Chapter 22 Flashcards
(145 cards)
1
Q
What is the selective variability within the CNS
A
Functionality, level of activity, connections, neurotransmitters, metabolic requirements
2
Q
What is swells within a neuronal injury
A
-swelling of soma and axons (“spheroids”)
3
Q
What is displaced within a reversible neuronal injury
A
The Nissl body (central chromatolysis)
4
Q
What neuronal injury is associated with red neurons
A
Irreversible
5
Q
What is an acute neuronal injury
A
Irreversible
6
Q
What are 2 characteristics of irreversible neuronal injury
A
- Eosinophil
- 12-24 hours
7
Q
What neuronal injury deals with shrunken soma or “red neurons”
A
Irreversible injury
8
Q
What performs gliosis
A
Astrocytes (astroglia)
9
Q
What is activation of an astrocyte
A
Gemistocytic astrocyte
10
Q
What happens to oligodendrocytes when activated
A
They get enlarged
11
Q
What are phagocytes of the CNS
A
Microglia they perform neuronophagia
12
Q
What lines the ventricles and spinal cord
A
Ependymal cells
13
Q
What is it called when ependymal cells become infected
A
It is cytomegalovirus
14
Q
What happens when ependymal cells get infected
A
Possible choroid plexus dysfunction
15
Q
What is associated with the negri body
A
Rabies
16
Q
What has an owl eye appearance in intracellular inclusions
A
Cytomegalovirus
17
Q
What is associated with lewy bodies in intracellular inclusions
A
Parkinson’s disease
18
Q
What two intracellular inclusions are associated with alzheimer’s disease
A
- neurofibrillary tangles
- b-amyloid plaques (Tau proteins)
19
Q
What is associated with lipofuscin in intracellular inclusions
A
Aging, lipid accumulation
20
Q
What happens in cerebral edema
A
Fluid accumulation, limited expansion, increased intracranial pressure (blood, pus, tumor)
21
Q
What is vasogenic edema
A
Disrupted BBB
22
Q
What happens in cytotoxic edema
A
Disrupted neuronal/glial membrane
23
Q
What are 3 identifiers of cerebral edema
A
Gyri are flattened, suli narrowed, ventricles compressed
24
Q
What is hydrocephalus
A
Increased volume of CSF within ventricles
25
What causes hydrocephalus
Disturbed CSF flow or resorption
26
Which type of hydrocephalus is bilateral or even
Communicating
27
What kind of hydrocephalus is localized, unevenn
Noncommunicating
28
How old are you if you cranium expands in hydrocephalus
<2 yrs old
29
What age are you when there is an increases in ICP and enlarged ventricles with hydrocephalus
>2 years old
30
What is the treatment for hydrocephalus
Shunting MC
31
What is hydrocephalus ex vacuo
Infarction or neurodegeneration
32
What happens in a herniation of the CNS
Shifting/protrusion of CNS tissue
33
Where does brain tissue shift during a herniation
Through foramen magnum
34
What is the positive feedback loop of herniation within CNS
Ischemia to infarction to inflammation to edema
35
What is the most common type of CNS herniation
Subfalcine (cingulate)
36
What happens in a subfalcine herniation
Displaced cingulate gyrus causing abnormal posturing/coma
37
Which type of herniationn displaces the temporal lobe
Transtentorial
38
What causes a duret hemorrhage
A transtentorial herniation
39
What happens in a tonsillar herniation
Cerebral tonsils through FM
40
What causes decorticate rigidity
Injury between the cortex and red nuclei (midbrain)
41
What causes decerebrate rigidity
Injury to the brainstem, between red nuclei and vestibular nucleus
42
What does a duret hemorrhage do
Disrupts vessels in the pons
43
Which type of Arnoldܿ-Chiari Malformations is MC
Type 1 it is mild
44
Who is most susceptible to type 1 Arnoldܿ-Chiari Malformations
Adults
45
Who is most susceptible to type 2 Arnoldܿ-Chiari Malformations
In utero or infants, most severe
46
What is the 5rh MC cause of mortality in USA
Cerebrovascular disease
47
What is the number one cause of neurologic morbidity
Cerebrovascular disease
48
How does a stroke happen from Cerebrovascular disease
Acute dysfunction, due to cerebral infarction
49
What two things cause a stroke in Cerebrovascular disease
- thrombosis or embolic occlusion
| - vascular rupture (dissection)
50
What is a mini stroke
TIA =transient ischemic attack
51
What 3 results of ischemia in CNS
