XXIII - The Nervous System Flashcards
2
Q
This pattern of neuronal cell injury leads to shrunken individual cell bodies and nuclei. They are prominently stained by eosin, leading to the term “red neurons.”
A
Acute hypoxic/ischemic injury(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 860
3
Q
These are round, faintly basophilic, PAS-positive, concentrically lamellated aggregates of polyglucosans that range between 5 and 50 μm, and are located wherever there are astrocytic end processes, especially in the subpial and perivascular zones, seen more frequently with advancing age.
A
Corpora amylacea (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 861
4
Q
Cells which produce myelin in the CNS.
A
Oligodendrocytes (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 861
5
Q
Cells which line the ventricles, and are located in the region of the obliterated central canal of the spinal cord.
A
Ependymal cells (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 861
6
Q
These are responsible for the secretion of CSF. It has a specialized epithelial covering with a fibrovascular stroma that may contain meningothelial cells.
A
Choroid plexus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 861
7
Q
These are bone marrow-derived cells that function as the phagocytes of the CNS.
A
Microglia (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 861
8
Q
IT is the accumulation of excess fluid within the brain parenchyma. The brain is softer than normal and often appears to “overfill” the cranial vault. In generalized edema the gyri are flattened, the intervening sulci are narrowed, and the ventricular cavities are compressed.
A
Cerebral Edema (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 861
9
Q
This occurs when the integrity of the normal blood-brain barrier is disrupted. With increased vascular permeability, fluid shifts from the vascular compartment into the intercellular spaces of the brain.
A
Vasogenic edema (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 861
10
Q
This is due to an increase in intracellular fluid secondary to neuronal, glial, or endothelial cell membrane injury, as might be encountered in an individual with a generalized hypoxic/ischemic insult or with exposure to some toxins.
A
Cytotoxic edema(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 861
11
Q
Refers to the accumulation of CSF leading to dilation of the ventricular system which resulted from an obstacle or disruption of flow seen most commonly at the foramen of Monroe or aqueduct of Sylvius.
A
Noncommunicating hydrocephalus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 862
12
Q
Refers to the accumulation of CSF leading to dilation of the ventricular system due to reduced resorption of CSF. All of the ventricular system is enlarged.
A
Communicating hydrocephalus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 862
13
Q
This refers to dilation of the ventricular system with a compensatory increase in CSF volume secondary to a loss of brain parenchyma, as may occur after infarcts or with a degenerative disease.
A
Hydrocephalus ex vacuo (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 862
14
Q
This ccurs when unilateral or asymmetric expansion of a cerebral hemisphere displaces the cingulate gyrus under the edge of falx. This may be associated with compression of branches of the anterior cerebral artery.
A
Subfalcine (cingulate) herniation(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 862
15
Q
This occurs when the medial aspect of the temporal lobe is compressed against the free margin of the tentorium. As the temporal lobe is displaced, the third cranial nerve is compromised, resulting in pupillary dilation and impairment of ocular movements on the side of the lesion (“blown pupil”).
A
Transtentorial (uncinate) herniation (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 862
16
Q
This refers to displacement of the cerebellar tonsils through the foramen magnum. This pattern of herniation is life-threatening, because it causes brain stem compression and compromises vital respiratory and cardiac centers in the medulla.
A
Tonsillar herniation (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 862
17
Q
These linear or flame-shaped lesions usually occur in the midline and paramedian regions, which are hemorrhagic lesions that accompany transtentorial herniation. Presence of these lesion implies poor prognosis.
A
Duret hemorrhages(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 862
18
Q
In the setting of this condition, the brain is swollen, with wide gyri and narrowed sulci. The cut surface shows poor demarcation between gray and white matter. Results from generalized reduction of cerebral perfusion, usually below systolic pressures of less than 50mmHg.
A
Global Cerebral Ischemia (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 863
19
Q
These are wedge-shaped areas of infarction that occur in those regions of the brain and spinal cord that lie at the most distal fields of arterial perfusion.
A
Border zone (“watershed”) infarcts(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 863
20
Q
Pattern of necrosis seen in nonhemorrhagic infarcts of the brain.
A
Liquefaction necrosis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 863
21
Q
This is a disease in which amyloidogenic peptides are deposit in the walls of medium- and small-caliber meningeal and cortical vessels, which results in the weakening of the vessel wall and increases the risk of hemorrhage.
A
Cerebral amyloid angiopathy (CAA) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 863
22
Q
Hemorrhages associated with cerebral amyloid angiopathy (CAA) are called due to involvement of the cerebral hemispheres?
