Pathology Flashcards
Meninges
leptomeninges
- Dura Mater (outer layer)
- Arachnoides
- Pia Mater
Brain : Frontal
- motor functions
- Behavior
- emotions
- higher intellectual functions
Brain : Parietal
Sensory functions
Brain : Temporal
Hearing
Smelling
Brain : occipital
Visual Center
Brainstem : Midbrain
*Visual/auditory reflex center
Brainstem : Pons
- Point of connection b/w cortex + cerebellum + medulla
- MOUTH: chewing/biting/swallowing
- FACE: expressions/sensation
Brainstem : Medulla oblongata
- cardiac center
- vasomotor center
- respiratory center
Cerebellum
- Motor activity regulator
* Integration: spinal cord/vestibular organ sensory impulses + cereberal cortex motor impulses
Gray matter
- cortex
* made of NEURONS
White matter
made of:
- AXONS
- oligodendroglial cells = produce myelin
Which nerve cells are facultative/mitotic/divisible?
Glial = YES Neuron = NO
Glial cells :
- Astrocytes
- Oilgodendrocytes
- Ependymal cells
- Schwann cells
- Microglia
TUMOR = GLIOMAS
What separates CNS from body?
BBB
Meninges
Dysraphic Disorders/Malformations:
Neural tube defect
- *Failure of Neural Folds to close during development
- MC hind end
- -Anencephaly/encephalocele/meningocele
- -*Spina bifida occulta
- myelomeningocele (spine + meninges)
- meningocele (meninges)
- raskiskesis = spinal cord doesn’t close from top to bottom
CNS Hemorrhage:
Epidural hematoma
- MIDDLE MENINGEAL ARTERY rupture
- coma
- Lethal if no Dx
CNS Hemorrhage:
Subdural
- BRIDGING VEINS rupture
- B/w dura + arachnoid
- increased intracranial pressure –> s/s
CNS Hemorrhage:
Subarachnoid
****2nd MC ANEURISM rupture
*trauma
- under arachnoid layer
- High mortality
CNS Hemorrhage:
Intracerebral
2ndary to:
***HTN 2nd MC
*Trauma
*Hematologic dz
Cerebrovascular Dz : 2 types
*Ischemic MC (atherosclerosis/vessel occlusion)
Hemorrhagic (HTN)
Cerebrovascular Dz :
global ischemia
lacunar infarct
vascular dementia
Cerebrovascular Dz :
Cerebral infarct
Stroke
Cerebrovascular Dz :
Intracerebral Hemorrhage
HTN
basal ganglia MC location
Cerebral edema/Herniations
*Cingulate gyrus (subfalcine)
*Cerebral Uncus
(transtentorial = VISON)
*Cerebral Tonsil
(RESPIRATORY)
*Broken skull opening
Brain injury:
concussion
transient loss of consciousness
Brain injury:
contusion
blood supply disruption
Brain injury:
laceration
major neuro deficit
Neck/spinal cord injury
hyperextension/hyperflexion
Infxns from
- Penetrating trauma
- Hematogenous spread (bacterial/fungal/viral/protozoal)
- Middle ear/mastoid
- Frontal sinusitis
encephalitis
brain PARENCHYMA inflammation
*viruses
Myelitis
SPINAL CORD inflammation
*viruses
Autoimmune CNS disease:
Multiple Sclerosis
- Demyelination
- Women MC
- Oligoclonal T-cell brain populations
- IgG CSF = oligoclonal bands
- loss of touch
- motor abnormalities
- Die from respiratory infection
Metabolic/Nutritional dz
- Metabolism/enzyme deficiency = Tay Sachs, Niemann-Pick
- Nutritional - B1/B12/Nicotinic (Ds)
- alcoholism
Alcoholism/B1 deficiency
- Wernicke/Korsaoff syndrome***
- subdural hematoma/pontine myelinolysis
- Delirium tremens
- hypothalamus/mamillary body changes
Neurodegenerative Dz
- Alzheimer’s
- Parkinson’s
- Huntington’s
- Amyotrophic lateral sclerosis (ALS)
