Intro to Neuropathology part 2

Question 1

What type of necrosis occurs with CNS infarcts?

Answer 1

Liquefactive Necrosis

Question 2

Describe Liquefactive Necrosis

Answer 2

Digestion of tissue into liquid viscous mass with NO architectural remnants!

Question 3

Liquefactive Necrosis involves the loss of architectural remnants. How does that differ from coagulative necrosis that occurs in other organs besides the CNS?

Answer 3

Coagulative necrosis involves the architecture remaining!

Question 4

Describe the general steps that occur in the CNS with an acute ischemic injury

Answer 4

• Red neurons
• Presence of macrophages and reactive gliosis
• CNS infarct and liquefactive necrosis

Question 5

What malformations/developmental disorders are the most common with the CNS?

Answer 5

Neural tube defects

Question 6

Neural tube defects involve the failure of the tube to close or a portion reopening. What deficiency is common? When does the tube usually close?

Answer 6

Folate deficiency

– Tube closes by day 28 = before pregnancy is usually noticed

Question 7

List some of the possible Neural Tube Defects

Answer 7

Spina Bifida – occulta/meningocele/myelomeningocele
Encephalocele
Anencephaly

Question 8

Spina Bifida Occulta

Answer 8

Asymptomatic bony defect

Question 9

Meningocele

Answer 9

Bony defect with meninges protruding in a pouch

Question 10

Myelomeningocele

Answer 10

Bony defect with meninges + CNS tissue protruding in a pouch

Question 11

Meningocele and Myelomeningocele neural tube defects may present with what symptoms?

Answer 11

LE deficits
Bowel issues
Infections

Question 12

Encephalocele and Anencephaly neural tube defects occur in what trimester?

Answer 12

1st

Question 13

Encephalocele

Answer 13

Disorganized brain tissue extends through a defect in the cranium
– usually posterior fossa

Question 14

Anencephaly and when it occurs?

Answer 14

Absence of most of the brain and calvarium

– forebrain development disrupted at 28 days gestation

Question 15

Forebrain Anomalies involve abnormalities in?

Answer 15

Generation and migration of neurons

Question 16

List some of the possible Forebrain Anomalies

Answer 16

Mega/microcephaly
Lissenencephaly
Polymicrogyria
Neuronal Heterotopias
Holoprosencephaly
Agenesis of corpus callosum

Question 17

Microcephaly involves a decreased number of neurons and a small head. What is it associated with?

Answer 17

Fetal alcohol syndrome, HIV1, Zika virus

Question 18

Lissenencephaly

Answer 18

DECREASED # of gyri = smooth or cobblestone surface of brain

Question 19

Polymicrogyria

Answer 19

Small and numerous irregular gyri

– gray matter is < 4 layers and meningeal tissue is trapped

Question 20

Neuronal Heterotopias

Answer 20

Collections of neurons in inappropriate locations along pathway

Question 21

What are Neuronal Heterotopias associated with?

Answer 21

Epilepsy

Question 22

If the X chromosome Filamen A and DCX proteins are altered, what forebrain anomalies will occur in males and females respectively?

Answer 22

Males = lissenencephaly 
Females = Neuronal Heterotopias

Question 23

Holoprosencephaly and its possible symptoms

Answer 23

Incomplete separation of cerebral hemispheres

- cyclopia, absent CN1, associated with trisomy 13

Question 24

Agenesis of corpus callosum appears how?

Answer 24

Bat wing lateral ventricles

– normal or decreased IQ

Question 25

List some of the Posterior Fossa Anomalies

Answer 25

Arnold-Chiari Malformation Dandy-Walker Malformation Syringomyelia/Hydromyelia Joubert Syndrome

Question 26

Arnold - Chiari Malformation

Answer 26

SMALL posterior fossa

Question 27

Type 1 Chiari malformation

Answer 27

Low-lying cerebellar tonsils | == Usually SILENT

Question 28

Type 2 Chiari malformation is more severe. Describe it.

Answer 28

Downward extension of cerebellar vermis through the foramen magnum -- usually with a myelomeningocele and hydrocephalus

Question 29

Dandy - Walker Malformation

Answer 29

ENLARGED posterior fossa

Question 30

What are the manifestations in the brain of the Dandy-Walker Malformation?