A
Lobar hemorrhages(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 863
23
Q
The most frequent cause of subarachnoid hemorrhage. It is a thin-walled outpouching of an artery. At the neck of the aneurysm, the muscular wall and intimal elastic lamina stop short and are absent from the aneurysm sac itself; the sac is made up of thickened hyalinized intima. The adventitia covering the sac is continuous with that of the parent artery
A
Saccular (berry) aneurysm(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 866
24
Q
Patients with this type of intracranial hemorrhage complains of having “the worst headache I’ve ever had”/ thunderclap headache.
A
Subarachnoid Hemorrhage (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 866
25
Q
Most common location for berry/saccular aneurysms.
A
Anterior communicating artery in the Circle of WIllis (40%)(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 867
26
This is a disease in which amyloidogenic peptides are deposit in the walls of medium- and small-caliber meningeal and cortical vessels, which results in the weakening of the vessel wall and increases the risk of hemorrhage.
Cerebral amyloid angiopathy (CAA) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 863
27
Hemorrhages associated with cerebral amyloid angiopathy (CAA) are called due to involvement of the cerebral hemispheres?
Lobar hemorrhages(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 863
28
The most frequent cause of clinically significant subarachnoid hemorrhage.
Rupture of a saccular (berry) aneurysm(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 866
29
A type of vascular malformation which are characterized by of ectatic venous channels.
Venous angiomas (varices) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 868
30
Most common location for berry aneurysms.
Anterior communicating artery in the Circle of WIllis (40%)(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 867
31
The involved vessels in this condition resemble a tangled network of wormlike vascular channels. Microscopically, they are enlarged blood vessels separated by gliotic tissue, often with evidence of prior hemorrhage.
Arteriovenous malformations (AVM)(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 868
32
This is an inflammatory disorder that involves multiple small to medium-sized parenchymal and subarachnoid vessels and is characterized by chronic inflammation, multinucleated giant cells and destruction of the vessel wall. Affected individuals manifest a diffuse encephalopathic clinical picture, often with cognitive dysfunction; improvement occurs with steroid and immunosuppressive treatment.
Primary angiitis of the CNS (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 868
33
A type of vascular malformation which are characterized by microscopic foci of dilated, thin-walled vascular channels separated by relatively normal brain parenchyma and occurring most frequently in the pons.
Capillary telangiectasias(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 868
34
Injury which may occur from collision of the brain with the skull opposite the site of impact.
Contrecoup injury(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 868
35
Minute aneurysms in vessels that are less than 300 μm in diameter, associated with chronic hypertension.
Charcot-Bouchard microaneurysms (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 868
36
This leads to accumulation of arterial blood between the dura and the skull. The expanding hematoma has a smooth inner contour that compresses the brain surface. Clinically, patients may experience a lucid interval between the moment of trauma and development of neurologic symptoms.
Epidural Hematoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 870
37
This is an inflammatory disorder that involves multiple small to medium-sized parenchymal and subarachnoid vessels and is characterized by chronic inflammation, multinucleated giant cells and destruction of the vessel wall. Affected individuals manifest a diffuse encephalopathic clinical picture, often with cognitive dysfunction; improvement occurs with steroid and immunosuppressive treatment.
Primary angiitis of the CNS (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 868
38
This describes reversible altered consciousness from head injury in the absence of contusion. The characteristic transient neurologic dysfunction includes loss of consciousness, temporary respiratory arrest, and loss of reflexes.
Concussion(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 869
39
Injury which may occur from collision of the brain with the skull opposite the site of impact.
Contrecoup injury(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 868
40
These are wedge shaped lesions of the brain parenchyma which occur secondary to trauma. The broad base of the wedge spans the surface and centered on the point of impact.
Contusions(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 868
41
Clinically, patients may experience a lucid interval between the moment of trauma and development of neurologic symptoms.
Epidural Hematoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 870
42
Blood vessel involved in epidural hematoma.
Middle meningeal artery(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 870
43
This describes reversible altered consciousness from head injury in the absence of contusion. The characteristic transient neurologic dysfunction includes loss of consciousness, temporary respiratory arrest, and loss of reflexes.
Concussion(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 869
44
This is a diverticulum of malformed CNS tissue extending through a defect in the cranium. It most often involves the occipital region or the posterior fossa.
Encephalocele(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 872
45
Blood vessels involved in subdural hemorrhage.
Bridging veins(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 870
46
This is an extension of CNS tissue through a defect in the vertebral column, most commonly in the lumbosacral region. both The meninges and spinal cord parenchyma are included in the cystlike structure visible just above the buttocks.
Myelomeningocele(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 872
47
Herniation of the meninges through a defect in the vertebral column.