Alzheimer’s Dz
- beta amyloid deposits from APP
- > 70 yrs
- dementia
- gyri narrow, sulci widen
- cortex histological changes
- Down syndrome = chrom 21
Parkinson’s
- Tremor
- Instability when walking
- Depression/dementia
- Pale substantia nigra
- lewy bodies/lose melanin rich neurons = SUBSTANTIA NIGRA
Huntington’s dz
- auto dominant
- involuntary movement
- atrophy of cortex/subcortical nuclei (MC in caudate/putamen)
- s/s appear midlife, incapacitated at 50-60 yrs
Amylotrophic Lateral Sclerosis (ALS)
*lose motor neurons - Spinal Cord, Midbrain, Cerebral cortex, Lateral cerebrospinal pathways
CNS Neoplasms
USUALLY do not metastasize
Tumor Origins
Glial
Neurons
Meninges
Cranial/peripheral nerves
Tumor Origin:
Glial
Astrocytomas
Oligodenrogliomas
Ependymomas
Astrocytomas
MC adults = cerebral hemispheres
- MC kids = Cerebellum (Pilocytic)
- solid OR cystic
- Grade 4 glioma = GLIOBLASTOMA (worst)
Glioblastoma
- MC CNS tumor
- lateral hemispheres
- Necrotic yellow/red/white parts
- radiologic butterfly = cross corpus callosum
- poorly demarcated
Oligodendrogliomas
- in cerebral hemispheres
- middle-age adults
- well-circumscribed
- maybe progress to GLIOBLASTOMA
Ependymomas
- Ependymal lining = ventricles
- adults = spinal cord
- in filum terminale (myxopapillary type)
*Pseudorosette = vessel w/ RBC in middle, tumor cells around
Meningioma
- benign/malignant
- different place, different s/s
- epileptic seizure/motor deficit
- benign = excellent prognosis!
Medulloblastoma
- cerebellum
- MC malignant tumor kids
- poor prognosis
Schwannomas/Neurofibromas
- MC benign
* Neurofibratomatosis II = bilat schwannomas
Schwannoma :
compressive / infiltrative?
compressive
Neurofibratoma
compressive / infiltrative?
infiltrative
Metastases to Brain
- MC tumor
* Lung/Breast/Melanoma
Schwann cells make….
Myelin in the PERIPHERY
Spinal cord vs. brain structure
Spinal = white outside, grey inside
Brain = Grey outside, white inside
Oligodendroglial cells make…
myelin for CNS
Astrocytes
Function
Supporter cells
BBB
Ependymal cells
Function
Around ventricle
Ependymal lining
Microglia
Function
- No tumors from here
* Eat dead tissue (infarcts, infxn)
ALL CNS hemorrhages
MC cause
Trauma
Coup vs. Countercoup lesion
Brain
Coup = same side as trauma
Countercoup = opposite side as trauma
Multiple Sclerosis
Lesions
Demyelinating Plaque = Ventricular location
Lymphocytes eat myelin —> bad neuron transmission
Alzheimer’s Dx
Dementia +
- Neuritic plaques
- Neurofibrillary
- Granulovacuolar degeneration (GVB)
Huntington’s dz
Genetics
Auto dominant
Hunter = Dominant
Neoplasm CNS
Location = adults vs. Kids
Adult = Supratentorial
Kids = Infratentorial
MC malignant brain tumor in adult
Metastasis
MC common PRIMARY malignant brain tumor = adult
Glioblastoma
Invade brain
MC benign brain tumor
Meningioma
Dura mater = compress
MC malignant tumor = kids
Medulloblastoma
Cerebellum
MC benign brain tumor = kids
Pylocystic astrocytoma
Cerebellum
Glioblastoma
Histological characteristics
- A = atypia (Gr1)
- M = Mitosis (Gr2/3)
- E = Endothelial Vascular Peforation
- N = necrosis (Gr4)
Oligodendroma
Histology
*Chicken-wire vasculature
- Fried-egg cells
- nucleus
- spread out cytoplasm