Chapter 22 Flashcards by Lauren Molinaro

symptoms of CNS pathologies

degeneration
inflammation
infection
neoplasia
*SELECTIVE VARIABILITY*

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patterns of neuronal injury

neuronal
astrocytes
oligodendrocytes
microglia
ependymal cells

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decrease in axonal transport
SWELLING of soma
displacement of Nissl substance

reversible neuronal injury

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result of acute-hypoxic injury

SHRINKING* of soma (but axonal swelling)
RED NEURONS*

irreversible neuronal injury

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shrinking of cell body/soma

red neurons

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CNS fibrosis - astroglia or gliosis
injury –> hypertrophy and hyperplasia
enlarged nucleus

atscrocytes (neuronal injury pattern)

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glial filament sprout; activated and change shapes

type of astrocyte injury pattern

gemistocytic astrocyte

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produce myelin in CNS
acquired demyelinating disorders and leukodystrophies
ENLARGED nucleus

oligodendrocytes (neuronal injury pattern)

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resident PHAGOCYTES of CNS
proliferate and enlarge: injury, infection, trauma
demyelination, infarction, hemmorhage

microglia (neuronal injury pattern)

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line ventricles and spinal cord
infections: cytomegalovirus (CMV)
irregularities of ventricular surface (ependymal GRANULATIONS)
may involve CHOROID plexus

ependymal cells (neuronal injury pattern)

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3 types of intracellular inclusions

viral infections
neurodegernative diseases
lipofusion

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rabies: NEGRI BODY
CMV: owl’s eye
types of which intracellular inclusion

viral infections

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Parkinson’s Disease: LEWY BODIES

Alzheimer disease: B AMYLOID PLAQUES

neurodegenerative disease

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lewy bodies

parkinson’s disease

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negi body

rabies

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owl’s eye

CMV

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accumulation of lipids in neuronal areas, aging

lipofusion

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fluid accumulation within the brain tissue

limited expansion, increase ICP (blood, pus, edema)

cerebral edema

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BBB disruption
increase in permeability
localized: tumors, infection
generalized: severe trauma

vasogenic (edema)

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neuronal/glial membrane injury
intracellular edema
hypoxic-ischemic injury, toxic exposure

cytotoxic (edema)

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3 characteristics of cerebral edema are _____ GYRI, ____ SULCI, and ______

flatten gyri
narrowed sulci
ventricular compression

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disturbance in CSF flow/resorption/overproduction
increase CSF volume in ventricles
communicating
noncommunicating (localized)
* 2 y.o. = increase ICP, ventricular enlargement

hydrocephalus

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MC type of hydrocephalus

disturbed flow/resorption

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MC treatment for hydrocephalus

shunting

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hydrocephalus with infarction and neurodegeneration

hydrocephalus ex vacuo

cerebrum shifts across dura or through foramen magnum tissue compression: decrease blood (infarction) injury (swelling/vasculature)

brain herniation

MC form of brain herniation with displaced cingulate gyus, under falx cerebri abnormal posturing, coma

subfalcine (cingulate)

brain herniation with displaced temporal lobe, under anterior tentorium involves CN III hemiparesis, brainstem compression *DURET HEMORRHAGE*

transtentoral (uncinate)

brain herniation with displaced cerebellar tonsils, through foramen magnum cardiorespiratory arrest, hydrocephalus, headaches

tonsillar

vessels that enter the PONS are disrupted by herniation | "flame shaped" hemorrhage

duret hemorrhage

3rd leading cause of mortality in US & MC cause of NEUROLOGIC morbidity

cerebrovascular disease (CVA)

Stroke: acute dysfunction, infarction steps (3)

thrombotic occlusion embolic occlusion vascular rupture

temporatory neurological dysfunction (<24 hours)

transient ischemic attack (TIA)

SPOT A STROKE acronym

F (face drooping) A (arm weakness) S (speech difficulty) T (time to call)

liquefactive necrosis

ischemia/hypoxia

decrease in O2, partial pressure (hypoxemia) | decrease in O2 availability (CO, anemia, cyanide)

functional hypoxia

hypotension occlusion TRANSIENT (temporary) STROKE (permanent)

ischemia

widespread ischemic-hypoxic injury decrease perfusion mild confusion (TIA) --> severe (stroke)

global cerebral ischemia

widespread NEURONAL death cerebral EDEMA RED NEURONS neurological impairment: COMA

severe global cerebral ischemia

arterial occlusion--> localized ischemia collateral flow limits injury: circle of Willis *emboli *thrombi

focal cerebral ischemia

deep tissues have ___ collateral supply (thalamus, basal ganglia, deep white matter)

minimal

MC form of focal cerebral ischemia cardiac mural thrombi valave disease

emboli

atherosclerotic plaques | carotid artery, aortic arch, middle cerebral artery

thrombi

intercranial hemorrhage injury that is MC due to HTN

vessel wall injury

*SPONTANEOUS* hemorrhage that leads to CLOT and then to cavity formation MC cause= HTN can be clinically SILENT to DEVASTATING (severe) Avg age= 60 y.o. cerebral *MICROBLEEDS*

