Neuropathology - Stogner - Exam 1 Flashcards
Features of the CNS:
Response to injury?
There is a limited capacity for____. A ___ is formed by what cell? What is it called?
You get ___ rather than fibrosis.
Features of the CNS
Response to injury?
There is a limited capacity for regeneration. A gliosis is formed by astrocytes?
You get gliosis rather than fibrosis.
- Different disease processes produce same response –> ___ loss and gliosis
- There is also selective vulnerability
- Different cells in the CNS respond differently to injury
- Example: neurons are more sensitive to ____ than glial cells or endothelial cells.
- Different regions of the CNS respond differently to injury.
- Example: __ neurons in hippocampus, ____ cells of the cerebellum, and neurons in cortical layers _ and _ are more sensitive to ____ than other areas.
- Different cells in the CNS respond differently to injury
- Different disease processes produce same response –> neuronal loss and gliosis
- There is also selective vulnerability
- Different cells in the CNS respond differently to injury
- Example: neurons are more sensitive to ischemia than glial cells or endothelial cells.
- Different regions of the CNS respond differently to injury.
- Example: pyramidal neurons in hippocampus, purkinje cells of the cerebellum, and neurons in cortical layers 3 and 5 are more sensitive to ischemia than other areas.
- Different cells in the CNS respond differently to injury
Blood pressure in the brain is ____. It is auto-regulated.
Blood pressure in the brain is constant. It is auto-regulated
Anatomical Features of the Brain:
- Enclosed by rigid bony structure (calvarium)
- Most organs are not completely enclosed by the skeleton like the brain is. While this protects the brain and spinal cord, it also makes the tissue ____ to injury if the volume of the contents of the bone space ___.
- Compartments created by meninges in relationship to bone and brain
- The ____ space isn’t really a space but a potential space. The ____ is adherent to the inner surface of the skull, but it can be dissected off by ___ under ____, which is what happens during the formation of an ___ hematoma.
- The subdural space is between the inner surface of the ___ and the outer surface of the ___.
- The subarachnoid space (includes the perivascular) is between the ___ and the ___ surface of the brain.
- Ventricular system filled with ___.
- Absence of ___.
Anatomical Features of the Brain:
- Enclosed by rigid bony structure (calvarium)
- Most organs are not completely enclosed by the skeleton like the brain is. While this protects the brain and spinal cord, it also makes the tissue vulnurable to injury if the volume of the contents of the bone space increases.
- Compartments created by meninges in relationship to bone and brain
- The epidural space isn’t really a space but a potential space. The dura is adherent to the inner surface of the skull, but it can be dissected off by blood under pressure, which is what happens during the formation of an epidural hematoma.
- The subdural space is between the inner surface of the dura and the outer surface of the arachnoid.
- The subarachnoid space is between the arachnoid and the pial surface of the brain.
- Ventricular system filled with cerebrospinal fluid (CSF)
- Absence of lymphatics.
Production of CSF:
- Derived from ____
- Actively secreted by the __ __
- Fills the ___, ____, and ____ space
Production of CSF:
- Derived from plasma
- Actively secreted by the choroid plexus
- Fills the ventricles, cisterns, and subarachnoid space
Blood-Brain Barrier:
–Tight junctions between __ ___ cells
–____ cell processes also contribute to the BBBB
- Prevents entry of __, __, etc
- Penetration may be increased if ____ is present.
Blood-brain barrier
–Tight junctions between capillary endothelial cells
–Astrocyte cell processes also contribute to the BBB.
- Prevents entry of drugs, toxins, etc
- Penetration may be increased if inflammation is present.
Pathophysiologic Reactions in the CNS
- H___
- E___
- Increased ____ pressure
- Her___
Pathophysiologic Reactions in the CNS
- Hydrocephalus - too much CSF build up
- Edema
- Increased intracranial pressure
- Herniation
C.
Injury to the CNS would be expected to result in which of the following?
Neuronal Loss and Gliosis
Causes of Hydrocephalus:
____ of all or part of the ventricular system
- Increase in ___ of ___ can result in increase in ___ pressure, which may be life-threatening.