Meningocoele(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 872
48
This is a malformation of the anterior end of the neural tube, with absence of the brain and top of skull.
Anencephaly(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 872
49
This is a diverticulum of malformed CNS tissue extending through a defect in the cranium. It most often involves the occipital region or the posterior fossa.
Encephalocele(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 872
50
Cerebral malformation characterized by an enlarged posterior fossa. The cerebellar vermis is absent, and replaced by a large, midline cyst that is lined by ependyma and is contiguous with leptomeninges on its outer surface.
Dandy-Walker malformation (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 872
51
Characterized by an increased number of irregularly formed gyri that result in an irregular bumpy or cobblestone-like surface.
Polymicrogyria(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 872
52
Characterized by a disruption of the normal midline patterning. In severe forms the brain is not divided into hemispheres or lobes and may be associated with facial midline defects like cyclopia.
Holoprosencephaly (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 872
53
Consists of a small posterior fossa and a misshapen midline cerebellum with downward extension of vermis through the foramen magnum; hydrocephalus and a lumbar myelomeningocele are typically also present.
Arnold-Chiari malformation Type II(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 872
54
Consists of low-lying cerebellar tonsils which extend through the foramen magnum at the base of the skull. This can lead to obstruction of CSF flow and compression of the medulla, resulting in symptoms of headache or cranial nerve deficits.
Arnold-Chiari malformation type I(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 872
55
Cerebral malformation characterized by an enlarged posterior fossa. The cerebellar vermis is absent, and replaced by a large, midline cyst that is lined by ependyma and is contiguous with leptomeninges on its outer surface.
Dandy-Walker malformation (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 872
56
Spinal cord abnormality characterized by a discontinuous or confluent expansion of the ependyma-lined central canal of the cord.
Hydromyelia(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 873
57
CSF findings in bacterial meningitis.
Increased pressureabundant neurophilsprotein - elevatedglucose - reduced(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 874
58
This is an inflammatory process of the leptomeninges and CSF within the subarachnoid space.
Meningitis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 874
59
In acute cases of this condition, an exudate is evident within the leptomeninges over the surface of the brain. On microscopic examination, neutrophils fill the entire subarachnoid space in severely affected areas or may be found predominantly around the leptomeningeal blood vessels.
Acute meningitis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 874
60
Caused by invasion of the brain by Treponema pallidum and manifests as insidious but progressive loss of mental and physical functions with mood alterations (including delusions of grandeur), terminating in severe dementia. There is parenchymal damage particularly in the frontal lobe, characterized by loss of neurons with proliferation of microglia (rod cells) and gliosis.
Paretic neurosyphilis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 875
61
A form of neurosyphilis, resulting from damage to the sensory nerves in the dorsal roots producing impaired joint position sense and resultant ataxia, loss of pain sensation, leading to skin and "Charcot joints". There is loss of both axons and myelin in the dorsal roots, with pallor and atrophy in the dorsal columns of the spinal cord.
Tabes dorsalis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 875
62
CSF findings in bacterial meningitis.
Increased pressureabundant neurophilsprotein - elevatedglucose - reduced(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 874
63
Presents with generalized symptoms of headache, malaise, mental confusion, and vomiting. The subarachnoid space contains a gelatinous or fibrinous exudate, most often at the base of the brain, obliterating the cisterns and encasing cranial nerves. There may be discrete white granules scattered over the leptomeninges. Obliterative endarteritis may be seen.
Tuberculous meningitis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 874
64
CSF findings in tuberculous meningitis.
moderate pleiocytosis - predominantly monocytesprotein - elevatedglucose - medorately reduced/normal(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 874
65
Caused by invasion of the brain by Treponema pallidum and manifests as insidious but progressive loss of mental and physical functions with mood alterations (including delusions of grandeur), terminating in severe dementia.
Paretic neurosyphilis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 874
66
This virus tends to localize in the paraventricular subependymal regions of the brain, which results in a severe hemorrhagic necrotizing ventriculoencephalitis and choroid plexitis.
Cytomegalovirus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 877
67
These are discrete lesions with central liquefactive necrosis and a surrounding fibrous capsule. On microscopic examination, there is exuberant neovascularization around the necrosis that is responsible for the marked edema and formation of granulation tissue. Outside the fibrous capsule is a zone of reactive gliosis.
Brain Abscesses (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 876
68
The pathognomonic finding of this disease is a spongiform transformation of the cerebral cortex and deep gray matter structures (caudate, putamen); consists of a multifocal process that results in the uneven formation of small, empty, microscopic vacuoles of varying sizes within the neuropil and sometimes in the perikaryon of neurons.
