intro to neuropath, CSF, and brain trauma

Question 1

what is the preferred imaging modality for brain

Answer 1

CT

Question 2

when reading a CT what are you looking for

Answer 2

Blood Can Be Very Bad:
blood
cisterns
brain
ventricles
bones

Question 3

blood

Answer 3

appears bright white if fresh

Question 4

cisterns

Answer 4

is there blood?

are the cisterns open?

Question 5

brain

Answer 5

symmetry
grey-white differentiation
shift
hyper/hypodensity

Question 6

ring-enchancing lesion

Answer 6

d/t to vessel proliferation
abscesses
glioblastoma
mets

Question 7

T1 weighted MRI

Answer 7

like CT

Question 8

T2 weighted MRI

Answer 8

water is bright- pathology easier to see

Question 9

what stain is needed to visualize dendrites and axons?

Answer 9

silver stain

Question 10

chromatolysis

Answer 10

when nissl bodies migrate towards periphery following axonal injury
reversible

Question 11

nissl bodies

Answer 11

RER aggregates

stain blue

Question 12

pink neurons

Answer 12

aka anoxic neurons
d/t hypoxia, ischemia, hypoglycemia
irreversible neuronal injury
neurons shrink, become eosinphillic d/t condensation of mito, and nuclei become pyknoitc

Question 13

astrocytes

Answer 13

stain GFAP positive

help stimulate and maintain tight jnxs of BBB

Question 14

glial lamina-layer

Answer 14

formed by astrocytes
coverers brain parenchyma
wraps large vessels of brain and dives deep with these vessels all the way to, but NOT including capillaries
provides avenue for infection to penetrate

Question 15

alzheimer type II astrocytes

Answer 15

d/t hepatic encephalopathy or cerebral ischemia
astrocytes enlarge and their nuclei are large and appear clear in H&E
dendritic processes do not cover vessels well -> leaks -> potentiates edema

Question 16

gliosis

Answer 16

most important histopathologic indicator of chronic CNS injury
characterized by astrocyte hyperplasia and hypertrophy

Question 17

virchow-robbin space

Answer 17

space created by glial lamina layer of astrocytes
ends at capillaries
fills with neutrophils with infection

Question 18

blood in CSF

Answer 18

if blood stains fluid initially, but then clears most likely that the needle punctures a vessels, if the blood does not clear indicated subarachnoid hemorrhage

Question 19

xanthocrhomia

Answer 19

blonde color CSF
following subarachnoid hemorrahge d/t oxyhemoglobin which appears in 4-6 hours and bilirubin which appears in 2 days
may also be seen w/jaundice

Question 20

causes of bloody CSF

Answer 20

SAH
intracerebral hemorrhage
cerebral infarct
traumatic spinal tap

Question 21

hemosiderin laden marcophages

Answer 21

aka sideriphages

seen in CSF post SAH

Question 22

neutrophilillia of CSF

Answer 22

meningitis
bac, viral, tubercular, mycotic, amoebic infections
abscesses
AIDs related CMV
post seizures
post hemorrhage
repeated LPs
foreign material
mets

Question 23

lymphocytosis of CSF

Answer 23

meningitis (viral, tubercular, fungal, syphilitic, lepto, parasitic)
degenerative disorders
subacutre sclerosing panencephalitis, MS, drug abuse enchephalopathy, GB,
sarcoidosis, polyneuritis, CNS periarteritis, Handl syndrome

Question 24

what should you test for to confirm CSF Rhinorrhea

Answer 24

beta 2-transferrin

Question 25

how do you localize a CSF leak

Answer 25

injection of intrathecal fluroescein

Question 26

what are the primary ventricle tumors

Answer 26

choroid plexus papilloma choroid plexus carcinoma (rare) ependymoma

Question 27

choroid plexus papilloma

Answer 27

``` rare kids- lateral ventricels adults- 4th ventricle produces increased CSF -> hydrocephalus obstruction -> hydrocephalus ```

Question 28

ependymoma

Answer 28

mostly kids and adolescents begin to loose coordination and become ataxic usually 4th ventricle -> obstructive hydrocephalus well demarcated good prognosis w/skilled surgeon

Question 29

epidural hematoma

Answer 29

lens shaped confined by sutures of skull aa supply bleed

Question 30

subdural hematoma

Answer 30

brr that traverese the subdural space can be stretched and torn more common in young and old bc this space is larger half-moon shaped, not confined by sutures

Question 31

hygroma

Answer 31

chronic subdural hematoma

Question 32

traumatic subarachnoid hemorrhage

Answer 32

one-punch -> dead C1 severs vertebral aa -> massive hemorrhage berry aneurysm another type of subarachnoid bleed

Question 33

hypoxic ischemic event

Answer 33

blood in subarachnoid space has toxic effect on vessels -> vasoconstrict -> global ischemia -> glial death -> dump contents -> more edema

Question 34

Shaken baby syndrome tirad

Answer 34

1) enchephalopathy 2) subdural hematomas- brain is farther from dura in children and brr more likely to be broken 3) retinal hemorrhages - vitreous humor moves and severs retinal attachment may also have DAI

Question 35

Cerebral contusions

Answer 35

hemorrhagic necrosis of brain tissue | coup-contre-coup

Question 36

diffuse axonal injury (DAI)

Answer 36

most frequently in MVAs and football/boxing axons of deep white matter stretched if severe -> allerian degeneration CNS oligodendrocytes CANNOT regenerate to remyelinate damages axons

Question 37

DAI pathophys

Answer 37

get swellings at site of injury d/t accumulation of beta amyloid precursor protein do not confuse w/red neurons

Question 38

red/pink neurons

Answer 38

early reversible damage

Question 39

chronic traumatic encephalopathy

Answer 39

d/t repeated concussions and DAI -> build up of tau protein

Question 40

subfalcine herniation

Answer 40

small herniation at base of falx cerebri above corpus collosum not usually of clinical significance may cause compression of ANCA

Question 41

central herniation

Answer 41

CNVI compromised - lateral rectus palsy | b/l uncal herniation -hemiparesis or full paresis to coma

Question 42

uncal transtentorial herniation

Answer 42

CNIII compromised- blown pupil compression of PCA - primary visual Cx cortocospinal tract - hemiplagia, coma

Question 43

tonsillar herniation

Answer 43

brain stem compromise with respiratory and cardiac effects -> death

Question 44

duret hemorrhage

Answer 44

d/t to compression of brain stem | get hemorrhages in pons