Neuropathology Flashcards
What is your Dx?
Epidural hematoma
Which vessels are damaged to produce a subdural hematomas?
Bridging veins
What is the germinal matrix? What is the clinical significance of it?
A region of cells involved in brain development; exist near the lateral ventricles. The region is vulnerable to hypoxia (which happens a lot with premature infants) and hemorrhage.
Subarachnoid hemorrhages most commonly occur as a result of rupture of…?
What is a common clinical sign/symptom of subarachnoid hemorrhage?
Rupture of a berry aneurysm in the circle of Willis.
Sudden onset terrible headache (thunderclap headache) is a common symptom.
What is the most common underlying cause of intracerebral hemorrhage?
Where in the brain do these most commonly occur?
Hypertension + arteriosclerosis –> vessel hemorrhage.
Most commonly occur in basal structures of the brain.
Rank the cell types found in gray matter with respect to their vulnerabilities to hypoxia.
Neurons are most vulnerable
Oligodendrocytes
Astrocytes
Vessels
Rank the cell types found in white matter with respect to their vulnerabilities to hypoxia.
Oligodentrocytes are most vulnerable
Astrocytes
Vessels
Which two areas in the brain are particularly susceptible to hypoxia in both kids and adults?
CA1 aka Sommer’s sector of the hippocampus
Purkinje cells of the cerebellum
Describe the histologic and cellular features of brain parenchyma after suffering from an infarct at 1 day post-infarct (acute phase), 1 day through 2 weeks post-infarct (subacute phase), and beyond 2 weeks post-infarct.
Acute: red neurons (necrotic neurons are highly eosinophilic)
1 day - 2 weeks: tons of neutrophils and macrophages
2+ weeks: astrogliosis (scar/cavitary lesion)
You’re a pathologist and need to determine the time of death for some reason and you’re only given this histo slide. How long ago did this brain tissue suffer from ischemia?
1 day - 2 weeks ago
You’re a pathologist and need to determine the time of death for some reason and you’re only given this histo slide. How long ago did this brain tissue suffer from ischemia?
1 day ago (or earlier)
What are the risk factors for developing arteriole brain infarcts?
Hypertension, diabetes, old age
In which region of the brain do lacunar infarcts most commonly happen?
In or near the basal ganglia
Rickettsial infection may lead to regional brain infarcts involving ________ (type of vessel), leading to _______ hemorrhages.
capillaries –> petechial hemorrhages
Regional brain infarcts involving veins often occur in patients who are _________.
What is the gross appearance of these?
hypercoagulable (cancer, dehydration, phlebitis)
Triangular shaped. If they involve the superior saggital sinus, there will be bilateral lesions in the cerebral hemispheres.
What is cerebral amyloid angiopathy?
Idiopathic deposition of amyloid in small arteries and arterioles of the brain.
Compare where primary CNS neoplasms occur within the brain for adults vs. kids.
Adults - supratentorial
Kids - infratentorial
Name two infiltrative primary CNS neoplasms that occur in adults, and kids, respectively.
Adults: diffuse gliomas, primary CNS lymphomas
Kids: medulloblastomas, ependymomas
Name the non-infiltrative primary CNS neoplasms that occur in adults, and kids, respectively.
Adutls: meningioma, schwannoma, metastatic disease -> brain
Kids: pilocytic astrocytoma, craniopharyngioma
What are the most common presenting signs/symptoms of primary CNS neoplasms?
New onset of seizures, focal neurologic signs
Astrocytomas and oligodendrogliomas are neoplasms of _____ cells.
glial
GBM is a high grade neoplasm of ________ (cell type).
How do these appear grossly on imaging?
What are some histological characteristics of these?
neoplasm of astrocytes
CT: butterfly lesion (crosses midline)
Histology: pseudopalisading necrosis, vascular proliferation
Your 81 year old senator patient presents with new onset seizures, so you cut their brain out to make the diagnosis histologically. What is your Dx?
GBM
What is a predisposing factor for developing a primary CNS lymphoma? How is it treated?
Being immunocompromised is a predisposing factor (ex. HIV)
Steroids, chemo for Tx
What kind of primary CNS neoplasm is seen here?
Primary CNS lymphoma
Which hereditary cancer syndrome is associated with multiple meningiomas? What do these tumors characteristically have on CT imaging?
NF2
Dural tail
Where do schwannomas/acoustic neuromas usually occur?
Vestibular branch of CN VIII
Which hereditary cancer syndrome is associated with bilateral schwannomas?
NF2
Describe three histopathologic characteristics of schwannomas.
Verocay bodies, Antoni A (densely cellular regions), Antoni B (less densely cellular regions)
What is your Dx?
Metastasis to the brain (usually from a carcinoma). Could be a GBM, but look for them butterflies for those.
What are the most common presenting signs/symptoms of primary CNS neoplasms in kids and why?
Ataxia and nausea/vomiting, cuz they occur near the cerebellum
What type of primary CNS neoplasm are these found in?
Pilocytic astrocytoma
What kind of tumor is this? Are these treatable via resection?
Pilocytic astrocytoma - yeah treatable with surgery
Your patient presents with multiple neurofibromas and malignant peripheral nerve sheath tumors. You suspect a hereditary cancer syndrome, which encodes the _________ gene on chromosome _____.
NF1 is associated w/ neurofibromas and malignant peripheral nerve sheath tumors.
NF1 gene on ch. 17 encodes the neurofibromin protein
What gene, chromosome, and associated neoplasms are seen in patients with NF2 syndrome?
NF2 gene on ch. 22 encodes merlin/schwannomin
It is also called MISME syndrome:
Multiple Inherited
Schwannomas
Meningiomas
Ependymomas
Is NF2 syndrome associated with neurofibromas?
No
Name the genes and tumors associated with tuberous sclerosis.
TSC1 hamartin or TSC2 tuberin
Cortical tubers
Hamartomas
Subependymal giant cell astrocytoma
Name the genes, chromosome, and tumors associated with Von Hippel-Lindau disease.
VHL on chromosme 3
Cortical tubers
Hemangioblastoma
Renal cell carcinoma
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