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Neuro > Neuro pathology > Flashcards

Neuro pathology Flashcards

1
Q

acute response to neuronal injury (hypoxia, hypoglycemia, trauma)

A

red neurons (intense eosinophilia)
shrinkage
pyknosis

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2
Q

Intranuclear inclusions in response to neuronal injury

A

herpes cowdry body

CMV owl’s eye (both intranuclear and intracytoplasmic)

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3
Q

(Astro)gliosis

A

most important indicator of CNS injury
astrocyte hypertrophy and hyperplasia
astrocyte foot processes contribute to BBB

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4
Q

Gemistocyte

A

swollen astrocyte, indicates damage
pink cytoplasm
nuclei pushed off to the edge of the cell

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5
Q

Rosenthal fibers

A

eosinophilic fibers within astrocyte processes

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6
Q

Corpora amylacea

A

basophilic concentric circles
↑ with age
represents degenerative change

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7
Q

surface markers of microglia

A

CR3 and CD68
same as peripheral macrophages

microglia are the macrophages of the CNS

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8
Q

vasogenic edema

A

↑ extracellular fluid due to BBB disruption

follows ischemic injury

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9
Q

cytotoxic edema

A

↑ intracellular fluid due to cell injury (ischemic, hypoxic, metabolic)

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10
Q

hydrocephalus

A

↑ CSF
enlargement of all spaces
papilledema

Pathogenesis:
↑ production (rare, choroid plexus papilloma)
obstruction (tumors, thrombosis, exudates, congenital, infections)
↓ absorption

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11
Q

pyogenic meningitis

A

causes obstructive hydrocephalus

suppurative exudate covering brainstem and cerebellum

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12
Q

communicating hydrocephalus vs

non-communicating hydrocephalus

A

communicating → symmetrical

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13
Q

congenital causes of hydrocephalus

A 
TORCH infections
agenesis/atresia/stenosis
AV malformation
Arnold Chiari malformation
Dandy Walker syndrome
Cranial defects
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14
Q

acquired causes of hydrocephalus

A 
infections → meningitis, others
tumors
inflammation
hemorrhage 
thrombosis
excess vitamin A
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15
Q

Hydrocephalus ex-vacuo

A

any process where the brain shrinks and is replaced by fluid
slow process
intracranial pressure is normal

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16
Q

transtentorial herniation

A

dilated pupil, impaired eye movement

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17
Q

tonsillar herniation

A

cerebellar tonsils are displaced through the foramen magnum

respiratory and cardiac depression → life threatening

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18
Q

Kernohan’s notch phenomenon

A

transtentorial herniation → right
notch → left (causes symptoms)
motor sx → right (same side as herniation)

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19
Q

liquefactive necrosis

A

necrosis occuring in the CNS

no architectural remnants

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20
Q

neural tube defects

A

folate deficiency,
neural tube closes day 28

spina bifida occulta → asymptomatic
meningocele → meninges and CSF
meningomyelocele → CNS extending through defect in spine
encephalocele → brain tissue protruding from skull
anencephaly → absence of most of brain and calvarium

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21
Q

Arnold Chiari malformation

A

small posterior fossa

type 1 → silent
type 2 → cerebellar vermis is partly displaced inferiorly through the foramen magnum

causes:
- obstructive hydrocephalus (type 2)
- ↑ intracranial pressure
- meningomyelocele (type 2)

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22
Q

lissencephaly

A

↓ number of gyrations

smooth or cobblestone surface

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23
Q

neuronal heterotopias

A

associated with epilepsy

collections of neurons in inappropriate places

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24
Q

holoprosencephaly

A

incomplete separation of hemispheres across midline

cyclops

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25
Q

agenesis of corpus callosum

A

batwing appearance of ventricles

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26
Q

dandy walker malformation

A

enlarged posterior fossa
expanded roofless 4th ventricle
absent/rudimentary cerebellar vermis

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27
Q

syringomyelia

A

fluid-filled cavity in the middle of the spinal cord

isolated loss of pain and temperature in the upper extremities (cape-like)

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28
Q

diastatic fracture

A

fracture that crosses a suture line

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29
Q

basilar skull fracture

A

battle’s sign → mastoid hematoma
raccoon eyes with tarsal plate sparing
CSF draining from ear or nose

