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Putthoff Lectures/CIS > Part 2 > Flashcards

Part 2 Flashcards

1
Q

Which cells of CNS are most vulnerable to injury?

A

-pyramidal cells of hippocampus, Sommer Sector (CA1), Purkinjee cells of cerebellum

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2
Q

Reactive cell in CNS that proliferates

A

astrocytes

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3
Q

“Fried egg” appearance–which cell type?

A

oligodendrocytes

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4
Q

Pyknotic and rectangular–which cell type?

A

microglial

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5
Q

What are the inflammatory cells of the CNS?

A

Trick question! There are NO inflammatory cells in CNS

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6
Q

What are Purkinjee cells found? What are they?

A

Major motor neurons found between the granule layer and molecular layer of cerebellar cortex

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7
Q

Homunculus–Face, LE, Mouth/tongue, UE

A

Face–lot of sensory and motorLE–LITTLE sensory/motorMouth–lots of sensory/motorUE=More sensory and motor compared to LE

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8
Q

What is gliosis

A

astrocytic proliferation

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9
Q

Acute injury changes

A

central chromatolysis (clearing), spheroidal, red neurons

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10
Q

What are axonal spheroids? When are they seen?

A

aka diffuse axonal injury–When axons are transected, they tend to roll up/ball up Seen POSTTRAUMATICALLY and in DIFFUSE injury to the brain like blunt force trauma

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11
Q

What is Lipofuscin? Where is it found?

A

Yellowish brownish pigment related to aging and found in NEURON CELL BODY

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12
Q

Bubbly vacuolization of astrocytes is called?

A

gemistocytic astrocyte

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13
Q

Which astrocytes have a spindle cell configuration?

A

Fibrillary astrocytes

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14
Q

Corpora amylacea

A

Calcium concretions seen in arachnoid granulations (like brain sand–is gritty)

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15
Q

Can you see lymphatic inflammatory response in CNS?

A

NO! only see gliosis

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16
Q

Astrocytes cover _____

A

inner surface of pia mater and every blood vessel of CNS

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17
Q

Cells in CNS associated with wound healing? How? Are there fibroblasts in CNS?

A

Astrocytes via gliosis NO fibroblasts in CNS so no scar formation in CNS–see gliosis instead and get cavitary lesion instead

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18
Q

What are Rosenthal fibers? When do you see them in the CNS?

A

Chronic reactive astrogliosis; brightly eiosinophilic and hylanized (waxy appearance under microscope); elongated/rectangular cells; seen in hemartomas of posterior fossa

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19
Q

Which cells are affected in PML? Which cells are affected in CMV?

A

Oligodendrocytes in PML (demyelination)Ependymal cells in CMV

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20
Q

What does oligodendrocytes look like when there is hypoxia?

A

Perinuclear halos; fried egg appearance

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21
Q

What does an ependymal cell look like?

A

can be flattened/cuboidal or can have cilia/microvilliPlicae on ependyma does NOT mean neoplasm!

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22
Q

Normal Adult vs. child ependymal cells

A

Adult: obliterated with residual rests and rosettes of ependymal cellsChild: ciliated cuboidal ependymal cells

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23
Q

Which type of lesions (primary or metastatic) generate more edema in the CNS?

A

Primary

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24
Q

Cytotoxic edema is intercellular or intracellular?

A

Intracellular

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25
Q

Meningitis causes what kind of hydrocephalus–communicating or non-communicating?

A

CommunicatingNO lumbar tap if ICP is high–brain can herniate!!

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26
Q

Increased ICP is usually due to?

A

Usually due to Hemorrhage or ischemia but may be due to tumor sometimes

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27
Q

S/S of raised intracranial pressure

A

Headache, impaired upward gaze, CN VI palsy, seizures, papilledema, ataxia

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28
Q

Taenia solium (pig tapeworm) causes what and what geographic region do you see it in?

A

Cystercircosis–see in Latin AmericaNon-communicating hydrocephalus

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29
Q

What is kernohans notch?

A

compression of cerebral peduncle on left against tentorium cerebelli due to transtentorial herniation results in IPSILATERAL hemiparesis/ hemiplegia (on the side of herniation)

30
Q

Herniation through foramen magnum affects which vascular structures? What level is the formamen magnum at?

A

Foramen magnum is at the level of the superior cerebellar peduncle which means vital structures like the basilar artery and vertebral artery are affected (duret hemorrhage??)

31
Q

How can you use the pineal gland as a marker for midline structures?

A

As we age, there is normal calcifications of the pineal gland which can be used to access midline

32
Q

Cerebral palsymost common insult?

A

Non progressive neurologic motor defects characterized by spasticity, dystonia, ataxia/athetosis and paresis attributable to insults during prenatal/perinatal period Most common insult is ischemia during vaginal birth

33
Q

Diseases/disorders associated with perinatal brain injury

A

Cerebral palsy, intraparencymal hemorrhage, periventricular leukomalacia, ulegyria, multicystic encephalopathy

34
Q

Multicystic encephalopathy morphology?

A

-Diffuse, ischemic injury with cystic formations in brain–dont survive

35
Q

Germinal matrix vessels form around ventricles but in normal people they become atretic. In children sometimes these vessles can hemorrhage–this is called?

A

Periventricular leukomalacia

36
Q

Neural tube inner vs outer part

A

inner=ventricular systemoutside=brain and spinal cord

37
Q

Cerebral cortex and posterior fossa absent

A

Anencephaly

38
Q

Protrusion of brain through defect in neural tube

A

Enencephalocele

39
Q

Difference between Arnold Chiari and Dandy Walker

A

Arnold Chiari=SMALL posterior fossa so cerebellum goes into foramen magnumDandy Walker= LARGE posterior fossa so cerebellum wings out because its not constrained so compromises CSF drainage through Foramen of Luschka and Magende; absense of cerebellar vermis, dysplasias of brainstem nuclei

40
Q

Dandy Walker malformation is associated with what symptoms and what abnormalities of organs?