Creutzfeldt-Jakob Disease (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 880
69
Viral encephalitis which involves inferior and medial regions of the temporal lobes and the orbital gyri of the frontal lobes. Perivascular inflammatory infiltrates are usually present, and Cowdry type A intranuclear viral inclusion bodies can be found in both neurons and glia.
Herpes Encephalitis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 876
70
Reactivation of varicella in adults manifests as a painful, vesicular skin eruption in the distribution of one or a few dermatomes.
Shingles / Herpes Zoster(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 876
71
This virus tends to localize in the paraventricular subependymal regions of the brain, which results in a severe hemorrhagic necrotizing ventriculoencephalitis and choroid plexitis.
Cytomegalovirus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 877
72
This lesion caused by JC virus, consist of patches of irregular, ill-defined destruction of the white matter that enlarge. Each lesion is an area of demyelination, in the center of which are scattered lipid-laden macrophages and a reduced number of axons.
Progressive Multifocal Leukoencephalopathy (PML) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 877
73
These are predominantly benign tumors of adults, usually attached to the dura, and arising from the meningothelial cell of the arachnoid. Histologic patterns include syncitial, fibroblastic, psammomatous, secretory and microcystic.
Meningiomas(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 885
74
Five most common primary sites of carcinoma which may metastasize to the brain.
LungBreastSkin (melanoma)KidneyGIT(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 885
75
These are infiltrative tumors that form gelatinous, gray masses, and may show cysts, focal hemorrhage, and calcification. On microscopic examination, the tumor is composed of sheets of regular cells with spherical nuclei containing finely granular chromatin (similar to normal oligodendrocytes) surrounded by a clear halo of cytoplasm.
Oligodendrogliomas(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 883
76
A nonimmune process characterized by loss of myelin involving the center of the pons, most often after rapid correction of hyponatremia.
Central pontine myelinolysis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 889
77
These are inherited dysmyelinating diseases in which the clinical symptoms derive from either abnormal myelin synthesis or turnover.
Leukodystrophies (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 889
78
These are predominantly benign tumors of adults, usually attached to the dura, and arising from the meningothelial cell of the arachnoid. Histologic patterns include syncitial, fibroblastic, psammomatous, secretory and microcystic.
Meningiomas(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 885
79
Profound memory disturbances as a result of thiamine deficiency.
Korsakoff syndrome(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 890
80
An autoimmune demyelinating disorder characterized by distinct episodes of neurologic deficits, separated in time, attributable to white matter lesions that are separated in space. Affected areas show multiple, well-circumscribed, slightly depressed, glassy, gray-tan, irregularly shaped lesions, termed "plaques".
Multiple Sclerosis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 887
81
A nonimmune process characterized by loss of myelin involving the center of the pons, most often after rapid correction of hyponatremia.
Central pontine myelinolysis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 889
82
These are inherited dysmyelinating diseases in which the clinical symptoms derive from either abnormal myelin synthesis or turnover.
Leukodystrophies (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 889
83
This condition occurs in the setting of thiamine deficiency and chronic alcoholism. Characterized by foci of hemorrhage and necrosis, particularly in the mammillary bodies but also adjacent to the ventricle, especially the third and fourth ventricles.
Wernicke encephalopathy(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 890
84
Profound memory disturbances as a result of thiamine deficiency.
Korsakoff syndrome(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 890
85
Characterized by "flapping" tremor, depressed levels of consciousness, which may lead to coma. Result of decreased hepatic function.
Hepatic encephalopathy (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 891
86
It is the most common cause of dementia in the elderly, characterized by presence of plaques and neurofibrillary tangles, composed of tau proteins.
Alzheimer's disease(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 893
87
Mutation in Friedreich ataxia.
GAA trinucleotide repeat (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 895
88
This is a clinical syndrome characterized by masked facies, stooped posture, slowness of voluntary movement, festinating gait rigidity, and a "pill-rolling" tremor. There are single or multiple, intracytoplasmic, eosinophilic, round to elongated inclusions that often have a dense core surrounded by a pale halo or "Lewy bodies".
Parkinson disease (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 894
89
It is an inherited autosomal dominant disease characterized clinically by progressive movement disorders and dementia, with degeneration of the striatum (caudate and putamen).
Huntington Disease (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 894
90
Mutation in Huntington disease.
CAG trinucleotide repeats(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 895
91
It is an autosomal recessive progressive illness, generally beginning in the first decade of life with gait ataxia, followed by hand clumsiness and dysarthria.
Friedreich ataxia (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 895
92
Mutation in Friedreich ataxia.