Hypotension, TIA, stroke = permanent
52
What is indicative of a global cerebral ischemia
Widespread ischemic-hypoxic injury
53
What happens in a severe global cerebral ischemia
Widespread neuronal death
- cerebral edema, red neurons, gliosis
- neurological impairment, coma
54
What provides some collateral flow
Circle of willis
55
What is the purpose of the circle of willis
Limits ischemia injury, deep tissues have minimal collateral supply
56
What are the two types of focal cerebral ischemia
Emboli MC, thrombi (plaques)
57
What is common in non-hemorrhagic stroke
Liquefactive necrosis
58
What is common in a hemorrhagic stroke
Reperfusion
59
What happens secondly in a cerebral infarction
Nuclear fragmentation (karyorrhexis), liquefaction
60
What is a primary brain parenchymal hemorrhage
Spontaneous intraparenchymal bleed, cerebral microbleed
61
What is the MC cause of Primary Brain Parenchymal Hemorrhage
HTN
62
What is the average age of Primary Brain Parenchymal Hemorrhage
About 60
63
What is a silent Primary Brain Parenchymal Hemorrhage
Small
64
What is a lethal Primary Brain Parenchymal Hemorrhage
Large
65
What is subarachnoi hemorrhage
Bleeding into subarachnoid space
66
Within the first episode what is the % of death in a subarachnoid hemorrhage
25-50%
67
What are 3 causes of a subarachnoid hemorrhage
- ruptured saccular aneurysm MC
- malformed vessel
- tumor
68
What is another name for saccular aneurysm and when is it MC
Berry aneurysm, and MC in anterior circulation arteries
69
What might a saccular aneurysm produce
A scar and produce hydrocephalus
70
What contains a vascular fistula
Ateriovenous malformation (AVM)
71
What was the percentage of headacches in an ateriovenous malformation
50%
72
Who is more likely to have an ateriovenous malformation
Males (2x) age= 10-30 yares
73
What causes a hypertensive cerebrovascular disease
HTN weakens vessel walls producing a rupture
74
What is a lacunar infarct in hypertensive cerebrovascular disease
Occlusion of a single artery
75
What is a slit hemorrhage in a hypertensive cerebrovascular disease
Ruptured small cerebral vessel, hemorrhage, resorbed, “slit like cavity” remains
76
What is a hypertensive ecephalopathy in hypertensive cerebrovascular disease
Global cerebral disfunction, diastolic BP>130 = severe ICP
77
What is vasculitis
Vessel wall inflammation
78
What is primary angiitis of the CNS
Chronic inflammation of Multiple parenchymal and subarachnoid vessels injury produces diffuse encephalopathy
79
What is polyarteritis nodosa associated with
Vasculitis
80
Who is more common in CNS trauma
males 2x
81
What are the ABCD’s and what are they for
for CNS trauma
| Airway, breathing, circulation, disability
82
What is a contusion
Brain bruise = trauma disrupts vessels producing hemorrhage and injury to parenchyma
83
What is a coup injury
Contusion at impact site
84
What is a contrecoup injury
Contusion at opposite site of impact
85
What is a laceration in traumatic parenchymal injury
Tearing of cerebral parenchyma, disrupts vasculature producing hemorrhage
86
What is a diffuse axonal injury
Movement of one brain region to another
87
What does a diffuse axonal injury produce
Angular acceleration/shaking, diffuse white matter damage
88
What produces 50% of post traumatic comas
Diffuse axonal injury
89
What can be used in a concussion to rule out hemorrhage
CT
90
What assesments are used to evaluate a concussion
- cognitive assesment of attention and memory
| - neurological assesment
91
What causes a concussion most
Upper limb contact to head
92
What is indicative of a traumatic vascular injury
Confusion, HA, progressive neuro. Dysfunx, coma
93
What is an epidural hematoma
Dural artery damage, compresses brain tissue, may be lucid during bleeding
94
What happens in a subdural hematoma
Rapid movements tear veins, subdural bleed compresses the brain
95
What is MC involved in an epidural hematoma
Middle meningeal artery, is very aggressive, can be lethal in hours
96
What is common in subdural hematoma
Venous bleeds are MC, self limited, but still a medical emergency
97
What is spina bifida occulta
Bony defect, asymptomatic
98
