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Step 1 > Pathology - neuro > Flashcards

Pathology - neuro Flashcards

1
Q

Senile amyloid plaques, amyloid angiopathy
Intracellular neurofibrillary tangles
decr. ACh
ApoE4

A

Alzheimer’s

incr. risk with Down syndrome, APP

Look for B-amyloid (extracellular) and tau proteins (intracellular), increased intracellular NF tangles –> incr. degree of dementia

decr. ACh in basal nucleus of Meynert

first radiological sign: hippocampal atrophy

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2
Q 
Pick bodies (spherical tau protein aggregates)
Change in personality
A

Frontotemporal dementia

Look for parietal lobe sparing

Some parkinsonian aspects as well

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3
Q

Dementia + visual hallucinations + parkinsonism

A

Lewy body dementia

alpha-synuclein defect

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4
Q

Protein structure in CJD

A

Prions form beta-pleated sheet resistant to proteases

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5
Q

MS findings

A

incr IgG in CSF (oligoclonal bands)

MRI is gold standard - periventricular plaques (loss of oligos and reactive gliosis) with destruction of axons

Multiple white matter lesions separated in space and time

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6
Q

Autoimmune condition that destroys Schwann cells –> ascending weakness

A

Guillain-Barre syndrome

Inflammation and demyelination of peripheral nerves and motor fibers (molecular mimicry s/p infection) –> symmetric, ascending weakness

Look for incr. CSF protein w/ normal cells (albuminocytologic dissociation) that may be causing papilledema

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7
Q

Autosomal dominant, assoc. with scoliosis and foot deformities

A

Charcot-Marie-Tooth

defective production of proteins involved in the structure and function of peripheral nerves or the myelin heath

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8
Q

Excess buildup of very long chain fatty acids in the nervous system, adrenal gland, testes

A

Adrenoleukodystrophy

X-linked, seen in males, disruption of metabolism

Progressive, leads to coma/death or adrenal crisis

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9
Q

Origin of partial seizures

A

Medial temporal lobe

preceded by aura, can secondarily generalize

simple = consciousness intact, complex = loss of consciousness

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10
Q

headaches, bilateral, steady pain, no aura

A

Tension

Tx: analgesics, NSAIDs

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11
Q

Mechanism of migraine headaches

A

Irritation of CN V, meninges of blood vessels
release of substance P, calcitonin gene-related peptide, vasoactive peptides

POUND: pulsatile, one-day, unilateral, nausea, disabling

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12
Q

Peripheral vs. central vertigo

A

Peripheral: more common, inner ear etiology, delayed horizontal nystagmus

Central: brain stem/cerebellar lesion, diplopia/dysmetria/skew deviation, immediate nystagmus in any direction, assoc. w/ focal neuro findings

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13
Q

Port-wine stain on face
ipsilateral leptomeningal angioma
intellectual disability
early onset glaucoma

A

Sturge-Weber syndrome (affect small blood vessels/capillaries)

GNAQ gene activation - developmental anomaly of neural crest derivatives

STURGE: stain, tram track calcifications, unilateral, retardation, glaucoma, GNAQ gene, epilepsy

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14
Q

Neuro complications of tuberous sclerosis

A

Mental retardation, seizures, incr. incidence of subependymal astrocytomas and ungual fibromas

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15
Q

Hemangioblastomas in retina, brain stem, cerebellum, spine

Cavernous hemangiomas everywhere

A

von Hippel Landau disease

bilateral renal cell carcinomas + pheochromocytomas

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16
Q

Brain tumor that…
… crosses corpus callosum (butterfly glioma)
… stains for GFAP
… pseudopalisading pleomorphic tumor cells

A

GBM (adults)

1 yr survival

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17
Q

Brain tumor that…
… extra-axial, found near surface of brain
… arise from arachnoid villi
… spindle cells in whorl pattern + psmammoma bodies

A

Meningioma (adults)

Often asymptomatic, may present with seizures or focal signs

18
Q

Brain tumor that…
… cerebellar, assoc. w/ vHL syndrome
… can produce EPO, causing polycythemia
… closely arranged capillaries