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30
Q

CTE

A

chronic traumatic encephalopathy
progressive loss of brain tissue
build up of amyloid and tau, neurofibrillary tangles

behavioral and mood changes
memory loss, dementia

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31
Q

plaque jaune

A

depressed yellow brown patches indicating past contusion

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32
Q

Diffuse axonal injury

A

baby shaking injury
axonal swelling
amyloid precursor protein

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33
Q

diagnosing shaken baby

A

retinal hemorrhages
subdural hematoma
diffuse brain swelling and injury

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34
Q

epidural hematoma

A

often seen with skull fractures
arterial
dura detached

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35
Q

subdural hematoma

A

venous blood

dura still attached

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36
Q

anterior cerebral artery deficits

A 
contralateral hemiplegia (paralysis)
alien hand syndrome (arm not under their control)
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37
Q

posterior cerebral artery deficits

A

contralateral homonymous hemianopia

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38
Q

middle cerebral artery deficits

A

most common
aphasia, hemineglect, hemianopia, face-arm sensorimotor loss
gaze preference towards lesion
lacunes (small deep infarcts)

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39
Q

ACA-MCA watershed infarct

A

caused from occlusion of int. carotid a.
proximal arm and leg weakness
transcortical aphasia → language issues

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40
Q

MCA-PCA watershed infarct

A

deficits in higher order visual processing

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41
Q

carotid stenosis

A

int. carotid a. vulnerable to atherosclerosis
thrombi can orignate here and embolize to MCA, ACA, & ophthalmic a.

symptoms: 
contralateral face-arm weakness
contralateral visual field defects
aphasia
neglect
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42
Q

paradoxical embolus

A

patent foramen ovale

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43
Q

lacunar infarct

A

lenticulostriate arteries

motor hemiparesis

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44
Q

hypertensive encephalopathy

A

caused from malignant hypertension

causes deep brain parenchymal hemorrhages

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45
Q

charcot-bouchard microaneurysms

A

chronic hypertension

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46
Q

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)

A 
recurrent strokes
dementia
NOTCH 3 gene
thickening of tunica media and adventitia
basophilic PAS+ deposits
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47
Q

stroke risk factors

A 
HTN**
diabetes
hypercholesterolemia
smoking
FH
hypercoagulability
cardiac disease
prior history
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48
Q

most common site for saccular aneurysm

A

junction of ACA and ant. communicating artery

49
Q

the worst headache i’ve ever had

A

aneurysm → sub-arachnoid hemorrhage

50
Q

disease that travel from PNS to CNS

A

Rabies

Herpes Zoster

51
Q

Herpes simplex and zoster route of infection

A

latent infection of sensory ganglia
replicate in scwan cells
ascend to CNS via sensory nerves

52
Q

Rabies route of infection

A

virus binds near acetylcholine receptors

ascends to CNS via motor nerves

53
Q

Chronic meningitis pathogens

A

TB
spirochetes (syphilis & borreliosis)
cryptococcus

54
Q

leptomeningeal fibrosis

A

causes hydrocephalus

55
Q

pneumococcal meningitis

A

chronic adhesive arachnoiditis

56
Q

waterhouse friderischen syndrome

A

neisseria meningitidis infection

adrenal hemorrhage → death

57
Q

CSF changes in bacterial infection

A

cloudy/turbid
↑ neutrophils
↑ protein
↓↓ glucose **

58
Q

CSF changes in viral infections

A

clear
↑ lymphs/monos
↑ protein

59
Q

risk factors for meningitis

A 
younger than 5 or older than 60
diabetes
immunosuppression
IV drug abuse
bacterial endocarditis
sickle cell anemia

basilar skull fracture
head trauma
surgery

60
Q

acute meningitis in neonate

A

E. Coli

group B strep

61
Q

acute meningitis in 3month- 2 years unvaccinated

A

haemophlius influenza type B

62
Q

acute meningitis in adolescents and young adults

A

N. meningitidis

63
Q

acute meningitis in elderly

A

Strep pneumo ***

Listeria monocytogenes

64
Q

Neisseria meningitidis

A

Gram - diplococci
crowded populations (military, college dorms)
petechial and purpuric lesions which can turn gangrene
waterhouse-friderichsen syndrome → adrenal heme