- Overproduction of CSF (rare)
___ ___ papilloma
•Obstruction of ___ flow
–Within the ventricular system
–Outside the ventricular system
Causes of Hydrocephalus:
•Dilation of all or part of the ventricular system
- Increase in volume of CSF can result in increase in intracranial pressure, which may be life-threatening.
- Overproduction of CSF (rare)
–Choroid plexus papilloma
•Obstruction of CSF flow
–Within the ventricular system
–Outside the ventricular system
Types of Hydrocephalus:
•Communicating hydrocephalus:
–Dilation of all _____.
–Ventricles are patent and communicate with each other –> no obstructon within the ventricular system. Obstruction of CSF is outside of the ventricular system.
–Obstruction to CSF flow outside the ventricular system or defective reabsorption of CSF
Causes of communication hydrocephalus?
•Meningeal fibrosis due to previous ____ or subarachnoid____ leads to impaired ___ of CSF.
Types of Hydrocephalus:
•Communicating hydrocephalus:
–Dilation of all ventricules.
–Ventricles are patent and communicate with each other –> no obstructon within the ventricular system. Obstruction of CSF is outside of the ventricular system.
–Obstruction to CSF flow outside the ventricular system or defective reabsorption of CSF
Causes of communication hydrocephalus?
•Meningeal fibrosis due to previous meningitis or subarachnoid hemorrhage leads to impaired reabsorption of CSF.
•Types of communicating hydrocephalus
- ___ ____ hydrocephalus
- Etiology unclear
- Symptoms – progressive dementia, incontinence, loss of coordination. “Wacky, wet and wobbly.”
- Hydrocephalus Ex Vacuo
- Dilation of ____ in response to loss of __ ___ (atrophy)
- ___ intracranial pressure
Types of communicating hydrocephalus
- Normal pressure communicating hydrocephalus
- Etiology unclear
- Symptoms – progressive dementia, incontinence, loss of coordination. “Wacky, wet and wobbly.”
- Hydrocephalus Ex Vacuo
•Dilation of ventricles in response to loss of tissue volume (atrophy)
normal intracranial pressure
Which hydrocephalus have normal intercranial pressure?
Hydrocephalus ex vacuo
Non-communicating hydrocephalus:
•Non-communicating (obstructive)
–Obstruction of flow of CSF within the ___ ___ so that the ventricular cavities no longer ____ with each other
Non-communicating hydrocephalus:
•Non-communicating (obstructive)
–Obstruction of flow of CSF within the ventricular system so that the ventricular cavities no longer communicate with each other
Cerebral Edema:
•Swelling due to increased fluid accumulation
–Vasogenic:
•Increased capillary permeability (breakdown of blood-brain barrier) with fluid accumulating in extracellular space
–Cytotoxic:
•Increased intracellular sodium and water causes swelling of cells
–Interstitial:
- CSF enters extracellular space of periventricular white matter
- No lymphatics to drain fluid
Cerebral Edema:
•Swelling due to increased fluid accumulation
–Vasogenic:
•Increased capillary permeability (breakdown of blood-brain barrier) with fluid accumulating in extracellular space
–Cytotoxic:
•Increased intracellular sodium and water causes swelling of cells
–Interstitial:
- CSF enters extracellular space of periventricular white matter
- No lymphatics to drain fluid
A - a tumor in the third ventricle:
•Non-communicating (obstructive) Hydrocephalus:
–Obstruction of flow of CSF within the ventricular system so that the ventricular cavities no longer communicate with each other
The lateral ventricles would
Cerebral Edema- Swelling due to _____
3 types:
- _____:
•Increased ___ ___ (breakdown of blood-brain barrier) with fluid accumulating in ___ space
- Cytotoxic:
•Increased intracellular ___ and water causes swelling of cells
- Interstitial:
- ____ enters extracellular space of __ ___ matter
- No __ to drain fluid
Cerebral Edema - Swelling due to increased fluid accumulation
3 types:
- Vasogenic:
•Increased capillary permeability (breakdown of blood-brain barrier) with fluid accumulating in extracelluar space
2. Cytotoxic:
•Increased intracellular sodium and water causes swelling of cells
3. Interstitial:
•CSF enters extracellular space of paraventricular white matter
•No lymphatics to drain fluid
Intercranial pressure and volume:
•Calvarium (skull cap) limits intracranial ___.