GAA trinucleotide repeat (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 895
93
This is the most common form of neurodegeneration affecting the motor system. It is characterized by muscle atrophy and hyper-reflexia due to loss of both upper and lower motor neurons.
Amyotrophic Lateral Sclerosis (Motor Neuron Disease; Lou Gehrig's Disease) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 895
94
This autosomal dominant disorder is characterized by neurofibromas (plexiform and solitary), gliomas of the optic nerve, pigmented nodules of the iris (Lisch nodules), and cutaneous hyperpigmented macules (café au lait spots).
Type 1 Neurofibromatosis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 901
95
This is one of the most common life-threatening diseases of the peripheral nervous system. It may develop spontaneously or after a systemic infection (usually viral) or other stress. Usually presents with rapidly progressive, ascending motor weakness that may lead to death from failure of respiratory muscles.
Guillain-Barré Syndrome (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 899
96
These are benign tumors arising from Schwann cells, which are well-circumscribed encapsulated, firm, gray masses but may also have areas of cystic and xanthomatous change.
Schwannomas (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 899
97
Present in the dermis and subcutaneous fat, these well-delineated but unencapsulated masses are composed of spindle cells. The stroma of these tumors is highly collagenized and contains little myxoid material.
Cutaneous neurofibroma.(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 899
98
These tumors may arise anywhere along a nerve, may be multiple, and is not easily separated from the nerve.
Plexiform neurofibroma(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 899
99
This autosomal dominant disorder is characterized by neurofibromas (plexiform and solitary), gliomas of the optic nerve, pigmented nodules of the iris (Lisch nodules), and cutaneous hyperpigmented macules (café au lait spots).
Type 1 Neurofibromatosis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 901
100
This is an autosomal dominant disorder in which patients develop a range of tumors, most commonly bilateral vestibular (acoustic) schwannomas and multiple meningiomas.
Type 2 Neurofibromatosis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 901
101
An autosomal dominant syndrome characterized by the development of hamartomas and benign neoplasms involving the brain and other tissues. The lesions are firm areas of the cortex that, in contrast to the softer adjacent cortex, have been likened to potatoes, hence the appellation "tubers."
Tuberous Sclerosis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 901
102
An autosomal dominant inherited disease in characterized by development of hemangioblastomas within the cerebellar hemispheres, retina, and less commonly the brain stem and spinal cord. A cerebellar capillary hemangioblastoma, is the principal neurologic manifestation of the disease.
von Hippel-Lindau Disease (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 901
103
What is the dominant histopathologic finding in Immune mediated neuropathies like Guillain- Barre Syndrome?
Inflammation of peripheral nerve, manifested as perivenular and endoneurial infiltration by lymphocytes, macrophages, and a few plasma cells(TOPNOTCH)
104
What is the most common type of peripheral neuropathy seen in adult-onset DM?
Symmetric neuropathy that involves distal sensory and motor nerves (TOPNOTCH)
105
In patients with peripheral neuropathy, what is the predominant histologic findings?
Axonal neuropathy (TOPNOTCH)
106
Morphology: Perifascicular Atrophy
Dermatomyositis (TOPNOTCH)
107
Morphology: presence of rimmed vacuoles within myocytes and are highlighted by basophilic granules at their periphery. In addition, the vacuolated fibers may also contain amyloid deposits that stain with Congo Red.
Inclusion body myositis (TOPNOTCH)
108
Morphology: Panfascicular atrophy
Spinal Muscular Atrophy (Infantile Motor Neuron Disease (TOPNOTCH)
109
What are the 5 histopathologic abnormalities common to Duchenne Muscular Dystrophy and Becker Muscular Dystrophy?
1. Variation in fiber diameter2. Increased numbers of internalized nuclei3. Degeneration, necrosis, and phagocytosis of muscle fibers4. Regeneration of muscle fibers5. Proliferation of endomysial connective tissue (TOPNOTCH)
110
Morphology: In later stages of this disease, all muscles eventually become almost totally replaced by fat and connective tissue
DMD (TOPNOTCH)
111
What is the histologic pathology that is usually seen in DMD and is rare in BMD?
Enlarged, rounded, hyaline fibers that have lost their normal cross striation, believed to be hypercontracted fibers (TOPNOTCH)
112
Morphology: Ring fiber ( subsarcolemmal band of cytoplasm that appears distinct from the center of the fiber) and Sarcoplasmic mass
Myotonic Dystrophy (TOPNOTCH)
113
Morphology: Disuse changes with Type 2 fiber atrophy, post synaptic membrane is simplified, with loss of AChRs from the region of the synapse. Immune complexes as well as the MAC of the complement cascade can be found along the post synaptic membrane as well
Myesthenia Gravis (TOPNOTCH)
114
Electron Microscopy: tubular and filamentous inclusions are seen in the cytoplasm and the nucleus, and they are composed of B-amyloid or hyperphosphorylated tau.