primary brain parenchymal hemorrhage

blood fills the subarachnoid space patient says "this is the worst headache I've ever had" (abrupt) TUNIA MEDIA defect --> aneurysm commonly recur

subarachnoid hemorrhage

ruptured saccular (BERRY) aneurysm is MC for _______ and in the _______ circulation

subarachnoid hemorrhage | anterior circulation

``` tangle of arteries and veins (worm-like) connected via 1+ fistula MALES= 2x age= 10-30 risks- hemorrhage, seizures headaches= 50% OF ALL CASES ```

arteriovenous malformation (AVM)

HTN weakens vessel walls --> rupture 1. Massive parenchymal hemorrhage 2. Lacunar infarct 3. Slit hemorrhage 4. Acute hypertensive encephalothy

hypertensive cerebrovascular disease

single artery occlusion in DEEP brain tissues (silent --> devastating)

lacunar infarct (hypertensive cerebrovascular disease)

ruptured small cerebral vessel, hemorrhage, resorbed, "slit-like cavity" remains

slit hemorrhage (hypertensive cerebrovascular disease)

global cerebral dysfunction

acute hypertensive encephalopathy (hypertensive cerebrovascular disease)

various causes of vessel wall inflammation that infers with blood flow --> infarct polyarteritis nodosa primary angiitis of CNS

vasculitis

systemic AI vasculitis, fibronoid necrosis, small cerebral arteries and heart

polyarteritis nodosa

chronic inflammation, multiple parenchymal and subarachnoid vessels -limited to brain and spinal cord -IDIOPATHIC MC MALES diffuse encephalopathy (decrease cognition)

primary angiitis of CNS

CNS trauma is silent in _____, disabling in _____ and fatal in _____

frontal cord brainstem

condition that is 2x MC in males, assess airway, breathing, circulation and disability (ABCD)

CNS tauma

traumatic parenchymal injury concussion diffuse axonal injury

CNS trauma

standard hemorrhage/bruise of brain; rapid displacement, vessel disruption -gyri are suspectible

contusion (traumatic parenchymal injury)

tearing of cerebral parenchyma, vascular disruption, hemorrhage

laceration (traumatic parenchymal injury)

impact site of contusion injury

coup injury

opposite of impact site of contusion injury

contrecoup injury

movement of 1 brain region, relative to another *ANGULAR ACCELERATION* causes diffuse WHITE MATTER/AXONAL damage cause of 50% OF POST-TRAUMATIC COMAS

diffuse axonal injury (DAI)

reversible altered consciousness from head injury in the absence of contusion neuroimaging studies are normal (don't show abnormalities), but may still be done to rule out more severe injury

concussion

CNS trauma: disrupts vessels --> hemorrhage * CONFUSION*, HA, PROGRESSIVE NEURO DYSFXN, COMA 1. subarachnoid 2. intraparenchymal * EPIDURAL HEMATOMA* * SUBDURAL HEMATOMA*

traumatic cerebrovascular injury

dural ARTERY damage compresses brain tissue neurosurgical emergency

epidural hematoma

rapid movement tears VEINS | subdural bleed --> compresses brain

subdural hematoma

MC artery involved in epidural hematoma; very aggressive within hours

middle meningeal artery

spina bifida occulta myelomeningocele anencephaly encephalocele

neural tube defects

MC CNS malformation

neural tube defects

bony defect, failed bony fusion

spina bifida occulta

extension of CNS through (lumbrosacral) vertebral defect, LE motor and sensory

myelomeningeocele

absence of brain, rostral aspect | leads to stillbirth

anencephaly

CNS diverticulum through cranium (usually occipital region)

encephalocele

hydromyelia | syringomyelia

spinal cord abnormalities

cyst within the cord, adults

syringomyelia

intraparenchymal hemorrhage infarct cerebral palsy

perinatal brain injuries

prematurity, near ventricles, may cause hydrocephalus

intraparenchymal hemorrhage (perinatal brain injury)

prematurity, supratentorial white matter, chalky plaques, possible cysts

infarct (perinatal brain injury)

non-progessive defects in motor neurons, and decrease is cognition/learning

cerebral palsy

MC type of infection of nervous system

hamatogenous

2 types of infections in the nervous system

epidural abcess | subdural empyema

nervous system infection-- adjacent infection (sinusitis, osteomyelitis) --> epidural space *NEUROSURGICAL EMERGENCY*

epidural abcess

nervous system infection-- infection of skull or sinus --> SUBDURAL space *emergency

subdural empyema

subarachnoid inflammation of LEPTOMENINGES 1 acute pyogenic 2 aseptic 3 chronic

meningitis