65
Q

chronic meningitis organisms

A

chronic → 4 weeks

TB, neuroborreliosis, neurosyphilis

66
Q

mycobacterium tuberculosis

A

causes chronic meningitis
subarachnoid space filled with galatinous or fibrinous exudate
obliterates cisterns → hydrocephalus
encases cranial nerves → CN symptoms
tuberculoma → intraparenchymal mass with central caseous necrosis
inactive lesions may calcify

67
Q

treponema pallidum

A

spirochete which causes syphilis

can cause chronic meningitis, paretic neurosyphilis, and tabes dorsalis

68
Q

meningovascular neurosyphilis

A

chronic menigitis involving base of the brain
communicating hydrocephalus
obliterative endarteritis

69
Q

paretic neurosyphilis

A

progressive disease
mood alterations, delusions of grandeur → dementia
granular ependymitis → hydrocephalus

70
Q

tabes dorsalis

A 
form of neurosyphilis
damage to sensory nerves causing impaired joint position sense → ataxia (loss of control)
loss of pain sensation
absence of deep reflexes
lightening pains
71
Q

Multiple sclerosis

A

autoimmune demyelinating disease
relapsing and remitting symptoms
acute optic neuritis with vision loss and pain
brainstem and cerebellum symptoms → ataxia, nystagmus, diplopia
spinal cord symptoms → motor and sensory deficits in trunk and limbs

periventricular plaques
myelin and IgG in CSF

women aged 20-30, living far from equator

72
Q

neuromyelitis optica

A

bilateral optic neuritis and spinal cord demyelination
antibody against aquaporins
high risk for MS

73
Q

Acute Disseminated Encephalomyelitis (ADEM)

A

follows viral infection or immunization

inflammation and demyelination

74
Q

Alzheimer disease

A

dementia
cortical atrophy with narrowing of gyri and widening of sulci
particularly in the hippocampus
ß-amyloid plaques (made from APP, amyloid precursor protein)
neurofibrillary tangles

Down syndrome at ↑ risk

75
Q

frontotemporal dementia

A

aka Pick disease
early onset of behavioral and personality changes with language disturbances
knife edge thin gyri
Pick bodies (silver stain)

76
Q

Vascular dementia

A

progressive cognitive decline with associated vascular injury

77
Q

Parkinson disease

A 
TRAPS
Tremor (pill rolling)
Rigidity (cogwheel)
Akinesia (or bradykinesia)
Postural instability
Shuffling gait

Loss of dopaminergic neurons
substantia nigra pallor
Lewy bodies composed of α-synuclein

may develop dementia with hallucinations (10-15%) this is called Lewy body dementia

78
Q

Multi System Atrophy (MSA)

A 
striatonigral circuit (parkinsonism)
Olivopontocerebellar circuit (ataxia)
ANS (autonomic dysfunction, ex: orthostatic hypotension)
79
Q

Huntington disease

A

Autosomal dominant trinucleotide repeat expansion (CAG) in the huntingtin (HTT) gene on chromosome 4
atrophy of caudate and putamen (also corpus callosum, and globus pallidus)
movement disorders (jerky, hyperkinetic, chorea)
dementia

80
Q

Friedreich ataxia

A

AR trinucleotide repeat disorder (GAA) in gene for frataxin on chromosome 9
Friedriech the frat brother, always staggering and falling but has a sweet big heart (hah, GAAAAAA)
staggering gait and frequent falling
diabetes
hypertrophic cardiomyopathy

81
Q

ataxia-telangiectasia

A 
AR
telangectasias → CNS, conjuctiva, skin
ataxia beginning in childhood
failure to remove damaged DNA
ATM gene on chromosome 11q22-23
death in early 20s
82
Q

Amyotrophic lateral sclerosis (ALS)

A

loss of LMN and UMN
adverse GOF mutation in SOD1 on chromosome 21
loss of anterior horn neruons
Bunina bodies

symptoms:
dropping objects
bulbar palsy → difficulty speaking and swallowing

83
Q

bunina bodies

A

ALS

84
Q

Aß

A

Alzheimer

85
Q

Tau

A

Alzheimer
Frontotemporal degen
Progessive supranuclear palsy
Corticobasilar degen

