Path VI Flashcards
What are the prenatal ischemic lesions
poencephaly
shizencephaly
hydrancephaly
what is the difference of HIE in mature infants vs adults
neonates have local energy crisis excitotoxicity lactic acidosis free radicals smaller brain, more H20 less antioxidant defense decreased myelin
most characteristic lesion in neonatal HIE
watershed areas because the vasculature is immature
moderate ischemia neonate HIE will cause what
cortical damage between major arterial territories
like cortex that arches from frontal to occipital poles
severe ischemia in neonate HIE will cause what
damage to deep nuclei and brainstem
causes of HIE in neonate
abruptio ppalcenta
difficult delivery
meconium aspiration
infection
what type of brain tissue lost in neonate HIE
grey and white matter
b/l atrophy in area of MCA
cardiopulm arrest at 6 mo
HIE
many cysts in neonate brain
multicycstic encephalopathy from HIE and autolysis of brain tissue
Periventricular leukomalacia in preterm infants
white matter lesions in frontal and occipital lobest
primary cause cerebral palsy
PVL
what area greatest affected by PVL
corpus callosum
deep white matter
why are periventricular areas susceptible to hypoxia
the vessels penetrate from exterior surface and dive into brain
so inside has less blood supply
where is germinal matrix relative to ventrical wall
closest layer, then white matter then grey
when can brain waves be measured
8weeks
noncustic white matter injury
areas of ischemia that become scars
as a child with PVL matures what are clinical signs
tight limb musculature
contracted legs
poor feeding and positioning problems
PVL blue color on H&E
calcifications of necrotic areas
periventricular loss of brain tissue
PVL
White matter injury common in mature infants with what
congenital heart disease
transposition of great vessels
hypoplastic left heart syndrome
what cause white matter injury prenatally
chronic hypoxia,
germinal matrix hemorrhage common in what babies
premature with hyaline membrane disease and RDS
majority cause of morbidity and mortality in newborn period
germinal matrix hemorrhage
picture of babies head and almost all of it transilluminates
hydrancephaly
what cause hydranencephaly
ischemic large vessel to brain
kernicturus
unconj bilirubinemia that results from hemolytic disease, hereditary spherocytosis and other hemolytic disorders
inability liver to conjugate (crigler najjar)
why is unconj bilirubin bad
can cross BBB and lipid soluble so penetrates neuronal and glial membraneas
areas of brain that bilirubin stains
thalamus and basal ganglia
most critical period for malformations and disruptions
3-8 week of gestation
malformation
flawed development
characteristics of malformation
midline or bilateral and symmetric
no gliosis
recurrence risk that can be calculated
distruption
destruction of normal brain
characteristics of disruption
focal and asymmetric
gliosis
do not recur unless exposure recurs
when can inflammation and calcification happen with disruption
if event occurs after 1st trimester
what is a key factor to how severe a malformation or disruption is
the time of exposure
earlier= worse
CMV infection in first trimester causes what
microcephaly and polymicrogyria
CMV infection in third trimester causes what
encephalitis
Neural tube closure defects result in what
anencephaly
craniorachischisis
myelomeningocele
what can cause NT closure defects
folate hyperglycemia B12 zinc maternal fever
what are the types of axial mesodermal defects
closed defects– high in spinal cord
with herniation of neural tissue- encephalocele, meningocele
what can cause axial mesodermal defects
ciliopathies
what are the tail bud defects
spina bifida occulta
split cord (low)
hydromyelia
where does the human embryo have Nt closure
midway
what drugs are teratogenic folate antagonists
carbamazepine
fumonisin
trimethoprim
what deficincies can be teratogenic
folate
inositol
vit B12
zinc
maternal fever during what time period is teratogenic
3-4 weeks pregnancy
one of most common neural tube defects
anencephaly
biomarkers for anencephaly
inc AFP and ACHE in amniotic fluid and maternal blood
how is anencephaly detected
US
look for what other defect in anencephaly
spina bifida
deficiency in anencephaly
folic acid