A

Hyperkinetic movement disorder (jerky movement of voluntary muscles–lacks control)Associated with HEART malformations as well as face and limb abnormalities

41
Q

Fluid associated anomalies

A

Syringomyelia and hydromyelia

42
Q

Epidural vs. Subdural Hematomas in terms of margins, shape on CT, cause

A

Both associated with traumaEpidural has smooth margin, subdural has irregular margin because hits sulciSubdural has membrane formation due to fibroblast proliferation in meninges so can contain itselfEpidural associated with lucid interval but subdural can have it too

43
Q

Post-traumatic hydrocephalus is a ____ process

A

astrogliotic

44
Q

Which kind of stroke (embolic or thrombotic) is associated with hemorrhage?

A

Embolic

45
Q

Most common etiology of embolic stroke?

A

from heart mural thrombi (arteriosclerosis with mural thrombus in heart–portion of it breaks off, travels to brain and causes stroke)

46
Q

Global ischemia is caused by and affects? Laterality?

A

Blood loss/asphyxiation and affects both hemispheresleads to death or vegetative state if not transient

47
Q

Local ischemia laterality

A

UNILATERAL

48
Q

MCA blood supply to?

A

face, throat, upper extremities (contralateral) and areas for speech, temporal areas, parietal, and frontal lobe, BASAL GANGLIA

49
Q

Which arteries are most vulnerable to general ischemic events like blood loss or asphixiation?

A

ACA and MCA

50
Q

Area most commonly affected in stroke?

A

Horizontal M1 segment and lenticulostriate vessels

51
Q

What kind of stroke is more common–Embolic or thrombotic?

A

Embolic

52
Q

Left MCA syndrome

A

Language loss (aphasia), right hemiparesis, right hemisensory loss, right visual field deficit, left gaze preference (preference toward side of stroke)

53
Q

Periventricular calcifications, microcephaly, brain damage in utero; also common in HIV patients; subacute encephalitis; what disease?

A

CMV

54
Q

Characteristic morphology of CMV

A

LARGE INTRANUCLEAR inclusions; also see cytoplasmic inclusions

55
Q

What part of brain does Rabies affec and what is the morphologyt? CMV?

A

Rabies affects brainstem distribution with perivascular inflammation while CMV affects periventricular areas

56
Q

Rabies symptoms

A

ascends along peripheral nerves; parasthesias at wound site, hydrophobia (foaming at mouth), flaccid paralysis, respiratory failure

57
Q

HIV encephalopathy morphology

A

chronic inflammation, microglial nodules, MULTINUCLEATED GIANT CELLS, reactive gliosis, myelin pallor

58
Q

When do you see HIV dementia

A

associated with quantity of microglial cells–higher quantity

59
Q

Disease susceptibility associated with HIV

A

CNS lymphoma (Karposi sarcoma), infiltrating squamous cell carcinoma of the cervix (from HPV)

60
Q

PML associated with what virus? Do you see it in everyone with the virus?

A

JV polyomavirus–everyone has it but PML only affects people with the virus who are immunocompromised

61
Q

Candida causes ____ when disseminatedMucor and aspergillus are ____ fungi

A

microabcesses (yeast form in body)angioinvasive–causes vasculitis; mucor–invades sinus walls (hyphae form in body)

62
Q

Geography: Histoplasmosis, blastomyces, coccidoides

A

Histo and Blasto in midwestBlasto–southwest

63
Q

Naeglaria amoeba affects what part of CNS?

A

inferior basal frontal lobe–access through cribiform plate

64
Q

cerebral toxoplasmosis morphology

A

calcifications, brain abcess near gray white junctions and deep gray nuclei; abcess is NOT necrotizing but is circumscribed and well loculated

65
Q

Arbovirus (eg. Easter Equine encephalitis) symptoms

A

Fever, headache, nausea, malaise, confusion

66
Q

mosquito types for the followingZika, west nile, yellow fever, dengue, chikin guna; where found?

A

Zika–aides West nile–aides and coolixyellow fever, dengue and chikin guna= aidesAides found in florida and southern louisina

67
Q

What does prion diseases do in the CNS? (which cells affected)

A

causes neuron loss

68
Q

What areas does Multiple sclerosis affect? Morphology of MS?

A

PERIVENTRICULAR; multiple well circumscribed, somewhat depressed, glassy, gray/tan irregularly shaped plaques; commonly occur adjacent to LATERAL VENTRICLES;

69
Q

Which cells are involved in destroying myelin in MS?

A

T-cell mediated–Th17 and TH1see T cells and macrophages

70
Q

CSF in MS

A

increased protein, some pleocytosis maybe, increased IgG, (oligoclonal bands) from B cell activation, MYELIN BASIC PROTEIN

71
Q

Neuromyelitis optica (NMO) aka Devic disease–mechanism; S/S

A

Humoral autoimmune mechanism against anti-aquaporin 4BILATERAL optic neuritis (MS is usually unilateral); SC demyelination, more common in women

72
Q

MS vs. ADEM (Acute demyelinating encephomyelitis) and ANHE (acute necrotizing hemorrhagic encephalomyelitis) vs CPM

A

MS is POLYPHASIC (lesions are different ages); ADEM and ANHE are MONOPHASIC (same age) ADEM follows a viral URI or antivral immunization (headache, lethargy, disorientation, coma; 20% mortality)ANHE is FATAL and ALWAYS preceded by URICPM–correction of hyponatremia, NON immunologic; quadroplegia seen

Putthoff Lectures/CIS (4 decks)

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