86
Q

α-synuclein

A

Parkinson

MSA

87
Q

TDP-43

A

ALS

Frontotemporal lobar degen

88
Q

SOD-1

A

ALS

89
Q

Ataxins

A

spinocerebellar ataxias

90
Q

Leukodystrophies

A

AR
myelin abnormalities
white matter → deterioration of motor skills, ataxia

91
Q

Mitochondrial encephalomyopathies

A

Ox Phos disroders

involve grey matter and skeletal muscle

92
Q

Tay-Sachs

A

gene → HEXA
enzyme → hexoaminidase A
accumulation → GM2 gangliosides
cherry red macula

93
Q

MELAS (mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes)

A

tRNA mutation
muscle weakness
lactic acidosis
stroke-like episodes

94
Q

MERRF (myoclonic epilepsy and ragged red fibers)

A 
tRNA mutation
myoclonus
seizures
myopathy
ataxia
95
Q

Kearn-Sayre syndrome

A

ataxia,
pigmented retinopathy
cardiac conduction defects
spongiform gray and white matter

96
Q

Leigh syndrome

A

lactic acidemia
seizures
hypotonia
spongiform appearance and vascular proliferation

97
Q

B12 deficiency

A

anemia
numbness, tingling,
some ataxia

swelling of myelin layers
subacute combined degen of spinal cord ***

98
Q

Thiamine (B1) deficiency

A

Wernicke → reversible
KorsakOFF → permanent

wernicke → hemorrhage and necrosis of the mammillary bodies**

99
Q

Hypoglycemia

A

pseudolaminar necrosis

100
Q

Hyperglycemia

A

confusion, stupor, and eventual hyperosmolar coma

IV fluids prevents severe cerebral edema

101
Q

Carbon monoxide poisoning

A

layers 3 and 5 of cerebral cortex
sommer’s sector and purkinje cells
bilateral necrosis of globus pallidi

102
Q

methanl

A

degen of retinal ganglion cells → blindness

selective bilateral putamenal necrosis

103
Q

Chronic ethanol use

A

atrophy of anterior vermis

bergmann gliosis

104
Q

radiation

A

radiation induced tumors → sarcomas, glioma, meningiomas

coagulative necrosis

105
Q

pinguecula vs pterygium

A

pterygium goes onto the cornea

106
Q

uveal melanoma

A

most common primary intraocular tumor
GNAQ and GNA11
epithelioid → worse prognosis

107
Q

Primary open angle glaucoma

A

↓ outflow

MYOC gene mutation

108
Q

Secondary open angle glaucoma

A

pseudoexfoliation → deposition of lens/iris material into trabecular meshwork
LOX1 gene mutation

109
Q

flexner-wintersteiner

A

retinoblastoma histology, most common

110
Q

new onset seizure

A

brain tumor

111
Q

Grading tumors

A

grade 1 → low proliferative potential
grade 2 → infiltrative, atypia
grade 3 → anaplasia and mitoses
grade 4 → fatal, microvascular prolif, necrosis

112
Q

Pilocytic astrocytoma

A

NF1 **
cystic with mural nodule **
rosenthal fibers ***

childhood
GFAP +
mostly cerebellum

113
Q

Glioblastoma

A

IDH1 → better prognosis
contrast enhancing ring

adult
histology hallmarks
- serpentine necrosis
- pseudo-palisading
- vascular endothelial proliferation
114
Q

oligodendroglioma

A

calcification
IDH1, IDH2, and 1p19q loss are favorable prognosis
Fried egg and chicken wire

adult

115
Q

medulloblastoma

A

cerebellum
homer-wright rosetts
i17q
sheets of anaplastic cells

116
Q

Primary CNS Lymphoma

A

AIDs patients
CD20 cell origine (B-cell)
EBV infection
Hooping

117
Q

Von hippel-lindau disease

A

VHL deletion
polycythemia
hemangioblastomas
pheochromocytoma

118
Q

Neurofibromatosis type 1

A

Cafe au lait spots
neurofibromas
Lisch nodules (iris)

119
Q

Neurofibromatosis type 2

A

bilateral schwannomas

CN VIII

Neuro (4 decks)

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