Inclusion body myositis (TOPNOTCH)
115
Grotton lesions (scaling erythematous eruption or dusky red patches over the knuckles, elbows, and knees) are seen in what disease entity?
Dermatomyositis (TOPNOTCH)
116
Morphology: the most consistent pathologic finding in skeletal muscle is aggregates of abnormal mitochondria that stain with modified Gomori Trichrome and fiber appears irregular on cross section "ragged red fibers" and on electron microscope, they contain "parking lot inclusions"
Mitochondrial Myopathies (Oxidative phosphorylation Disease) (TOPNOTCH)
117
This is general reaction of the motor unit which is a result of primary destruction of the axon, with secondary disintegration of its myelin sheath.
Axonal degereration (TOPNOTCH)
118
This general reaction of the motor unit occurs when there is dysfunction of the Schwann cell or damage to the myeling sheath; there is no primary abnormality of the axon
Segmental demyelination (TOPNOTCH)
119
Morphology: endoneurial arterioles show thickening, hyalinization, and intense PAS positivity in their walls and extensive reduplicaton of the basement membrane.
Peripheral Neuropathy in DM Type 2 (TOPNOTCH)
120
Of all the dystrophies, this type is the only one that shows pathologic changes in the intrafusal fibers of muscle spindles, with fiber splitting, necrosis and regeneration
Myotonic Dystrophy (TOPNOTCH)
121
Morphology: the principal morphologic characteristic is accumulation of lipid within myocytes. The myofibrils are separated by vacuoles that stain with oil red O or Sudan black
Lipid Myopathies (TOPNOTCH)
122
Lambert Eaton Myasthenic Syndrome is a paraneoplastic process which commonly develops in what type of carcinoma?
Small cell carcinoma of the lungs (TOPNOTCH)
123
The most important histopathological indicator of CNS injury, regardless of etiology
Gliosis(TOPNOTCH)
124
Lafora bodies
Myoclonic Epilepsy(TOPNOTCH)
125
Gross morphology: gyri are flattened, intervening sulci are narrowed, and the ventricular cavities are compressed
Generalized cerebral edema(TOPNOTCH)
126
A syndrome of sudden, deep intracerebral hemorrhage that follows even minor head trauma by an interval of 1-2 weeks
Spat-apoplexie (Delayed post traumatic haemorrhage) (TOPNOTCH)
127
Subdural hematomas most often become manifest approximately how many hours after the injury?
48 hours(TOPNOTCH)
128
The most widely accepted explanation for diffuse axonal injury
mechanical forces damage the integrity of the axon at the node of Ranvier, with subsequent alterations in axoplasmic flow(TOPNOTCH)
129
Morphology: wide asymmetric distribution of axonal swellings that appear within hours of the injury and are best demonstrated with silver impregnation techniques or with immunoperoxidase stains for AB protein
Diffuse axonal injury(TOPNOTCH)
130
How long does it take for the clot to lyse in subdural hematomas?
1 week(TOPNOTCH)
131
How long does it take for fibroblasts to grow from the dural surfaces into the hematoma after subdural hematoma/
2 weeks(TOPNOTCH)
132
How long does it take for the development hyalinazed connectice tissue in SDH
1-3 months(TOPNOTCH)
133
Gross morphology: brain is swollen, gyri are widened, and the sulci are narrowed
Global cerebral ischemia(TOPNOTCH)
134
In the setting of global ischemia, early histological changes are seen after how many hours after the insult?
12-24 hours(TOPNOTCH)
135
In the setting of global ischemia, sub acute changes are seen after how many hours after the insult?
24 hours to 2 weeks(TOPNOTCH)
136
In the setting of global cerebral ischemia, repair is seen after approximately how many weeks?
2 weeks(TOPNOTCH)
137
In the setting of global ischemia, this is characterized by evenutal removal of all necrotic tissue, loss of normally organized CNS structure, and gliosis
Repair(TOPNOTCH)
138
In the setting of global ischemia This is characterized by necrosis of tissue, influx of macrophages, vascular proliferation and reactive gliosis
Subacute changes(TOPNOTCH)
139
In the setting of global ischemiaThis is characterized by acute neuronal cell damage
Early change(TOPNOTCH)
140
Morphology: pathognomonic finding is a spongiform transformation of the cerebral cortex
CJD(TOPNOTCH)
141
Morphology: mononuclear cell perivacular cuffs and neuronophagia of the anterior horn motor neurons of the spinal cord
(TOPNOTCH)
142
In the immunosuprressed individual, the most common pattern of involvement in viral meningitis is?
