Intro to Neuropathology part 1 Flashcards by Kolbie Chancellor

What are the glial cells and what are their shapes?

Astrocytes = oval 
Oligodendrocytes = round

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Set of neurons, not necessarily located together, that share 1+ properties demonstrating response to 1 insult

Selective Vulnerability

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Injury response of Neurons to ACUTE injury (12-24 hours)?

“Red neurons”

Cell shrinkage and pyknosis
Intense eosinophilic staining

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Injury response of Neurons to SUBACUTE and CHRONIC injury (progressive)?

Reactive gliosis

- Cell loss and Apoptosis

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What occurs with the Axonal Reaction of Neurons due to an injury?

Increased protein synthesis + Axonal sprouting

–> displaces nucleus and Nissl substance to the periphery

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With the Axonal reaction, what is it called with the Nissl substance is pushed to the periphery?

Central Chromatolysis

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Neuronal Inclusions are also a Neuron response to injury. The inclusions can be of what 2 types?

Intranuclear

Intracytoplasmic

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What infection can cause Intranuclear Neuronal inclusions and which infection can cause both Intranuclear and Intracytoplasmic?

Intranuclear = Herpes cowdry bodies
BOTH intranuclear and intracytoplasmic = CMV
– everything else = intracytoplasmic

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What is the most important indicator of CNS injury?

Gliosis

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Gliosis

Hypertrophy and Hyperplasia of ASTROCYTES

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What is the job of Astrocytes?

Detoxifiers in the brain

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What are Gemistocytes?

Bright pink Astrocytes with displaced nucleus

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What are Alzheimers Type 2 Astrocytes?

Astrocytes with a large nucleus, pale stain and intranuclear glycogen droplet
– usually arise with metabolic disorders

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What are Rosenthal Fibers?

Elongated bright pink irregular structures within the Astrocytic processes

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Where do Rosenthal Fibers usually arise?

In areas of longstanding gliosis!

ex. Pilocytic Astrocytoma

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What do Rosenthal Fibers contain?

2 heat shock proteins: alpha B crystalline and HSP27

+ Ubiquitin

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Elongated bright pink irregular structures within the Astrocytic processes

Rosenthal Fibers

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What is Corpora Amylacea?

Round faint, concentrically laminated strictures adjacent to the Astrocytic end processes

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Round concentrically laminated strictures adjacent to Astrocytic end processes

Corpora Amylacea

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What does Corpora Amylacea represent?

Degenerative change

– Increased # with Increased age

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What is contained within Corpora Amylacea and what marker is (+)?

(+) PAS

- Polyglucosan bodies, 2 heat shock proteins, Ubiquitin

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What are Microglia and what surface markers are (+)?

Macrophages of the CNS

(+) CR3 and CD68

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What are 2 possible injury responses of Microglia?

Microglial Nodules

2. Neuronophagia

Microglial Nodules

Microglia aggregate around small foci of necrosis

Neuronophagia

Microglial congregate around cell bodies of dying neurons

Where and what type of cells are Ependymal Cells?

Ciliated cells that line the ventricles in the brain

What is an example of an infection that can injure Ependymal Cells and describe what occurs?

CMV | - Ependymal Granulations

What is one injury response of Oligodendrocytes?

Demyelination

Cerebral Edema

Accumulation of fluid in the brain parenchyma

What are the 2 types of Cerebral Edema? | -- Commonly occur together

1. Vasogenic Edema | 2. Cytotoxic Edema

Vasogenic Edema and what causes it?

Increased EXTRAcellular fluid due to BBB disruption and increased vascular permeability -- usually follows an ischemic injury

Cytotoxic Edema and what causes it?

Increased Intracellular fluid due to neuronal/glial/endothelial cell injuries -- Can follow ischemic or metabolic derangement

What changes can occur to the actual brain (gyri, sulci, ventricles) with Cerebral Edema?

Gyri flattened Sulci narrowed Ventricles compressed -- Can lead to herniation

Hydrocephalus

Increased ventricular volume due to increased CSF

"True" Hydrocephalus

Frontal horns > 1/2 internal skull diameter

If "True" Hydrocephalus is not present, what is likely occuring?

Hydrocephalus ex-vacuo = atrophy of the brain

Describe Hydrocephalus ex - vacuo

Atrophy of the brain with decreased brain substance + hydrocephalus * CSF pressure = NORMAL * - Can be caused by age, stroke, neurodegenerative disease

What are the general 2 causes of Hydrocephalus?

1. Obstruction - clot, tumors, stenosis, infections | 2. Increased CSF production - Choroid Plexus Papilloma (thick fibrous stalk)

How do TB and Neurosyphilis cause Obstructive Hydrocephalus?

- Pyogenic Meningitis = suppurative exudate covering brainstem/cerebellum - Thickened Leptomeninges - Obstructive Hydrocephalus

Communicating Hydrocephalus

CSF NOT properly absorbed at the dural sinus level | => ventricles are symmetrically dilated

With Communicating Hydrocephalus, is there a single point of obstruction?

NO | - CSF not properly absorbed at the dural sinus level

What is Normal Pressure Hydrocephalus?

CSF drainage is blocked gradually in older people | --> Symmetric hydrocephalus

What are the symptoms of Normal Pressure Hydrocephalus?

" wet, wacky, wobbly " - UI - Dementia -- troubles with recall - Magnetic gait -- feet stuck to the floor

UI, dementia and gait disturbances could indicate?

Normal Pressure Hydrocephalus

Why is it important to properly diagnose Normal Pressure Hydrocephalus?

It is reversible!

As the Intracranial Volume increases, what compensates so the Intracranial pressure does not increase dramatically?

Venous system can compress and displace CSF

There is a certain point where a small increase in the intracranial volume correlates with a LARGE increase in intracranial pressure. What usually occurs after that?

Brain tissue HERNIATION

What things can cause Increased Intracranial Pressure?

- Generalized brain edema - Expanding mass lesion - Increased CSF volume

Subfalcine Herniation

Cingulate gyrus displaced under Falx

Transtentorial Herniation

Medial temporal lobe compressed against Tentorium

What are the signs of Transtentorial Hernation?

CN3 => Dilated pupil and impaired eye movement

Tonsillar Herniation

Cerebellar tonsils displaced through Foramen Magnum

What are the signs of Tonsillar Hernation?

Respiratory and Cardiac center compression

What are the main symptoms of Increased Intracranial Pressure?

Papilledema Headache N/V Seizures, lethargy, etc.

Describe Kernohan's Notch Phenomenon

- Transtentorial Hernation - Contralateral Cerebral Peduncle compressed against tentorium which produces a "notch" in the peduncle => Ipsilateral hemiparesis on side of herniation

Describe what will occur if there is Right hemisphere transtentorial herniation with the Kernohan's notch phenomonen?

- Right hemisphere transtentorial herniation - -> Left cerebral peduncle notch - -> Right sided hemiparesis (motor impairment) and possible blown pupil

As a Transtentorial herniation progresses, what lesions may accompany it?

Duret Hemorrhage | -- Hemorrhagic lesions in midbrain and pons