What is a malformation of extension of CNS through vertebral defect in lubosacral region
Myelomeningocele
99
What is the absence of a brain, rostral aspect
Anencephaly
100
What is an encephalocele
CNS diverticulum through cranium
101
What spinal cord abnormality is a cavity connected to the 4th ventricle
Hydromyelia
102
What is a syringomyelia (syrinx)
Cyst within cord, adults
103
What is cerebral palsy
Perinatal brain injury of non progressive motor defects
104
What is an epidural abcess
Infection in the epidural space
105
What is a subdural empyema
Infection of the subdural space
106
What is meningitis
Subarachnoid inflammtion of leptomeninges
107
What is acute pyogenic meningitis
Bacterial meningitis with rapid onset causing HA, nuchal rigidity, photophobia
108
What happens in the CSF after acute pyogenic meningitis
Bacteria causes increase in pressure, increase in neutrophils and increase in protein (exudate)
109
What is aseptic meningitis
Viral infeciton with acute onset, pyrexia, decrease conciousness, nuchal rigidity, and edema
110
What does aseptic meningitis cause in the CSF
Increased lymphocytes, self limiting
111
What is viral encephalitis
Diffuse parenchymal infection
112
What is fungal encephalitis
Localized or diffuse pattern of parenchymal infection, possible granulomas
113
What is multiple sclerosis
Autoimmune attack on white matter with plaques causing demyelination
114
What is the MC myelin disorder
Multiple sclerosis (1 in 1,000)
115
What causes MS
Genetics: family history increase risk by 15x, uses HLA-DR2
116
What is episodic neurologic impairment of MS
Relapsing and remitting, gradually accumulate
117
Where is MS
Anywhere in CNS mostly affects optic nerve, cerebrum, cerebellum, brain stem/cord
118
What are some features of MS
- early = unilateral vision impairments/diplopia
- ataxia, motor/sensory impair
- bowel, bladder, sexual dysfunx
- seizures, decreased cognition, depression
119
What are 2 types of thiamin deficiency
- wernicke korsakoff syndrome = chronic alcoholics/ gastritis
- Beriberi = lower extremity
120
What is a thiamine deficiency
Vitamin B1 deficiency
121
What is cobalamin
B12 deficiency causing cord demyelination
122
What are two metabolic disorders
Hypoglycemia, hyperglycemia
123
What type of neurodegenerative diesease can cause personality changes and impaired memory/cognition
Dementia
124
What is the lethal infection of alzheimers
MC pneumonia
125
What does damage to dopaminergic neurons cause
Parkinsons
126
In parkinsons what causes lewy bodies
Alpha synuclein
127
What autosomal dominant disease affects huntington gene
Huntingtons disease
128
What are features of huntington disease
Inherited, delayed onset (30-40yrs), caudate/putamen, body wide chorea(jerking)
129
What is ALS
Degeneration of motor neurons causing muscle atrophy
130
What is associated with LMN death
Amyotrophic lateral sclerosis in cord/brainstem
131
What is associated with UMN death
Amyotrophic lateral sclerosis i betz cells (post frontal lobe)
132
Who does ALS mostly affect
Males 40-50 years
133
What are 3 types of gliomas
Astrocytoma, oligodendroglioma, ependymoma first two are diffuse/infiltrative
134
What are diffuse astrocytomas
Malignant, 80% of adult gliomas causing seizures, HA, necrotic, distort brain tissue
135
What do pilocytic astrocytomas do
Beningn, cystic, affect children/YA, cerebellum or spinal cord (rarely cerebral)
136
What is an oligodendroglioma
Benign or malignant, cerebral, prognosis = 5-20 years
137
What is an ependymoma
Cancer of transformed ependymal cells located at periventricular regions, MC in peds
138
Where are ependymoma’s in adults
Spinal canal, history of NF2 increases risk
139
What is a medulloblastoma
Malignant that makes up 20% of ped brain tumors, exlusively cerebellar
140
What has possible homer wright rosettes
Medulloblastoma
141
What is primary CNS lymphoma
Diffuse large B cell lymphoma
142
What is MC among immunosuppressed
Diffuse large B cell lymphoma
143
What involves transformed arachnoid cells
Meningioma
144
Who is affected by meningioma
MC adult females with history of cranial irradiation or NF2
145
Where are most metastasis from CNS from
Lung, breast, melanoma, kidney, GI