Subacute encephalitis(TOPNOTCH)
143
Although any type of cell within the CNS can be infected with CMV, the virus tends to localize at what particular area in the brain?
Paraventricular subependymal regions(TOPNOTCH)
144
What is the principal neurologic manifestation of Von Hippel Lindau Disease?
Cerebellar capillary hemangioblastoma(TOPNOTCH)
145
Antoni A and Antoni B patterns of growth are seen in what tumors of the CNS?
Schwannoma(TOPNOTCH)
146
Morphology: histologic appearance similar to anaplastic astrocytoma with the additional feature of necrosis and vascular or endothelial cell proliferation
Glioblastoma multiforme(TOPNOTCH)
147
Pseudopalisading
Glioblastoma multiforme(TOPNOTCH)
148
Glomeruloid body
Glioblastoma multiforme(TOPNOTCH)
149
Morphology: bipolar cells with long, thin hairlike processes that are GFAP positive; Rosenthal fibers, eosinophilic granular bodies, and microcysts are often present
Pilocytic astrocytoma(TOPNOTCH)
150
Lesion of what area of the brain appear to be the best correlate of the memory disturbance and confabulation seen in Korsakoff syndrome?
Medial dorsal nucleus of the thalamus(TOPNOTCH)
151
Morphology: foci of hemorrhage and necrosis, particularly in the mammillary bodies but also adjacent to the ventricle, especially the third and fourth ventricles
Wernicke encephalopathy(TOPNOTCH)
152
The spinal cord shows loss of axons and gliosis in the posterior columns, the distal portions of the corticospinal tracts, and the spinocerebellar tracts.
Friedreich Ataxia(TOPNOTCH)
153
The abnormalities are predominantly in the cerebellum,with loss of Purkinje and granule cells; there is also degeneration of the dorsal columns, spinocerebellar tracts and anterior horn cells and a peripheral neuropathy
Ataxia Telangiectasia(TOPNOTCH)
154
Gross morphology: palor of the substantia nigra
Parkinson Disease(TOPNOTCH)
155
Gross morphology: the brain shows pronounced, frequently asymmetric, atrophy of the frontal and temporal lobes with conspicuous sparing of the posterior two thirds of the superior temporal gyrus
Pick Disease(TOPNOTCH)
156
What are the 3 major microscopic abnormalities of Alzheimer disease?
Neuritic/Senile PlaquesNeurofibrillary tanglesAmyloid angiopathy(TOPNOTCH)
157
What is the principal clinical manifestation of Alzheimer disease?
Dementia(TOPNOTCH)
158
What is the most common cause of dementia in the elderly?
Alzheimer Disease(TOPNOTCH)
159
Gross morphology: variable degree of cortical atrophy with widening of the cerebral sulci that is most pronounced in the frontal, temporal, and parietal lobes with compensatory ventricular enlargement (hydrocephalus ex vacuo)
Alzheimer Disease(TOPNOTCH)
160
Neurotic plaques are focal, spherical collection of dilated, tortuous, silver staining neuritic processes often around a central amyloid core, which may be surrounded by clear halo, and can be stained with Congo red. What is the most predominant component of this plaque core?
AB peptide(TOPNOTCH)
161
Neurofibrillary tangles are bundles of filaments in the cytoplasm of the neurons that displace or encircle the nucleus. What is the major component of this structure?
Tau proteins(TOPNOTCH)
162
Hirano bodies
Alzheimer's disease (TOPNOTCH)
163
What is the principal neurologic manifestation of Von Hippel Lindau Disease?
Cerebellar capillary hemangioblastoma(TOPNOTCH)
164
Patients with Von Hippel Lindau Disease has the propensity to develop what type of carcinom?
Renal Cell Carcinoma(TOPNOTCH)
165
These are firm areas of the cortex that, in contrast to the softer adjacent cortex, have been likened to potatoes and are composed of haphazardly arranged neurons that lack the normal laminar organization of neocortex.
Cortical hamartomas or "tubers' of Tuberous Sclerosis (TOPNOTCH)
166
Malignant Peripheral Nerve Sheath Tumor (MPNST, Malignant Schwannoma) is strongly associated with what type of Familial Tumor Syndrome?
Neurofibromatosis Type 1(TOPNOTCH)
167
What are the 5 most common carcinoma that metastasize to the brain?