–Increase in volume of one component (brain, blood, CSF) can only occur at the ____ of the others.
- When there is more ___ than ___, pressure rises dramatically.
- When intracranial pressure exceeds mean arterial blood pressure, cerebral perfusion will cease, leading to brain death.
•Calvarium limits intracranial capacity
–Increase in volume of one component (brain, blood, CSF) can only occur at the expense of the others.
- When there is more volume than space, pressure rises dramatically.
- When intracranial pressure exceeds mean arterial blood pressure, cerebral perfusion will cease, leading to brain death.
Herniation: a brain herniation is when brain tissue, cerebrospinal fluid, and blood vessels are moved or pressed away from their usual position inside the skull.
- Increased intracranial ____
- Tissue herniates around rigid dural structures (falx and tentorium) and herniates though the ___ __ or defects in the skull
- Herniated tissues compress ___, ___ ___, and vital brain structures (brainstem)
Herniation: a brain herniation is when brain tissue, cerebrospinal fluid, and blood vessels are moved or pressed away from their usual position inside the skull.
- Increased intracranial pressure
- Tissue herniates around rigid dural structures (falx and tentorium) and herniates though the foramen magnum or defects in the skull
- Herniated tissues compress aretries, cranial nerves and vital brain structures (brainstem)
What types of hernation are these?
- Subfalcian herniation
__ ___:
- Skull fractures
- Parenchymal injuries
–> Contusions
–> Lacerations
–> Traumatic brain hemorrhages
•Diffuse axonal injury and Concussion
Brain Trauma:
- Skull fractures
- Parenchymal injuries
–Contusions
–Lacerations
–Traumatic brain hemorrhages
•Diffuse axonal injury and Concussion (Discussed in TBI lecture – Not included in this lecture)
Types of Skull Fractures
•_____: No bone displacement
______: Fragments displaced inward
- ______: Scalp laceration overlying fracture; risk of infection or CSF leak
- _____: Fractures that cross suture lines causing widening of the suture (infants and children)
- ____: Base of skull fracture
Types of Skull Fractures:
- Linear: No bone displacement
- Depressed: Fragments displaced inward
- Compound: Scalp laceration overlying fracture; risk of infection or CSF leak
- Diastatic: Fractures that cross suture lines causing widening of the suture (infants and children)
- Basilar: Base of skull fracture
Skull fracture. A skull fracture is a break in the skull bone. There are four major types of skull fractures, including the following:
Four types:
____. This is the most common type of skull fracture. In a linear fracture, there is a break in the bone, but it does not move the bone. These patients may be observed in the hospital for a brief amount of time, and can usually resume normal activities in a few days. Usually, no interventions are necessary.
____. This type of fracture may be seen with or without a cut in the scalp. In this fracture, part of the skull is actually sunken in from the trauma. This type of skull fracture may require surgical intervention, depending on the severity, to help correct the deformity.
____. These are fractures that occur along the suture lines in the skull. The sutures are the areas between the bones in the head that fuse when we are children. In this type of fracture, the normal suture lines are widened. These fractures are more often seen in newborns and older infants.
____. This is the most serious type of skull fracture, and involves a break in the bone at the base of the skull. Patients with this type of fracture frequently have bruises around their eyes and a bruise behind their ear. They may also have clear fluid draining from their nose or ears due to a tear in part of the covering of the brain. These patients usually require close observation in the hospital.
_____ fracture. This fracture occurs when the skin is broken and the bone emerges
Skull fracture. A skull fracture is a break in the skull bone. There are four major types of skull fractures, including the following:
Linear skull fractures. This is the most common type of skull fracture. In a linear fracture, there is a break in the bone, but it does not move the bone. These patients may be observed in the hospital for a brief amount of time, and can usually resume normal activities in a few days. Usually, no interventions are necessary.
