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NMSK B > pathology > Flashcards

pathology Flashcards

1
Q

treponema, RMSF, polio, HSV, cryptococcus, aspergillus, TB, rabies, SSPE (measles) / PML (JC virus) tropisms

A 
blood -> neural tissues -> infx, dementia, sensory defects
cerebral endothelial cells
motor neurons in spinal cord and bulbar areas
temporal lobes
leptomeninges, lungs
cerebral parenchyma -> abscesses
meninges at base of brain around chiasm
brainstem
cerebral hemispheres
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2
Q

leptomeningitis

pachymeningitis

A

between pia and arachnoid

external to dura due to chronic infx

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3
Q 
age and organism:
neonates
infant (3 mo to 3 yrs)
adult
close quarters
A

E. coli, GBS
H flu
Strep. pneumoniae
N. meningitidis

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4
Q

diagnosis of meningitidis

A

neutrophil presence! decreased glucose

lymphocytes for TB, viral, and cryptococcal meningitis; elevated protein but normal glucose

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5
Q

H flu meningitis

A

dense leukocytic exudate, rich in fibrin -> loculated barrier to antibiotics

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6
Q

TB meningitis gross and histologic appearance, stain

A

meningeal granulomas (spider-web appearance)
multinucleate giant cells with no PMN’s
AFB (acid fast bacilli) stain

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7
Q

TB meningitis complications

A

can cause meningeal fibrosis -> communicating hydrocephalus OR arteritis -> parenchymal infarcts

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8
Q

tuberculoma

A

hematogenous spread -> parenchymal involvement -> solitary spherical mass with central caseous necrosis

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9
Q

Pott’s disease

A

TB of spine

epidural granulomatous mass -> vertebrae destruction -> spinal cord compression

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10
Q

viral meningitis

A

lymphocytes, increased pro, normal glucose
enteroviri (including coxsackie B), echovirus, EBV, Herpes virus, mumps
most common viral CNS disease

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11
Q

C. neoformans

A

bird feces -> inhaled by immunocompromised -> pneumonia -> hematogenous spread -> lungs, leptomeninges -> disseminated and discrete white nodule lesions
number one AIDS meningitis

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12
Q

C. neoformans morphology

A

encapsulated sphere -> halo with india ink stain

latex agglutination from capsule antigens

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13
Q

cerebral abscess

A

blood -> richest capillary beds of cerebral cortex and subajacent white matter -> cerebritis (Acute inflammation) -> liquefactive necrosis -> expanding abscess

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14
Q

viral encephalitis

A

perivascular cuffs of lymphocytes involving small arteries / arterioles
intranuclear / intracytoplasmic inclusion bodies

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15
Q 
inclusion body tropisms of: 
HSV / H zoster
rabies
CMV
SSPE
PML
A 
eosinophilic intranuclear
cytoplasmic negri bodies
basophilic intranuclear
basophilic intranuclear (measles virus)
intranuclear ground glass appearance in oligodendrocytes (JC virus)
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16
Q

AVM prevalence, location, complications

A

most common congenital vascular malformation
second most common cause of a nontraumatic SAH
occurs at transition between artery and vein
results in seizure, SAH, intracerebral hemorrhage in 2nd or 3rd decade

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17
Q

cavernous angioma prevalence, structure, complication

A

much less common than AVM
large vascular spaces compartmentalized by prominent fibrous walls
usually asymptomatic, may cause intracranial bleed, epilepsy, or focal neuro disturbance

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18
Q

teleangiectasia

A

focal aggregate of small vessels with intervening parenchyma

may cause seizures but rarely ruptures

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19
Q

venous angioma

A

few enlarged veins randomly distributed in spinal cord or brain
asymptomatic

20
Q

cerebral aneurysm prevalence, types

A

most common non-traumatic SAH

1. berry 2. atherosclerotic 3. mycotic 4. HTN

21
Q

berry aneurysm

A

most common aneurysm
at bifurcation of arteries in circle of willis
muscle layer is lacking; only thin tunica adventita

