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2420 Pathology > Module 12 Neurocognitive > Flashcards

Module 12 Neurocognitive Flashcards

1
Q

Medical Imaging

A
  • Skull & spine x-ray
  • CT
  • Angiography
  • MRI
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2
Q

Electrophysiological Studies

A
  • EEG
  • EMG
  • Nerve conduction
  • Evoked potential
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3
Q

Cerebrospinal Fluid (CSF) Studies

A
  • Cell count
  • Biochem
  • Microbio
  • Cytology
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4
Q

Molecular Genetics & Cytogenetics

A
  • Inherited disorders
  • Tumours
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5
Q

Biochemical Analysis

A
  • Metabolic disorders
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6
Q

Frontal Lobe

A
  • Thinking
  • Feelings/emotion
  • Speech
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7
Q

Temporal Lobe

A
  • Hearing
  • Memory
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8
Q

Parietal Lobe

A
  • Sensation
  • Speech
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9
Q

Brainstem

A
  • Eye & facial movement
  • Breathing
  • Heartbeat
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10
Q

Cerebellum

A
  • Balance
  • Coordination
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11
Q

Unique CNS Tissues

A
  • Neurons
  • Astrocytes
  • Oligodendroglia
  • Ependyma
  • Microglia
  • Choroid plexus
  • Leptomeninges
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12
Q

CNS Tissues Found Elsewhere

A
  • Dura (connective)
  • Blood vessels
  • Pericytes
  • Smooth muscle
  • Phagocytes (macrophages)
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13
Q

Neurons

A
  • Initiate & transmit impulses
  • Synapses (point of connection)
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14
Q

Astrocytes

A
  • Scaffolding
  • Insulate nerve fibres
  • Growth & nutrition of neurons
  • Maintain CNS environment (BBB)
  • Repair of injuries
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15
Q

Oligodendrocytes

A
  • Maintain myelin
  • Conduction velocity of nerve fibers
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16
Q

Microglia

A
  • Defensive (immunologic) responses
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17
Q

Neuronal Degeneration

A
  • Atrophy
  • Damage
  • Necrosis
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18
Q

Axonal Degeneration

A
  • Axonal swellings/loss
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19
Q

Glial Reaction

A
  • Astrocytic hyperplasia
  • Proliferation
  • Astrocytosis/gliosis
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20
Q

Demyelination

A
  • Damage to myelin/oligodendrocytes
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21
Q

Vascular Changes

A
  • Vasculitis & vasospasm (ischemia)
  • Vasogenic edema (BBB breakdown)
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22
Q

Cerebral Edema

A
  • Vasogenic (breakdown of BBB)
  • Accumulation of extracellular fluid (tumour, abscess, cytotoxic)
  • Intracellular swellings of neurons/glia (hypoxia, ischemia)
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23
Q

Migration of Systemic Inflammatory Cells

A
  • Neutrophils, lymphocytes, macrophages
  • To CNS
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24
Q

Neoplastic Components

A
  • Gliomas
  • Metastases
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25
Q

Infectious Components

A
  • Bacterial
  • Fungal
  • Viral
  • Prion
  • Worm
  • Parasites
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26
Q

Vascular Components

A
  • Cerebral infarcts
  • Hemorrhages
  • Ischemia
  • Perinatal
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27
Q

Traumatic Components

A
  • Brain/spinal injuries
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28
Q

Neurodegenerative Components

A
  • Dementias, Alzheimer’s
  • Movement disorders, Parkinson’s
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29
Q

Demyelinanting Components

A
  • Multiple sclerosis
  • Leukodystrophies, adrenoleukodystrophy
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30
Q

Intrinsic Tumour

A
  • Intra-axial
  • Gliomas (astrocytic, oligodendroglia)
  • 3 tiered diagnosis (histology, molecular alterations, WHO grade)
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31
Q

Extrinsic Tumour

A
  • Extra-axial
  • Meningiomas, schwannomas
  • Secondary metastases (lung, breast, melanoma)
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32
Q

Primary Tumour (Adults)

A
  • Astrocytoma (includes glioblastoma)
  • Oligodendrogliomas
  • 90% supratentorial
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33
Q

Primary Tumour (Children)

A
  • Astrocytoma
  • Ependymomas
  • Medulloblastomas
  • 90% infratentorial
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34
Q

Histological Primary Tumour Features

A
  • Suggest higher grade & poor prognosis
  • Increasing cellularity
  • Mitoses
  • Nuclear pleomorphism
  • Endothelial proliferation
  • Necrosis
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35
Q

Primary Tumour Molecular Features

A
  • IDH mutation (better prognosis)
  • Chromosomal
36
Q

Meningiomas

A
  • Derived from meninges
  • Based on dura
  • Middle to old age
  • Cured by resection
  • Various histological patterns
37
Q

