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Clin Med Neuro Kelley > Neuropathology > Flashcards

Neuropathology Flashcards

1
Q

REVIEW:

What are the three layers

of the meninges and

what spaces lie between them?

A

Skull

Epidural

Dural

Subdural

Arachnoid

Subarachnoid

Pia

Brain

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2
Q

Review:

What are the primary functions

of each lobe of the cerebrum?

A

Frontal: Motor functions,

behavior, emotions, higher intellect

Parietal: sensory

Temporal: hearing, smelling

Occipital: Visual

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3
Q

REVIEW;
What are the three components

of the brainstem and

what do they do?

A

Midbrain: visual & auditory reflex centers

Pons: connection between cortex, cerebellum and medulla

Controls chewing, biting, swallowing, facial expressions, sensation

Medulla Oblongata: cardiac, vasomotor and respiratory centers

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4
Q

REVEIW:

What does the Cerebellum do?

A

Major regulator of motor activities

Integration of:

Sensory impulses from spinal cord and vestibular organ

Motor impulses of Cerebral Cortex

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5
Q

REVIEW

Where is the gray matter

and white matter

in the brain and spinal cord?

A

Brain: generally gray on the outside, white on the inside (but some gray on the inside as well.

Spinal Cord: gray on the inside, white on the outside

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6
Q

REVIEW:

What are key differences

between neurons and glial cells?

A

Neurons:

Nondividing, postmitotic, permanent cells

Glial Cells:

facultative, mitotic (labile), capable of dividing

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7
Q

What are the six types of cells in the nervous system,

what do they do,

and what do you call their tumors?

A

Neurons: signalling/information, neuroma

Glial Cells: support, glioma

Astrocytes: support, blood brain barrier, astrocytoma

Oligodendrocytes, myelination in brain, oligodendroma

Ependymal Cells: lining ventricles, ependymoma

Schwann cells: peripheral myelination, Shwannoma

Microglia, immune response, NO tumors!

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8
Q

What are the nine major types of diseases

of the nervous system?

A
  1. Developmental, genetic diseases
  2. Malformations
  3. Trauma
  4. Circulatory (vascular) disorders
  5. Infectious diseases
  6. Autoimmune diseases
  7. Metabolic, nutritional diseases
  8. Neurodegenerative and demyelinating diseases
  9. Brain tumors
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9
Q

What is a dysraphic disorder?

A

Incomplete closure

of the embryonic neural tube

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10
Q

What are three types of

dysraphic disorders

occuring at the hind end?

A

Spina bifida: incomplete closing of the backbond and membranes around the spinal cord. Three types:

Spina bifida occulta: outer part of vertebrae slightly open

Myelomeningocele: spinal cord and meninges protruding

Meningocele: meninges protruding

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11
Q

What happens

when the head end of the neural tube

does not close properly?

A

Anencephaly: absense of a major part of the brain and skull

Encephalocele: protursions of the brain through the skull that are coverered with membrane

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12
Q

What are four types of

CNS hemorrhages

and their causes?

A

Epidural Hematoma: middle meningeal artery rupture

Subdural Hematoma: bridging vein rupture

Subarachnoid Hematoma: 1. Trauma, 2. Aneurism

Intercerebral Hemorrhage: 1. Trauma, 2. HTN

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13
Q

What is the fifth leading cause of death in the US?

Hint: it used to be number 3!

A

Cerebrovascular Disease

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14
Q

What are the two types of stroke and their incidence?

A

Ischemic (85%)

atherosclerosis, occlusion of blood vessels

Hemorrhagic (15%)

often a complication of HTN

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15
Q

REVIEW:

What are the three large cerebral arteries?

What part of the brain to they perfuse?

Where do they originate?

A

Anterior Cerebral Artery (ACA) from Internal Carotid,

perfuses medial surface of frontal and parietal lobes

Middle Cerebral Artery (MCA) from Internal Carotid

perfuses lateral surfaces of frontal, temporal, parietal lobes

Posterior Cerebral Arteries (PCA) from Vertebral Artery

perfuses posterior aspect of temporal, occipital lobes

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16
Q

A patient has an MRI

showing an intracerebral hemorrhage

in the basil ganglia.

What is the likely cause?

A

Hypertension

(Trauma is most common cause

of intracerebral hemorrhage though)

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17
Q

What causes cerebral herniations?

A

Cerebral Edema

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18
Q

Where are the four most common locations

for cerebral herniations?

Which is most serious?

A

Tonsillar Herniation (most serious)

(cerebral tonsil exits skull through foramen magnum)

Transtentorial (uncinate) herniation

(cerebral uncus at cerebral-pontine angle)

Subfalcine herniation

(cingulate gyrus at falx)

Herniation through opening in broken skull

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19
Q

Which is more serious,

a concussion or a brain contusion?