Lung, breast, Melanoma, Kidney, and GIT. (TOPNOTCH)
168
What is the most common CNS neoplasm in immunosuppressed patients, including those with AIDS and immunosuppression after transplantaion?
Primary CNS Lymphoma(TOPNOTCH)
169
Morphology: composed of sheets of regular cells with spherical nuclei containing finely granular chromatin surrounded by a clear halo of cytoplasm and calcification if present in as many as 90% of these tumors.
Oligodendroglioma(TOPNOTCH)
170
Morphology: characterized by amild to moderate increase in the number of glial cell nuclei, somewhat variable nuclear pleomorphism, and an interveing feltwork of fine, GFAP positive astrocytic cell processes that give the background a fibrillary appearance.
Well differentiated fibrillary astrocytomas(TOPNOTCH)
171
Morphology: perivascular pseudorosettes
Ependymoma(TOPNOTCH)
172
Morphology: the anterior roots of the spinal cord are thin; the precentral gyrus may be atrophic and demonstrates a reduction the number of anterior horn neurons throughout the length of the spinal cord with associated reactive gliosis. Remaining neurons often contain Bunina bdoies and PAS positive cytoplasmic inclusions.
Amyotorphic Lateral Sclerosis(TOPNOTCH)
173
Morphology: composed of bipolar cells with long, thin "hairlike" processes that are GFAP- Positive; Rosenthal fibers, eosinophilic granular bodies, and microcysts are often present.
Pilocytic Astrocytoma (TOPNOTCH)
174
Morphology: similar to anaplastic astrocytoma with the additional features of necrosis and vascular or endothelial cell proliferation, each of which often has a stereotypic appearance.
Glioblastoma Multiforme(TOPNOTCH)
175
Morphology: characterized by areas of stromal response with collagen and reticulin deposition and nodules of cells forming "pale islands" that have more neuropil and lack the reticulin deposition
Desmoplastic variant of Medulloblastoma(TOPNOTCH)
176
Gross morphology: the brain is small and shows striking atrophy of the caudate nucleus and the putamen. The globus pallidus may be atrophied secondarily, and the lateral and third ventricles are dilated.
Huntington Disease(TOPNOTCH)
177
What are the two most common primary tumors of the optic nerve?
Glioma and Meningioma (TOPNOTCH)
178
Morphology: characterized histologically by chronic inflammation and replacement of orbital fat by fibrosis
Idiopathic orbital inflammation (TOPNOTCH)
179
What is the most common malignancy of the eyelid?
Basal cell carcinoma (TOPNOTCH)
180
Morphology: histological hallmark is the thinning of the cornea with breaks in the Bowman's layer
Keratoconus (TOPNOTCH)
181
Morphology: deposition of calcium in Bowmans layer
Calcific Band keratopathy (TOPNOTCH)
182
This type of keratopathy develops in patients who are exposed chronically to high levels of ultraviolet light
Actinic band keratopathy (TOPNOTCH)
183
Morphology: numerous drop like excrescences - guttata- protrude downward from Descemet's membrane
Fuchs dystrophy (TOPNOTCH)
184
Also known as the End-Stage Eye
Phthisis Bulbi (TOPNOTCH)
185
Morphology: diffuse loss of ganglion cells and thinning of the retinal nerve fiber layer, in advanced cases, the optic nerve is both cupped and atrophic
Glaucomatous optic nerve damage (TOPNOTCH)
186
Flexner Wintersteine Rosettes
Retinoblastoma (TOPNOTCH)
187
Morphology: a neovascular membrane is positioned between the retinal pigment epithelium and Bruchs membrane
Age related macular degeneration (TOPNOTCH)
188
"waxy pallor" of the optic disk
Retinitis Pigmentosa (TOPNOTCH)
189
In this condition, both rods and cones are lost to apoptosis
Retinitis Pigmentosa (TOPNOTCH)
190
Elschnig' spots
Malignant hypertension (TOPNOTCH)
191
What is known to be a reliable histological marker of diabetes mellitus in the eye?
Thickening of the BM of the epithelium of the pars plicata of the ciliary body (TOPNOTCH)
192
Cytoid bodies
Hypertension (TOPNOTCH)
193
Macular star
Malignant hypertension (TOPNOTCH)
194
Morphology: characterized by diffuse granulomatous inflammation of the urea. Plasma cells are typically absent, but eosiophils may be identified in the infiltrate
Sympathetic ophthalmia (TOPNOTCH)
195
What is the most common intraocular malignancy in adults?
Metastasis to the uvea, typically to the choroid (TOPNOTCH)
196
What is the most common primary intraocular malignancy in adults?
Uveal melanoma (TOPNOTCH)