``` type of meningitis with: RAPID ONSET HA NUCHAL RIGIDITY PHOTOPHOBIA CSF- increase PRESSURE (pus), increase NEUTROPHILS ```

acute pyogenic (bacterial)

type of meningitis with: acute onset *SELF LIMITING* CSF- increase lymphocytes

chronic

``` chronic meningitis with: HA malaise confusion "tuberculoma" in brain ```

tuberculous

chronic meningitis with: syphilis or lyme disease neuronal loss progressive loss of cognitive and physical fxn

spirochetal

3 parenchyma infections

bacterial abscess viral encephalitis fungal

localized, liquefactive necrosis progressive neuro destruction R-to-L shunt pulmonary infection

bacterial absess (parenchyma infection)

diffuse associated with meningitis, mononuclear WBCs rabies virus, poliovirus, rubella virus, west nile, etc

viral encephalitis (parenchyma infection)

localized of diffuse granulomas MC among immunospressed candida albicans

fungal (parenchyma infection)

MC disorder of MYELIN DYMELINATION episodic neurologic deficts "RELAPSING REMITTING"

multiple sclerosis

``` risks: YOUNG ADULTS FEMALES (2x) family Hx. HLA-DR2 *PLAQUES* in CNS sexual dysfxn, seizures, motor/sensory impairment, bowel issues, vision ```

multiple sclerosis

``` nutritional/metabolic disorder: wenicke-koraskoff syndrome confusion memory macrophages in THALAMUS ```

thiamine (B1)

``` nutritional/metabolic disorder: demyelination "subacute combined degeneration of spinal cord" ataxia paraplegia ```

cobalamin (B12)

nutritional/metabolic disorder: mimics global hypoxia (edema) hippocampus is susceptible to injury

hypoglycemia

``` nutritional/metabolic disorder: unctrolled DM hyperosmolar state confusion stupor coma ```

hyperglycemia

cellular DEGENERATION OF CNS PATTERNS of neuronal loss cortex- memory, language, insight/planning *DEMENTIA*

neurodegenerative disease

impaired MEMORY decrease FUNCTIONING COMMON FEATURE OF neurodegenerative disease

dementia

``` MC cause of DEMENTIA B-AMYLOID deposits INSIDIOUS/PROGRESSIVE DISORIENTATION LETHAL INFECTION- MC= PNEUMONIA down syndrome ```

alzheimer disease

``` MOTOR DISTURBANCES (tremor) BRADYKINESIA (slow) damage to DOPAMINERGIC neurons SUBSTANTIA NIGRA LEWY BODY-- PALE HALO PROGRESSIVE ```

parkinson disease (neurodegenerative disease)

``` COGWHEEL RIGIDITY PILL ROLLING (thumb, index finger) Poker Face Dementia Hallucinations ```

parkinson disease (neurodegenerative disease)

``` AUTOSOMAL DOMINANT severe cerebral ATROPHY CAUDATE AND PUTAMEN NUCLEI primary feature: CHOREA SEVERE DEMENTIA delayed onset, but present at birth progressive ```

Huntington Disease (neurodegenerative disease)

``` affects LMN and UMN preserves EXTRAOCULAR motor fxn MC: MALES 40-50 y.o. DENERVATION ATROPHY asymmetric distal extremity weakness rapid progression (muscle atrophy & strength) respiratory PARALYSIS ```

ALS (neurodegenerative disease)

CNS tumors are usually _____ tumors and ______

primary | non-resectable

features of CNS tumor

HA seizures increase cranial pressure

types of gliomas

astrocytoma oligodendeoglioma ependymoma

``` 80% of adult gliomas poorly circumscribed CEREBRAL NEURO DEFECTS MALIGNANT NECROTIC POOR PROGNOSIS *GLIOBLASTOMA* ```

DIFFUSE astrocytoma

BENIGN astrocytoma cerebellar cystic

pilocytic

diffuse astrocytoma with: leaky angiogenesis MEAN SURVIVAL: 15 months

glioblastoma

benign or malignant glioma CEREBRAL prognosis- 5-20 YEARS

oligodendoglioma

glioma that affects ependymal cells periventricular regions: pediactrics spinal canal: adults

ependymoma

MC embryonal malignancy 20% of pediatric brain tumors EXCLUSIVELY CEREBELLAR HIGHLY RADIOSENSITIVE and MALIGNANT

medulloblastoma

medulloblastoma may have ______ appearance on brain

homer-wright rosettes

diffuse LARGE B CELL LYMPHOMA- inside CNS | MC in immunosupressed (AIDS)

primary CNS lymphoma

MC benign tumor of ADULTS-FEMALES transformed ARACHNOID CELLS RISK: History, irradiation

meningioma

25-50% of intracranial tumors affects gray/white junction carcinomas: lungs, breast, melanoma, kidney, GI tract

CNS metastasis

Chapter 22 Flashcards

(119 cards)