CNS

Question 1

____ are the monocyte/macrophage of the CNS

Answer 1

Microglia

Question 2

What cells make up the myelin sheath in CNS?

Answer 2

Oligodendrocytes

Question 3

_________:defined as a mean
CSF pressure of more than 200 mm of water
(15 mm of mercury) as measured in the lateral
decubitus position.

Answer 3

Intracranial hypertension:

Question 4

T/F: IH and brain edema commonly occur together

but do not necessarily coexist

Answer 4

True

Question 5

• Penetrating wounds and non penetrating 
injuries
• Skull Fractures
• Brain disruption/destruction
• Closed head injury –Blunt head trauma
– Concussion
– Contusion

Answer 5

Trauma

Question 6

\_\_\_\_\_ injuries
– Scalp lacerations
– Skull fractures
– Contusions
– Intracranial 
hemorrhages/hematoma
– Lesions secondary to 
raised intracranial 
pressure

Answer 6

• FOCAL INJURIES

Question 7

\_\_\_\_\_\_\_\_ injuries
– Global ischemia
– Diffuse traumatic axonal 
injury
– Brain edema and 
swelling

Answer 7

• DIFFUSE INJURIES

Question 8

clinical syndrome of altered
consciousness secondary to head injury-
sudden disruption of neurologic function.

Answer 8

Concussion:

Question 9

direct parenchymal injury of the

brain (similar to bruising).

Answer 9

Contusion:

Question 10

____ injury is caused by the force of the blow to the specific area of brain

Answer 10

Coup injury

Question 11

____ injury of brain is caused on the opposite portion of the brain as the blow due to the movement of brain

Answer 11

Contre coup injury

Question 12

______: skull fracture and middle meningeal
artery injury (short period of consciousness
followed by rapidly developing signs of cerebral
compression)

Answer 12

– Epidural hematoma

Question 13

_______: venous bleeding from bridging veins
(gradual signs of cerebral compression-hours-
days-weeks)

Answer 13

– Subdural hematoma

Question 14

– Characterized by the widespread but often
asymmetric axonal swellings that appear within
hours of the injury and may persist for much
longer.
– The mechanical forces associated with trauma
are believed to damage the integrity of the axon
at the node of Ranvier, with subsequent
alterations in axoplasmic flow and function.

Answer 14

Diffuse axonal injury (DAI)

Question 15

______ diseases: They rank as the third major cause of death in
the US after heart disease and cancer

Answer 15

Cerebrobascular diseases

Question 16

The 4 most common cerebrovascular disorders

are?

Answer 16

global ischemia, embolism, hypertensive
intraparenchymal hemorrhage and ruptured
aneurysm.

Question 17

____ is the common clinical designation
that applies to relatively acute
cerebrovascular damage of the CNS due to
different disorders.

Answer 17

“Stroke”

Question 18

_______: destruction and dissection of the
tissue, mass effect. Secondary effects are
frequently necrosis and anoxic/ischemia of the
brain.

Answer 18

Hemorrhage:

Question 19

What are the 3 CNS diseases involved in Impairment of blood supply and oxygenation:

Answer 19

– Hypoxia, ischemia and infarct (necrosis) of the

brain

Question 20

______: brief
generally reversible episodes of impaired
neurological function (last <24 hours) –
considered to be precursors of more serious
occlusive events.

Answer 20

Transient ischemic attacks (TIA)-

Question 21

______: tissue necrosis more frequent than
hemorrhage (75-80%).
• Thrombosis (atherosclerosis) most frequent carotid
bifurcation and middle cerebral artery.
• Embolism: middle cerebral artery most frequent.
• Small infarcts: lacunar strokes (small arteries)

Answer 21

Infarcts:

Question 22

\_\_\_\_\_\_\_: (20-25%) associated with 
arterial hypertension, atherosclerosis, vascular 
malformations, berry aneurysms, trauma, 
coagulopathy
– Intracerebral (arterial hypertension)
– Subarachnoid hemorrhage (berry aneurysm of the 
circle of Willis). 
– Intraventricular hemorrhage (neonates)

Answer 22

Hemorrhages:

Question 23

______- Subarachnoid and

intraparenchymal hemorrhages

Answer 23

Berry aneurysms

Question 24

The brain receives ____% of the cardiac output and consumes

__% of the total body consumption.

Answer 24

15%; 20%

Question 25

Unlike other organs of | the body, the adult brain burns only _____ as fuel.