A

A contusion is more serious.

Concussion: transient loss of consciousness

Contusion: disruption of blood supply, can lose consciousness later, produce neurological deficit

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20
Q

What is Coup and Counter Coup?

A

Coup (a “blow” in French) is the damage to your brain near where your head is hit

Counter Coup (on Contre Coup) is the damage where your brain hits the opposite side in response to the coup

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21
Q

What are three ways

an infection can get inside the brain?

A

Penetrating trauma

Hematogenous Spread (blood vessels)

Nearby infections (otitis media, sinuses)

NOTE: if you squeez a pimple, it drains into your sinuses!

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22
Q

What are the four most common organisms

causing as infection

in the nervous system?

A

Bacteria

Viruses

Fungus

Protazoa

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23
Q

What bacteria

can cause an infection

in the nervous system?

A

Neisseria meningitidis,

S. pneumo,
E. coli,

H. influenza,

Treponema pallidum

(Hematogenous Route or Septic Emboli)

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24
Q

What viruses

can cause an infection

in the nervous system?

A

Measles

Rubella

Adenovirus

Herpesvirus

Cytomegalovirus

Rabesvirus

(via Hematogenous Route)

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25
Q

What fungi

can cause an infection

in the nervous system?

A

Candida albicans

Aspergillus flavus

Cryptococcus neoformans

(Hematogenous route)

26
Q

What protazoa

can cause an infection

in the nervous system?

A

Toxoplasma gondii

(Hematogenous route)

27
Q

Name four types of infections

of the Nervous System

A

Encephalitis:

inflammation of the brain parenchyma, usually viruses

Myelitis:

inflammation of the spinal cord, usually viruses

Cerebral Abscess:

suppurative cavitary lesion

from pyogenic bacteria, fungi or both

Meningitis:

Inflammation of meninges, viral or bacterial

28
Q

What is Multiple Sclerosis?

What is its incidence,

signs/Sx and

disease course?

A

Chronic, degenerative demyelinating disease

Incidence: women 2x men, genetic factors

Signs/Sx: loss of sense of touch, muscle weakness, unsteady gait, sphincter abnormalities

Course: exacerbation and remission

29
Q

What is the difference

between and early and late lesion

in MS?

A

Early: Lymphocytes attack myelin,

macrophages consume the debris.

Late: Astrocytes and surviving axons

30
Q

What are two congenital metabolic disorders

of enzymatic deficiency?

A

Tay-Sachs Disease

Neimann-Pick Disease

31
Q

What is a common cause

and result

of a Vitamin B1 defiency?

A

Vitamin B1 (Thiamine) deficiency:

excessive, chronic alcohol intake can cause

Wernicke-Korsakoff Syndrome

(uncoordinated movements, progressive mental deterioration, memory and concentration loss, irritability, confusion)

32
Q

What are the signs and symptoms

of Vitamin B12 (Cobalamin) deficiency?

A

Uncoordinated movements

Sensorimotor peripheral neuropathy

spinal cord disease

abnormal gait

psychiatric sx

33
Q

What are the signs/sx

of nicotinic acid deficiency?

A

Dermatitis

Diarrhea

Delirium

(The three “D”s)

34
Q

What are the effects of alcholism and B1 deficiency?

A

Wernicke Korskoff Syndrome

Subdural hematomas from falling

Pontine myelinolysis

Delirium tremens upon withdrawal

Degenerative changes to hypothalmus and mammillary bodies

Neuropathy

Myopathy

35
Q

Name four neurodegenerative Diseases

A

Alzheimer’s disease

Parkinson’s Disease

Huntingon’s Disease

Amyotrophic Lateral Sclerosis (ALS)

36
Q

Of the four key neurogenerative disorders,

what parts of the brain do they impact?

A

Alzheimer’s disease: diffuse (all over)

Parkinson’s Disease: substantia nigra

Huntingon’s Disease: cortex and subcortical nuclei (caudate, putamen)

Amyotrophic Lateral Sclerosis (ALS): motor neurons in the cerebral cortex, midbrain and spinal cord (lateral cerebrospinal pathways)

37
Q

What is Alzheimer’s Disease?

A

Progressive loss of cognitive functions and memory due to diffuse cortical atrophy caused by deposits of beta-amyloid. Genetic factors include Chromosomes 19 and 21

(Recall that Down’s Syndrome is Trisomy 21)

Note: serious diagnosis with no cure

so be sure to rule out other causes of Sx.

