Review Last 3 Lectures Flashcards
3 types of neurosyphilis besides ASX
meningovascular, paretic, tabes dorsalis
MC presentation of Neurosyphilis
stroke of the middle cerebral artery in a young person (Meningovascular)
well circumscribed meningeal granulomas
Gummas (neurosyphilis)
febrile Rxn several hours following Tx of early syphilis
Jarisch-Herxheimer Rxn
Progressive Multifocal Leukoencephalopathy (PML) generally caused by
Papovirus family, usually JC virus
disease with death in 3 years
Subacute Sclerosing Panencephalitis
disease w/ elevation in Rubeola IgG Ab.
Subacute Sclerosing Panencephalitis
white matter hemorrhage and gliosis
Subacute Sclerosing Panencephalitis
eosinophilic inclusion bodies are seen in cytoplasm of glial cells
Subacute Sclerosing Panencephalitis
flaccid paralysis from destruction of motor neurons in anterior horn and brainstem
poliomyelitis
inclusion bodies in neurons, negri bodies
rabies (100% diagnostic)
fatty infiltration of the liver and swelling of the kidneys and brain
Reye’s syndrome
associated with use of aspirin for flu or chicken pox
Reye’s syndrome
Two main examples of Spongiform Encephalopathy (prion Dz)
Kuru and Creutzffeldt-Jakob Dz. Each causes rapidly progressive dementia and death within one year.
swollen gyri and narrowed sulci
cerebral ischemia
12-24 hours after a Cerebral Infarction (stroke)
neurons become vacuolated and eosinophilia of the neuronal cytoplasm occurs (red neurons)
> 24 hours after a Cerebral Infarction (stroke)
infiltration by neutrophils begins at edges of lesion
1-14 days after a Cerebral Infarction (stroke)
area of infarction is characterized by macrophages and gliosis
most common cause of thrombotic occlusion
atherosclerosis
most common area of atherosclerosis in thrombotic occlusion
carotid bifurcation or in the vertebrobasilar system…middle cerebral artery is most common
primary underlying cause of Hemorrhagic Stroke
HTN…high mortality
cerebellar and brainstem stroke results from pathology in
vertebral or basilar arteries
MC clinically significant subarachnoid hemorrhage
rupture of Berry Aneurysm
MC type of clinically significant vascular malformation
Arteriovenous Malformations
tangled, wormlike vascular channels with prominent, pulsatile shunt
arteriovenous malformations
petechiae and fibrinoid necrosis of arterioles in gray and white matter
hypertensive encephalopathy
no structural brain damage occurs in
concussion…sx are caused by biochemical changes in neurons (however Dr. Miller is out of date on this FYI…there’s an entire new disease that has been discovered and is caused by concussions aka Chronic Traumatic Encephalopathy or CTE)
sign of brain injury more serious than a concusion
aniscoria
MC skull fracture
Linear
Artery especially vulnerable in Traumatic Vascular Injury
middle meningeal artery
bleed on venous side, dura still attached to skull
subdural hematoma
middle meningeal artery ruptured, dura peeled off
epidural hematoma
MC type of dementia
Alzheimer’s
2nd MC type of dementia
vascular
MC onset of Alzheimer’s
late-onset, >65 yo
amyloid plaque is characteristic
Alzheimer’s…It is a protein normally associated with tissue degeneration. Normally they are broken down, here they build up.
neurofibrillary tangles
Alzheimer’s…Insoluble, twisted fibers of Tau protein found within neurons. Tae normally forms microtubules
knifelike in appearance
Pick’s disease
cerebral atrophy is lobar and hits frontal and temporal lobes
Pick’s disease
substantia nigra with fewer neurons and less pigment
Parkinson’s disease
characteristic lesions in cytoplasm of neurons known as ___ occur in
Lewy body dementia…differential for Alzheimer’s
MC demyelinating disease
MS…women 2x more than men
Progressive Multifocal Leukoencephalopathy due to infection by
JC virus
dense infiltrates of foamy macrophages with large oligodendrocytes and enlarged astrocytes
Progressive Multifocal Leukoencephalopathy
due to overly rapid correction of hyponatremia
central pontine myelinolysis
myelin is destroyed but neurons and axons are spared, opposite of infarction
central pontine myelinolysis
no obvious accompanying inflammation
Central Pontine Myelinolysis (unline MS or PML)
MC brain tumors in kids
astrocytic tumors like glioblastomas followed by medulloblastomas, ependymomas, and craniopharyngiomas
MC brain tumor in adults
metastatic followed by astrocytic and meningiomas
How often do brain tumors METS outsides of the CNS
rarely
4 major classes of primary brain tumors
meningioma (benign), glioma (malignant), neuronal, poorly diff. neoplasms
Meningiomas are MC found on
external surface of brain
malignant tumors of glial cells
gliomas
30-40% of primary intracranial tumors
gliomas
MC type of glioma
astrocytomas
Most malignant astrocytoma grade
Grade 3–Glioblastoma multiforme
2 tumors that together make up 80% of primary brain tumors
fibrillary astrocytoma and glioblastoma
MC brain tumor in middle aged adults
Glioblastoma Multiforme
MC sites of Glioblastoma Multiforme
frontal and temporal lobes but could be any age/location
bifrontal butterfly S-shaped lesion seen on CT. Butterfly lesion infiltrates across the corpus callosum
Glioblastoma Multiforme
most often arise adjacent to ventricular system
ependymomas
if an ependymoma is found in posterior fossa near 4th ventricle
hydrocephalus is common
prognosis of ependymoma
slow growing but prognosis is poor
a neuronal tumor is called a ganglioma if
all tumor cells arise directly from ganglion cells
MC neuronal tumor
mixture of ganglion cells and glial cells, a ganglioglioma
poorly differentiated, appears embryonal (tumor)
medulloblastoma
20% of all brain tumors in kids
medulloblastoma
tumor that arises exclusively in cerebellum
medulloblastoma
tumor that is highly malignant, spreads to spinal cord, and responds well to Tx
medulloblastoma