Metastatic Tumours

A
  • Difficult to asses prevalence
  • Most common CNS neoplasm in adults
  • Lung, breast, melanoma, renal cell carcinoma, colorectal
  • Commonly located in cerebral hemispheres (grey/white matter junction)
  • Less commonly seen in cerebellum & brainstem
38
Q

Meningitis Types

A
  • Bacterial (neutrophils)
  • Viruses (lymphocytes)
  • Fungi (immunocompromised, cryptococcus, candida)
  • Cloudy leptomeninges
39
Q

Bacterial Meningitis

A
  • Many pathogens
  • Fever
  • Neck stiffness
  • Headache
  • Confusion
  • Cloudy CSF
40
Q

Cloudy Leptomeninges

A
  • Purulent exudate in subarachnoid space
  • Abundant polymorphs in leptomeningeal spaces
  • May extend to vessels, ventricular wall, brain
41
Q

Encephalitis

A
  • Headache
  • Fever
  • Seizure
  • Loss of consciousness
  • Viruses most common (HSV, HIV, CMV)
42
Q

Cerebral Abscesses (Direct Spread)

A
  • (50% of cases)
  • Middle ear, paranasal sinus, dental infections
  • Mixed flora
  • Streptococcus milleri
43
Q

Cerebral Abscesses Hematogenous Spread

A
  • (25% of cases)
  • Bronchiectasis
  • Congenital heart disease
  • Bacterial endocarditis
  • Mixed flora
  • Streptococcus viridians
  • Trauma & iatrogenic
44
Q

Cerebrovascular Disorder

A
  • Stroke
  • Symptoms lasting 24+ hours
  • Leading to death
  • No apparent cause (vascular origin)
  • Ischemic (infractions)
  • Hemorrhagic (non-traumatic)
45
Q

Cerebral Infarct

A
  • Localized area of tissue necrosis
  • Supplied by vascular pattern
  • Neurons, glia, vessels
  • Causes occlusion
46
Q

Occlusion Consequences

A
  • Narrowing of arteries
  • Cerebral, vertebral, internal carotid
  • Middle cerebral artery distribution most common
47
Q

Vascular Occlusion Causes

A
  • Thrombosis
  • Atherosclerosis
  • Vasculitis
48
Q

Vascular Occlusion Clinical Manifestations

A
  • Dependent on size & location of infract
  • Transient ischemic attack (TIA)
  • Symptoms subside in 24hrs
  • Stroke
  • Neurological defects (24+ hrs)
49
Q

Intracerebral Hemorrhage

A
  • Hypertension (Primarily)
  • Leukemia
  • Blood disorders
  • Tumours
  • Vascular malformation
  • Aneurysms
  • Amyloid angiopathy
  • Vasculitis
  • Immune mediated
  • Sepsis
  • Medications
  • Anticoagulants
  • Drug abuse
50
Q

Subarachnoid Hemorrhage

A
  • Developmental
  • Berry aneurysm
  • Vasculitis
  • Immune mediated (nonseptic)
  • Inflammatory aneurysm (mycotic)
  • Septic vasculitis
  • Amyloid angiopathy
  • Arteriovenous malformation (AVM)
51
Q

Hypertension Hemorrhage

A
  • Hypertensive arteriosclerotic changes
  • Wall weakening of arterioles/micro vessels
  • Results in rupture
  • Treatment of hypertension to reduce incidence
  • Rupture into ventricles/brain swelling (Fatal)
52
Q

Hypertension Hemorrhage Sites

A
  • Basal ganglia
  • Thalamus regions
  • Pons
  • Cerebellum
53
Q

Cerebral Amyloid Angiopathy

A
  • Deposition of amyloid (beta)
  • Weakens vessel wall (subarachnoid & cortical)
  • Leads to rupture
  • Intracerebral & subarachnoid hemorrhages
  • Elderly (Alzheimer’s)
54
Q

Berrys (Saccular) Aneurysm

A
  • Developmental defect
  • Weakening of arterial wall
  • Anterior communicating artery most common site
55
Q

Manifestation of Berry Aneurysm

A
  • Local pressure
  • Isolated 3rd cranial nerve palsy
  • Rupture/hemorrhage
  • Subarachnoid, intracerebral, intraventricular
56
Q

Duret’s Hemorrhage

A
  • Brain swelling
  • With uncal/tonsillar herniaition
  • Secondary brain hemorrhage
57
Q

Infarction

A
  • Compression necrosis/vasospasm
  • Constriction of vessel walls after subarachnoid hemorrhage
58
Q