Answer 30

Expanded roofless 4th ventricle = ABSENT cerebellar vermis | -- Replaced by ependymal cyst

Question 31

Syringomyelia (syrinx)

Answer 31

Fluid filled cavity in inner portion of spinal cord

Question 32

What are the symptoms of Syringomyelia (syrinx) and why?

Answer 32

Loss of pain and temperature sensation in the UE only!! | -- interrupts fibers that cross the white commissure

Question 33

Hydromyelia

Answer 33

Expansion of ependymal-lined central canal of spinal cord

Question 34

Joubert Syndrome

Answer 34

Vermis hypoplasia that creates a "molar tooth" sign

Question 35

What are some Perinatal Brain Injuries that can occur?

Answer 35

``` Cerebral palsy Intraparenchymal hemorrhage Periventricular leukomalacia Multicystic Encephalopathy Ulegyria ```

Question 36

Cerebral palsy

Answer 36

Non-progressive neurologic motor deficit attributable to insults that occurred during the prenatal/perinatal period

Question 37

Where and in who are Intraparenchymal Hemorrhages seen?

Answer 37

In the germinal matrix (between thalamus and caudate nucleus) of preemies

Question 38

Periventricular Leukomalacia

Answer 38

Infarcts in supratentorial white matter | = Chalky yellow plaques that turn into large cystic spaces in preemies

Question 39

Multicystic Encephalopathy

Answer 39

Ischemic damage --> large destructive lesions

Question 40

Ulegyria

Answer 40

Ischemic lesions in the depth of sulci --> thinned gliotic gyri

Question 41

If a person is awake and they fall, the likely direction was? If a person loses consciousness and they fall, the likely direction was?

Answer 41

Awake = occipital injury by falling back | Loss of consciousness = frontal injury by falling forwards

Question 42

Diastatic skull fracture

Answer 42

Fracture that crosses a suture

Question 43

What is unique about later skull fractures?

Answer 43

They do NOT cross previous fracture lines

Question 44

Displaced/Depressed skull fractures

Answer 44

Bone displaced into cranial cavity by a distance > bone thickness

Question 45

Basal skull fracture

Answer 45

Break of bone in the base of the skull | -- orbital or mastoid hematomas

Question 46

What are the signs of a basal skull fracture?

Answer 46

- CSF drainage from ear or nose - Raccoon eyes - Battle's bruise behind the ear

Question 47

What are the 3 parenchymal injuries?

Answer 47

1. Concussion 2. Direct Parenchymal Injury 3. Diffuse Axonal Injury

Question 48

A concussion is a _____ syndrome that is brought about by?

Answer 48

CLINICAL syndrome | -- head momentum change

Question 49

Concussions involve transient neuro dysfunction. The patient will fully heal although they may have?

Answer 49

Amnesia of event

Question 50

Direct Parenchymal Injury

Answer 50

Contusions from blunt trauma and lacerations due to kinetic injury to the brain

Question 51

What area of the brain is the most susceptible to direct parenchymal injuries and what is the shape of the contusion?

Answer 51

Crests of gyri with wedge shaped contusion

Question 52

Coup

Answer 52

Contusion at the point of impact

Question 53

Countercoup

Answer 53

Contusion opposite of the site of impact -- ex. deceleration

Question 54

Plaque Jaune

Answer 54

Old countercoup lesions that are depressed yellow/brown patches

Question 55

What can Plaque Jaunes become?

Answer 55

Epileptic focus

Question 56

Diffuse Axonal Injury

Answer 56

Axonal swelling +/- focal hemorrhagic lesions

Question 57

What stains can be (+) with Diffuse Axonal Injuries?

Answer 57

Silver stain Amyloid precursor protein Alpha Synuclein

Question 58

What constellation of injuries is usually present with Shaken Baby Syndrome?

Answer 58

Diffuse Axonal Injury/cerebral edema Subdural hematomas Retinal hemorrhages

Question 59

Altered state of consciousness with brain function temporarily or permanently impaired

Answer 59

Traumatic Brain Injury

Question 60

Chronic Traumatic Encephalopathy (CTE)

Answer 60

Repetitive brain trauma

Question 61

What are the signs of CTE on the brain?

Answer 61

Atrophy Enlarged ventricles Tau neurofibrillary tangles

Question 62

Epidural hematomas occur rapidly. What type of blood, its source and why?

Answer 62

Arterial blood from middle meningeal artery due to skull fracture

Question 63

Subdural hematomas occur slowly. What type of blood?

Answer 63

Venous blood