
Q

Where does the blood collect in an epidural hematoma?

A

between the skull bone and the dura mater (high pressure area)

49
Q

Where does the blood collect in a subdural hematoma?

A

between the dura and archnoid membranes

50
Q

True or False: There is the presence of a “lucid interval” following rupture of bridging veins.

A

False,
veins = subdural
lucid interval = arterial = epidural

51
Q

A _______ is the loss of consciousness with full recovery.

A

concussion

52
Q

A _______ is the disruption and hemorrhage of superficial brain, caused by blunt force trauma.

A

contusion

53
Q

What is a brain laceration?

A

tearing of brain parenchyma

54
Q

True or False: Areas of the brain that come in contact with the skull are more prone to develop contusions.

A

True

55
Q

True or False: The contusion immediately below the site of impact is call the contrecoup lesion.

A

False
impact site = coup
region at opposite pole from impact = contrecoup

56
Q

True or False: Exit and entry wounds from a gun shot injury are easily decipherable.

A

True, the exit wound is always more extensive

57
Q

Why is the exit wound more extensive?

A

the bullet will “tumble and mushroom” as it passes through the skull

SP16- Gen Path Exam 3 (12 decks)

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