Depressed skull fractures. This type of fracture may be seen with or without a cut in the scalp. In this fracture, part of the skull is actually sunken in from the trauma. This type of skull fracture may require surgical intervention, depending on the severity, to help correct the deformity.
Diastatic skull fractures. These are fractures that occur along the suture lines in the skull. The sutures are the areas between the bones in the head that fuse when we are children. In this type of fracture, the normal suture lines are widened. These fractures are more often seen in newborns and older infants.
Basilar skull fracture. This is the most serious type of skull fracture, and involves a break in the bone at the base of the skull. Patients with this type of fracture frequently have bruises around their eyes and a bruise behind their ear. They may also have clear fluid draining from their nose or ears due to a tear in part of the covering of the brain. These patients usually require close observation in the hospital.
Compound fracture. This fracture occurs when the skin is broken and the bone emerges
___ of ___ fracture:
- Seen better with ___ than plain films
- ____tear –> risk of ____
- Clinical signs:
–______ (blood behind TM)
–CSF otorrhea or rhinorrhea
–Facial _____ (damage to facial nerves)
–____ over mastoid
–____ (damage to olfactory bulbs)
–Bilateral _____ ecchymosis (raccoon eyes)
Base of Skull fracture:
- Seen better with CT than plain films
- Dural tear –> risk of meninges
- Clinical signs:
–Hemotympanum (blood behind TM)
–CSF otorrhea or rhinorrhea
–Facial weakness (damage to facial nerves)
-ecchymosis over mastoid
–Anosmia (damage to olfactory bulbs)
–Bilateral periorbital ecchymosis (raccoon eyes)
Contusions:
- ____ (at site of impact)
- ____ (on opposite side of head from impact site)
Brain strikes opposite inner surface of skull after sudden deceleration
- In general, if head is immobile at time of impact, only ___ injury is seen
- May enlarge in the first day or so after injury or not be seen on initial imaging studies
Contusions:
Coup (at site of impact)
Contra-coup (on opposite side of head from impact site)
Brain strikes opposite inner surface of skull after sudden deceleration
- In general, if head is immobile at time of impact, only coup injury is seen
- May enlarge in the first day or so after injury or not be seen on initial imaging studies
Follow up question:
could the accident in the previous question cause a contrecoup contusion?
D. Basilar
Yes! It can cause contracoup contusion because he was mobile (sledding down the hill)
The first one is epidural hematoma
The second is subdural hematoma
C. This is an epidural hematoma because it impacted his temporal bone. It is a lens shaped bleed caused by aretrial bleeding.
He also has a lucid interval where he is fine at first, but then a few hours later is not fine.
What is going on here?
ALS!
Myelin stains dark so you can see the lateral and anterior columns (pale) being demyelinated.
You also see atrophy of ventral nerve roots. They should be the same size of the dorsal nerve roots, but it is much smaller and sparser.
D - Spasticity!
C. ALS
ALS
- skeletal muscle atrophy
-
Lewey Bodies:
•Positive for ____
–Spherical with ____ core surrounded by pale halo
–Found in ___ __ in Parkinson’s disease
–Also seen in the___ in Dementia with Lewy bodies
Lewey Bodies:
•Positive for α-synuclein
–Spherical with eosinophilic core surrounded by pale halo
–Found in Substantia nigra in Parkinson’s disease
–Also seen in the cortex in Dementia with Lewy bodies
B. Lewey bodies are in Parkinson’s disease alpha-synuclein.
All of them!
What disease is this?
Wilson’s Disease:
- Autosomal recessive disease leading to copper accumulation in tissues (brain, eye, liver)
- Decreased serum copper and ceruloplasmin, increased urinary copper excretion
- Presents as liver disease followed by extrapyramidal movement disorder and dementia
- Neurologic problems can be prevented by early institution of chelation therapy.
B.