22
Q

berry location

A

ACA-AComm
ICA-PComm-ACA
MCA trifurcation

23
Q

berry complications

A

rupture -> SAH or intracerebral / intraventricular H or CN 3, 4, 6 palsies or seizures due to medial temporal lobe compression
can rebleed if they survive

24
Q

atherosclerotic aneurysm

A

vertebral, basilar or ICA
fusiform elargement due to progressive luminar narrowing due to atherosclerotic plaque
cause thrombosis but rarely rupture

25
Q

mycotic aneurysm

A

infections of arterial walls due to septic emboli usually from infected cardiac valve (endocarditis)
often in MCA branches
proliferation -> inflammation -> destruction of arterial walls
SAH / intracerebral H or cerebral abscess / meningitis

26
Q

Charcot-Bouchard aneurysm description

A

HTN -> lipohyalinosis in interparenchymal cerebral arterioles
associated with long-standing HTN -> small fusiform dilations on trunk of a vessel that are predisposed to rupture causing HTNsive intercerebral hemorrhage

27
Q

Charcot-Bouchard aneurysm locations

A

Basal ganglia / thalamus
pons
cerebellum

28
Q

Charcot-Bouchard aneurysm presentation / complications

A

hematoma -> HA and weakness -> transtentorial hernation or interventricular hemorrhage

29
Q

interventricular hemorrhage

A

expanding 3rd and 4th ventricle -> compression of medulla by ventricle 4 -> death

30
Q

cerebellar hemorrhage

A

abrupt ataxia, occipital HA, vomiting -> compression of medulla

31
Q

cerebral ischemia histology

A

shrunken nuclei, eosinophilic cytoplasm, perineuronal halo

due to extracerebral or occlusive disease

32
Q

infarct types

A

hemorrhagic - emboli

bland - thrombi

33
Q

infarct histology

A

liquefactive necrosis -> neutrophils -> macrophages -> astrogliosis and capillary proliferation -> cystic healing and regressive neovascularity

34
Q

striate and MCA thrombosis deficits

A

striate - from MCA, ischemia of internal capsule -> hemiparesis / hemiplasia
MCA trifurcation -> cerebral cortex ischemia -> motor and sensory defects, aphasia

35
Q

frequent sites of atherosclerosis

A

most common - CCA, esp at bifurcation into ECA, ICA

36
Q

lacunar infarcts

A

ischemic lesions due to stenosis of AComm and PComm (secondary atherosclerosis) -> multi-infarct dementia

37
Q

hypertensive encephalopathy

A

fibrinoid necrosis of small arteries with petechiae due to HTN -> cerebral edema, papilledema -> HA, vomiting -> lethargy -> coma and death

38
Q

fat embolism syndrome

A

traumatic leg fracture -> release of fat emboli -> occlude brain / lung capillaries -> distal capillary ischemia -> development of petechiae restricted to white matter

39
Q

cause of cerebral contusions

A

anteroposteriro displacement

40
Q

contra-coup contusion location

A

frontal and temporal lobes

occipital lobe protected by broad, smooth contour

41
Q

herniations

A

subfalcine (cingulate gyrus)
tonsillar (coning)
transtentorial (uncal)

42
Q

minimal force vs more force contusions

A

minimal - restricted to apex of gyri of cortex
greater force - destroy larger areas of cortex, deeper cavities that expand into white matter or lacerate -> cortical or subcortical hemorrhage and edema -> mass lesion

43
Q

repair of contusions

A

permanent!

necrosis -> phagocytized -> astrogliosis -> pigmented crater lesion

44
Q

subfalcine herniation

A

cingulate gyrus is pushed down and under the falx -> compression of ACA branches

45
Q

tonsillar herniation

A

coning

tonsils of cerebellum are pushed down through foramen magnum -> compression of medulla

46
Q

transtentorial herniation

A

medial temporal lobe (hippocampus) is compressed under tenterium -> compression of CN3 -> ipsilateral fixed pupil dilation, impaired EOM -> duret hemorrhage

47
Q

duret hemorrhage

A

flame-shaped or linear necrotic and hemorrhagic lesions in the midline of the midbrain and pons

NMSK B (11 decks)

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