Path VIII Flashcards
Abnormal neuronal glial proliferation can lead to what malformation
microcephaly or megalocephaly
abnormal neuronal migration can lead to what
periventricular nodular heterotopia
lissencephaly/subcortical band heterotopia
cobblestone Cx/ congenital muscular dystrophy
abnormal cortical organization leads to
polymicrogyria
focal cortical dysplasia
fetal alcohol syndrome affects what layers
ventricular zone and bipolar zone
disrupt myelin and migration of neurons
5 outcomes in malformations of cortical development
1: fewer or more than normal neurons
2: neurons fo not migrate at all from ventricles or half way
3: some neurons reach Cx but man do not
4: neurons overshoot Cx and are in subarachnoid space
5: late stage migration and cx organization disrupted
fewer or excessive normal neurons leads to
micro or megalocephaly
if neurons do not migrate from ventricles what is it called
periventricular heterotopia
nodular– nodules protrude into ventricle
if neurons migrate half way from ventricles it is called
subcortical band heterotopia
if many neurons do not reach Cx
lissencephaly
pachygyria
cobble stone Cx
lissencephaly
smooth brain no gyri
neurons overshoot Cx and go to subarachnoid space
marginal leptomeningeal glioneuronal heterotopia
cobblestone Cx
if late stage migration and cortical organization is disrupted
polymicrogyria
normal adult brain weight
1200-1400 gm
classificaiton for microcephaly
3 standard deviations below mean head circumference or less than 42 cm at full growth
genetic abnormality in lissencephaly
LIS1 mutation
sometimes assoc with microtubule motor proteins or microtubule dynamics
neurlogic disability with polymicrogyria
seizures, sever pyschomotor retardation, spasticity
what can cause polymicrogyria
ischemia, twinning, infections
how many layers of grey matter in polymicrogyria
4 or less
What is Focal Cortical Dysplasia
sporadic developmental malformation of cerebral Cx causing intractable seizures and cognitive impairment
core pathology of focal cortical dysplasia
abnormal cortical cytoarchitecture from loss of normal layering
most frequent path in brain tissure removed in epilepsy surgery in children
focal cortical dysplasia
most frequent lesion in adults with FCD
hippocampal sclerosis
areas affected by fetal alcohol synrome
corpus callosum
cerebral Cx
hippocampus and cerebellum
clinical signs fetal alcohol syndrome
loss of nasal bridge epicanthal folds minor ear abnormalities indistinct philtrum micrognathia thin upper lip plat midface and short nose short palpebral fissures
lab values for neural tube defect
inc AFP
normal b HCG, inhibin A and estriol
lab values for trisomy 21
dec AFP
inc b HCG
inc inhibin A
dec estriol
lab values for trisomy 18 (edwards)
dec AGP, b-HCG, inhibin A, estriol
what is a deformation
extrinsic cause of congenital anomaliy, mechanical stress usually
disruption
secondary breakdown of normal structure
e.g. oligohydramnios
what is a sequence congenital abnomaly
multiple defects from single thing
like Potter sequence
how does infection spread to subdural space
air sinuses or from middle ear
do antibiotics help subdural infections
no because the space is traversed by bridging arteries with no vascular supply of its own
Tx subdural abscess
evacuation and intravenous antibiotics
risk factors for meningitis
local infectino recent brain surgery recent head injury spinal abnormalities CSF shuntplacement UTI, UT abnormalities weakened immune system
differentiate bacterial CSF with viral
purulen high pressure high protein low glucose and polynuclear cells = bacterial
aseptic normal pressure normal protein normal glucose and mononuclear cells = viral
clinical picture acute bacterial meningitis
acute onset in hours
fever lethargy, HA altered mental status, signs of meningeal irritation like neck stiffness
most common infection of CNS
acute leptomeningitis aka meningitis
how can meningitis cause hydrocephalus
pus blocks 4th ventricle
if see lymphocytes in virchow robbin space
viral meningitis
neutrophils in virchow robbin space
bacterial meningitis
clinical picture of acute aseptic viral meningitis
similar to bacterial with fever,lethargy, HA, altered mental status and signs of meningeal irritation
best course of action for fever, lethargy, HA, altered mental status and signs of meningeal irritation
lumbar tap
most common organism for aseptic meningitis
enterovirus
subtype enterovirus for aseptic meningitis
B71
what organisms cause bacterial meningitis
birth- 2 months
E coli
Group B strep
Listeria
what organisms cause bacterial meningitis
2 mo- 5 yrs
strep pneumo
meningococcus
H flu
what organisms cause bacterial meningitis
older child/adult
strep pneumo
N meningitis
what organisms cause bacterial meningitis
elderly
Strep pneumo
E coli
Group B strep
Listeria
organism that can cause epidemics of bacterial meningitis
N meningitis
Tx for bacterial meningitis
ampicillin and ceftriaxone
when do you not use ampicillin for meningitis 3 mo-7 yr
not ampicillin
only ceftriaxone
veins in bacterial meningitis
cloudy from neutrophils and pus
thick vessels
what type of inflammatory cell is found in acute pneumococcal meningitis
neutrophils
gross picture of brain with bacterial meningitis
pus on top