Answer 25

glucose

Question 26

``` ____: – Low partial pressure of oxygen (PO2) – Impairment of the blood ‘s oxygen-carrying capacity – Inhibition of oxygen use in the tissue ```

Answer 26

Hypoxia:

Question 27

_____: transient or permanent interruption of the normal circulatory flow. Reduction in perfusion (hypotension), vascular obstruction or both.

Answer 27

Ischemia:

Question 28

____ cerebral ischemia: generalized reduction of cerebral perfusion (cardiac arrest, shock, severe hypotension)

Answer 28

Global cerebral ischemia:

Question 29

_______ cerebral ischemia:: localized reduction or cessation of blood flow to a defined portion of the brain.

Answer 29

Focal cerebral ischemia:

Question 30

• Most are intracranial; spinal cord tumors are less frequent • Adults: supratentorial • Children: infratentorial • Children: second most common malignancy (leukemia is first) • Primary CNS tumor rarely metastasizes • Location important in clinical consequences • Metastasis to CNS are more frequent than primary in the general population

Answer 30

CNS Tumors

Question 31

What is most common CNS tumor in adult?

Answer 31

Metastatic tumor

Question 32

What are the 4 Main microscopic features in grading (WHO):

Answer 32

– Cellular atypia - A – Mitosis- M – Endothelial proliferation E – Necrosis - N

Question 33

What is the most common adult primary tumor?

Answer 33

Glioblastoma

Question 34

• 25% of primary adult tumors –most common adult primary tumor • Histologic Features – Anaplasia, pseudopalisading necrosis, vasc proliferation • Imaging Characteristics – Ring-enhancement on MRI • Average survival < 1 year without treatment; with treatment only 15 months

Answer 34

Glioblastoma (diffuse)

Question 35

Are CNS tumors in children more commonly infra or supratentorial?

Answer 35

Infratentorial

Question 36

* Children * Infratentorial > supratentorial * Cystic, contrast-enhancing * Rosenthal fibers and EGBs (eosinophilic granular bodies) * Localized tumor * Generally favorable outcome (WHO 1)

Answer 36

Pilocytic astrocytoma (Localized)

Question 37

* Adults (4th-5th decades) * WHO grades II, III * Diffuse * White matter * Calcification * Better prognosis than astrocytoma

Answer 37

Oligodendroglioma

Question 38

``` • Childhood/adolescence • Intracranial in children (often fourth ventricle) • Spinal cord in adults • Ependymal rosettes and perivascular pseudorosettes • WHO grade I –III, grade II most common ```

Answer 38

Ependymoma

Question 39

• Pediatric, WHO grade IV neoplasm • Small round blue cell tumor • Located in the cerebellum • Despite the WHO grade IV designation, this tumor has a very favorable prognosis in many cases

Answer 39

Medulloblastoma

Question 40

• Second most common primary intracranial tumor in adults > 30 years > Female • Benign behavior, slowly growing • Convexities of the cerebral hemispheres and parasagittal region; other falx cerebri, sphenoid ridge, olfactory area, suprasellar region

Answer 40

Meningioma

Question 41

* Cranial nerve VIII (cerebellopontine angle) * Antoni A, Antoni B * Verocay bodies * Benign * Neurofibromatosis type 2

Answer 41

Schwannoma

Question 42

``` • Gray-white junction • Often multiple lesions • Older adults • 25-30% of all CNS tumors • Most common: – Lung – Breast • Often hemorrhagic – Kidney – Melanoma – Choriocarcinoma ```

Answer 42

Metastases CNS tumor

Question 43

____ is the 3rd most common intracranial primary tumour in adults

Answer 43

Schwannoma

Question 44

inflammation of the brain

Answer 44

Encephalitis:

Question 45

inflammation of the meninges

Answer 45

Meningitis:

Question 46

inflammation of the brain and | meninges

Answer 46

Meningoencephalitis:

Question 47

inflammation of the meninges, | brain and spinal cord

Answer 47

Meningoencephalomyelitis:

Question 48

inflammation of the spinal cord and its | membranes

Answer 48

Meningomyelitis:

Question 49