38
Q

What are the gross and histologic changes

in the brain of

an Alzheimer’s patient?

A

Gross: atrophic, narrowing gyri, widening sulci

Histologic: neuritic plaques, neurofibrillary tangles, granovacuolar degeneration, amyloid deposits

39
Q

What is Parkinson’s Disease?

A

Subcortical neurodegenerative disorder

affecting mainly the elderly

Decreased dopaminergic neurons in the substantia nigra

40
Q

What are the Signs/Sx

of Parkinson’s Disease?

A

Tremor/twitchin muscles

Cogwheel rigidity

Unstable walking

Depression

Dementia (10%)

41
Q

What are the gross and histologic changes

to the brain

of a patient with Parkinson’s

A

Gross: substantial nigra is pale (not black)

Histologic: loss of melanin rich neurons,

presence of Lewy bodies

42
Q

What is Huntington’s Disease?

A

Autosomal dominant neurodegenerative disease

affecting men more than women

43
Q

What are the signs/sx of

Huntington’s Disease?

A

Involuntary, gyrating movements

Progressive dementia

First Sx do not appear until midlife

Most are mentally incapacitated by 50-60 yo

44
Q

What are the gross and histological changes

to the brain

of a patient with Huntington’s

A

Gross: Atropy of cortex and subcortical nuclei,

especially the caudate and putamen

Enlarged and rounded ventricle

Histological: atrophy, degeneration, loss of neurons, reactive gliosis

45
Q

What is

Amyotrophic Lateral Sclerosis (ALS)

A

Rare neurodegenerative disease

of motor weakness and

progressive wasting

affecting older men and women

46
Q

What are the symptoms of ALS?

A

Motor weakness

progressive wasting in extremities (small hand muscles)

fasciculations

slurred speech

intact intellect!

Death in a few years.

47
Q

What are the gross and histological changes

in the nervous system

of someone with ALS ?

A

Loss of motor neurons in the

cerebral cortex,

midbrain and

spinal cord

(loss of lateral cerebrospinal pathways)

48
Q

Brain tumors occur at what age range?

A

Any age

49
Q

What are the most common malignant

and benign

brain tumors

in children?

A

Malignant: Medullablastoma

Benign (low grade): pilocytic astrocytoma

50
Q

What are the most common malignant

and benign

brain tumors

in adults?

A

Malignant: Glioblastoma

Benign: Meningioma

51
Q

What are the primary locations

of brain tumors in

adults and

children?

A

Adults: supratentorial

Children: infratentorial

52
Q

What is the difference in the impact on the brain

of gliomas versus

meningiomas?

A

Gliomas invade brain tissue

Meningiomas compress brain tissue

53
Q

What is a glioblastoma?

A

Most common CNS tumor

Peak: 65 y.o.

Lateral hemispheres

Crosses corpus collosum!!

Highly variegated appearance (yellow, red, white, irregular shape)

54
Q

What are the histologic characteristics of a

glioblastoma?

A

Anaplastic astrocytic cells

Enlarged, multinucleated cells w abundant cytoplasm

Mitoses

Necrosis

55
Q

What is the AMEN criteria

for staging CNS tumors?

A

A - nuclear Atypia

M - mitosis

E-endothelial proliferation

N - necrosis

56
Q

What is an oligodendroma?

A

Occurs in cerebral hemispheres

Middle-aged adults

Well circumscribed

Well differentiated

Can progress to glioblastoma

57
Q

What is an ependymoma?

A

From ependymal lining of ventricles

Tumor cells form “pseudo-rosettes”

around papillary structures

58
Q

What is a meningioma?

A

Arises from meninges

Can be benign or malignant

Compression can cause seizures or motor deficits

Excellent prognosis if benign

59
Q

What is a Medulloblastoma

A

Most common malignant tumor in children

Cerebellum

Poor prognosis

60
Q

What is the difference between a

Schwannoma and a

Neurofirbroma?

A

Both can be solitary or multiple.

Neurofibromas are infiltrative.

Schwannomas are compressive (easy to resect)

Bilateral Schwannoma think Neurofibromatosis Type II

61
Q

What is the most common

malignant tumor in the brain?

A

Metastasis

(so look for the primary tumor!)

Commonly from: lungs, breast, melanoma

62
Q

What are the five most common PRIMARY brain tumors?

A

Glioma (75%)

Meningioma (15%)

Cranial/Spinal Tumors (neuroma/schwannoma)(5%)

Neural Cell Precursors (Medulloblastoma)(2%)

Others (3%)

(Hemangioma, cerebral lymphoma, pinealoma)

50% of ALL brain tumors are metastatis

Clin Med Neuro Kelley (1 decks)

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