A

Hemangioblastoma (adults)

19
Q

Brain tumor that…
… stains for S-100
… cerebellopontine angle

A

Schwannoma (adults)

bilateral in NF2

20
Q

Brain tumor that…
… rare, slow growing
… chicken-wire pattern, fried egg cells

A

Oligodendroglioma (adults)

21
Q

Brain tumor that…
… well circumscribed in posterior fossa
… grossly, cystic and solid components
… stains for GFAP

A

Pilocytic astrocytoma (children)

benign, good prognosis

22
Q

Brain tumor that…
… highly malignant cerebellar tumor, commonly in the vermis
… neuroectodermal
… can compress 4th ventricle

A

Medulloblastoma (children)

23
Q

Brain tumor that…
… found in 4th ventricle
… perivascular rosettes
… poor prognosis

A

Ependymoma (children)

perivascular rosettes

24
Q

Cingulate herniation under falx cerebri

A

Compression of anterior cerebral artery

Sensory and motor loss in the lower extremities

25
Q

Downward transtentorial herniation

A

Caudal displacement of brain stem, rupture of paramedian basilar artery branches, Duret hemorrhages

usually fatal

26
Q

Uncal herniation

A

Medial temporal lobe

Compresses ipsilateral CNIII (blown pupil), ipsilateral PCA (contralateral vision loss), ipsilateral paresis

27
Q

Cerebellar tonsil herniation

A

Coma and death if there is compression of brain stem

28
Q

Lacunar infarcts

A

due to hypertensive changes in the arterioles

Look for arteriolar sclerosis

ischemic changes

29
Q

Charcot-Bouchard pseudoaneurysms

A

less than 1mm in diameter

long-standing hypertension

hemorrhagic changes

30
Q

Lesions found in Wernicke encephalopathy

A

Foci of hemorrhage and necrosis in mamillary bodies

31
Q

Complications of subarachnoid hemorrhage

A

secondary arterial vasospasm –> cerebral ischemia

due to impaired brain autoregulation

32
Q

Autosomal recessive, trinucleotide repeat, impairment in mitochondrial functioning, degeneration of spinal cord tracts

A

Friedrich ataxia

gait ataxia, scoliosis, foot abnormalities, hypertrophic cardiomyopathy

33
Q

impaired upward gaze + hormone secretion (bhCG) + obstructive hydrocephalus

A

Pineal gland tumor

Most commonly, germinoma

34
Q

Sensory ataxia + lancinating pains + urinary incontinence + Argyll Robertson pupil

A

Tabes dorsalis caused by syphillis

35
Q

Dystrophies genetics

A

Duchenne - loss of protein that normally helps anchor muscle fibers (connects actin cytoskeleton to dystroglycan, which connect to ECM)

Myotonic - abnormal expression of myotonin protein kinase, myotonia, cataracts, testicular atrophy,

36
Q

Liquefactive necrosis

A

Cystic cavity surrounded by gliosis

Release of lysosomal enzymes from ischemic neurons results in degradation of local tissue

phagocytes clean up, then area is surrounded by astrocytes to form a glial scar

37
Q

Alcohol withdrawal

A

Tremor then autonomic dysfunction then seizures then delirium tremens (hallucinations, confusion, severe symp discharge)

38
Q

Spinal cord syndromes

Tabes dorsalis vs. B12 deficiency vs. ASA syndrome

A

Tabes dorsalis - dorsal columns, dorsal roots (loss of position/vibration)

B12 deficiency - dorsal columns, lateral corticospinal tracts, axonal degeneration of peripheral nerves (loss of position/vibration, UMN signs, numbness/parasthesia)

ASA - complete loss of strength below the level of injury with loss of pain and temp sensation

39
Q

Global cerebral ischemia

A

Affects hippocampus first!

Also Purkinje cells of cerebellum

40
Q

Complications of meningitis

A

Communicating hydrocephalus - decr. function of the arachnoid granulations

41
Q

Association with cerebral amyloid angiopathy

A

Recurrent hemorrhagic strokes

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