``` • Hematogenous spread is most common • Trauma • Local spread from paranasal sinuses, dental infections, skin (facial) infections • Peripheral nerves (viruses) ```

Answer 49

Infections

Question 50

• Meningitis: peak incidence in children (75% of cases) • Etiology: – Neonates and infants: group B strep, E. Coli, Listeria – Older infants and young adults: Strep Pneumoniae (pneumococcus) and Neisseria meningitides – Older adults: S Pneumoniae and Gram negative bacilli

Answer 50

Bacterial meningitis

Question 51

• Penetrating skull injuries • Spread of infection from other sources: Para nasal sinuses, middle ear (most common source), infective endocarditis, bronchopulmonary infections, and other sources • May be bacterial or fungal in origin

Answer 51

Cerebral abscess

Question 52

``` • Multiple necrotizing abscesses, some hemorrhagic, in basal ganglia and cortico- subcortical junction • Look for free tachyzoites at periphery of necrotic lesions ```

Answer 52

Toxoplasmosis

Question 53

``` ______ encephalitis • Arbovirus: St Louis Encephalitis, western equine encephalitis, West Nile • Herpes Simplex • Cytomegalovirus (CMV) • HIV infection (progressive dementia, vacuolar myopathy) • Poliomyelitis • Rabies ```

Answer 53

Viral Meningitis-Encephalitis

Question 54

_______ encephalitis • Lytic and hemorrhagic process distributed in an asymmetric fashion throughout the medial temporal and inferior frontal lobes • Untreated is progressive and often fatal in 7-14 days

Answer 54

Herpes simplex encephalitis

Question 55

• Rare in adults, typically immunocompromised • Important in pregnancy and early postnatal period • One of the TORCH infections • Causes periventricular calcifications • Viral particles in brain and persist for decades after fetal infection

Answer 55

CMV

Question 56

• Opportunistic demyelinating disease caused by the JC polyomavirus (JCV) • Most common in immunocompromised patients • Classical histopathology is that of a multifocal white matter disease with demyelination secondary to extensive involvement of oligodendrocytes by JCV infection • Diagnostic hallmark = presence of oligodendrocytes with enlarged nuclei containing intranuclear amphophilic inclusions, as well as astrocytes with bizarre, malignant appearing nuclei in areas of demyelination

Answer 56

PML

Question 57

______ are abnormal forms of a cellular protein that causes transmissible neurodegenerative disorders. • Creutzfeldt-Jakob disease (CJD) • Scrapie in sheeps and goats • Bovine spongiform encephalopathy

Answer 57

Prions

Question 58

Normal ___ is a 30 kD protein present in neurons.

Answer 58

PrP

Question 59

Disease occurs when the PrP undergoes modification to an abnormal b-pleated sheet isoform termed ______

Answer 59

PrPsc

Question 60

______ is characterized by more than one episode of neurologic deficits separated in time, attributable to CNS white matter lesions that are separated in space. ▪ Lesions initially involve destruction of myelin; axonal damage may occur later in the process. • On MRI, findings of multifocal lesions of various ages, especially those involving the periventricular white matter, brainstem, cerebellum, and/or spinal cord white matter, support the clinical impression ▪ Gross pathology: Multiple areas of demyelination (plaques) in white matter of the brain and spinal cord (NOT the peripheral nervous system), frequently located adjacent to lateral ventricles (periventricular).

Answer 60

Multiple sclerosis

Question 61

• MC neurodegenerative disease causing dementia • Pathologic findings are though to develop well in advance of significant clinical deficits and may be seen in younger patients • Pathologic hallmarks = neuritic plaques and neurofibrillary tangles in combination with neuronal loss • Onset before age 50 should raise the possibility of a familial form of disease

Answer 61

Alzheimer disease

Question 62

• Neurodegenerative disorder characterized by the presence of Lewy bodies in neurons of various cortical structures • Characterized by severe loss of substantia nigra (SN) dopaminergic neurons, visible in brain sections as depigmentation of the substantia nigra in the midbrain.

Answer 62

Parkinson disease