Hydrocephalus

A
  • Blood clots
  • Ventricles & subarachnoid space
59
Q

Head Injury

A
  • Leading cause of death in people under 45
  • Impact/blunt force
  • Focal, diffuse pattern
60
Q

Skull Fracture

A
  • Radiate/pass impact site
  • Not always associated with brain damage
  • Force required
61
Q

Skull Fracture Patterns

A
  • Linear, single line
  • Comminuted, multiple lines
  • Compound, communicates with cranial cavity
  • Depressed, margins pushed into cranial cavity
  • Hinge, across base of skull
62
Q

Traumatic Intracranial Hemorrhage

A
  • Bleeding inside cranium
63
Q

Traumatic Intracranial Hemorrhage Sites

A
  • Outside dura (epidural)
  • Under dura (subdural)
  • Under arachnoid (subarachnoid)
  • In brain (intracerebral)
  • Cerebral ventricles (intraventricular)
64
Q

Epidural Hematoma

A
  • Result of fracture to squamous temporal bone
  • Damage to middle meningeal artery/vein
  • Lucid interval association
65
Q

Subdural Hemorrhage

A
  • Acute
  • Associated with other brain trauma
  • Fall/blow to head
  • Various tears
66
Q

Brain Contusion

A
  • Hallmark of brain damage in head injury
  • Bruise to surface
  • Overlying pia matter intact
67
Q

Topography

A
  • Involve gyri crest
  • Contact with protuberance within skull
68
Q

Coup Contusion

A
  • Occur under site of impact
  • Result of blowC
69
Q

Contre-Coup Contusion

A
  • Opposite (at distance) from impact site
  • Result of fall
  • Occipital impact most obvious
70
Q

Alzheimer’s

A
  • Cortical degeneration
  • 50-70% of dementia cases
  • Slow progression
  • Motor & sensory systems in tact
71
Q

Alzheimer’s Gross Pathology

A
  • Atrophy
  • Frontal & temporal emphasis
72
Q

Alzheimer’s Mirco Pathology

A
  • Neuronal loss in cerebral cortex
  • Gliosis (astrocytes proliferation & hypertrophy)
  • Amyloid deposits
  • Neurofibrillary tangles
  • Neuritic plaques
73
Q

Alzheimer’s Stages

A
  • Thal (A)
  • Braak (B)
  • CERAD ©
  • National institute on aging (NIA-AA)
74
Q

Parkinson’s

A
  • Movement disorder
  • Slow progression
  • Unknown causes
  • No cure
75
Q

Parkinson’s Symptoms

A
  • Resting tremor (shaking)
  • Generalized slowness (bradykinesia)
  • Stiffness of limbs (rigidity)
  • Gait/balance (postural dysfunction & frequent falls)
76
Q

Parkinson’s Neurochemistry

A
  • Loss of dopamine (DA)
  • Imbalance of neurotrans in basal ganglia
  • Dopamine replacement relives symptoms
77
Q

Parkinson’s Pathology

A
  • Loss of pigments in substantia nigra (midbrain)
  • Eosinophilic inclusions in cytoplasm (Lewy Bodies)
  • Increased astrocytes (gliosis)
78
Q

Lewy Bodies

A
  • Cortical degeneration
  • Cerebral cortex dementia association
  • Mutation of alpha synuclein gene PD early onset
79
Q

Primary Demyelination

A
  • Damage/breakdown of myelin
  • Sparing of axons
  • MS
80
Q

Secondary Demyelination

A
  • Myelin breakdown
  • Injured/dying axons
  • Neurodegenerative diseases
81
Q

Primary Demyelination Incidence

A
  • Common in temperate latitudes
  • 20-40 yrs onset
  • Female more common
82
Q

Primary Demyelination Etiology

A
  • Genetic predisposition
  • Environmental
83
Q

Primary Demyelination Pathogenesis

A
  • Autoimmune reaction against oligodendroglia
  • CNS myelin with T-lymphocyte sensation
84
Q

Primary Demyelination Clinical Manifestations

A
  • Relapsing
  • Intermittent chronic course
  • Unilateral limb weakness
  • Paresthesia
  • Optic neuritis
  • Charcot’s tirad (nystagmus, tremor, dysarthria)
  • Impaired intelligence
  • CSF increased IgG
85
Q

Macro Pathology of MS

A
  • Scattered
  • Grey
  • Sharply defined plaques (demyelinated areas)
  • White matter, brain stem, spinal cord, optic nerve
86
Q

Micro Pathology of MS

A
  • Early active lesions
  • Perivenous demyelination
  • Perivascular lymphocytes (T-cells)
  • Oligodendroglia loss
  • Areas coalesce visible MS plaques with inflammation
  • Chronic lesions show gliosis
  • Axon preservation

2420 Pathology (13 decks)

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