Neuropathology Flashcards

(429 cards)

1
Q

The outermost layer of the meninges

A

Dura
“pachymeninges”

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2
Q

send, stores, and receive electical and chemical signals
lots of different types
cell body, dendrytes, axons

A

neurons

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3
Q

local immune cells of the CNS

A

Microglia

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4
Q

Types of glial cells (supportive cells)

A

1) Microglia
2) Astrocytes
3) Oligodendrocytes

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5
Q

cells of the CNS that function for regulation, repair and support

A

astrocytes

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6
Q

cells of the CNS that produce myeline for insulation

A

oligodendrocytes

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7
Q

What does polio- root word mean

A

disease affecting the gray matter (neurons or stroma-neurpil)

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8
Q

What does the leuko- rootword mean

A

disease affecting the white matter

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9
Q

anterograde transport

A

moved towards the synapse

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10
Q

retrograde transport

A

moved away from the synapse (upwards)

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11
Q

in the spinal cord, the white matter is on the _______ while the grey matter is on the _______

A

inside; outside

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12
Q

layers of the meninges

A

1) Dura mater
2) Arachnoid
3) Pia mater

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13
Q

Which of the following cell types is local immune cell of CNS

A

Microglial cell

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14
Q

Encephalo-

A

brain

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15
Q

myelo-

A

spinal cord

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16
Q

polio-

A

greymatter

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17
Q

leuko-

A

white matter

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18
Q

gross softening of the brain (necrosis)

A

malacia

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19
Q

malacia

A

gross softening of the brain (necrosis)

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20
Q

What are the neuronal reactions to injury

A

1) Chromatolysis
2) Ischemic cell change (acute neuronal necrosis

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21
Q

degenerative change seen in cell body associated with axonal injury
swelling of nerve cell body (perikaryon) with dispersion (loss) of Nissl substance and peripheral displacement of the nucleus

A

Chromatolysis

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22
Q

Chromatolysis

A

-degenerative change seen in cell body associated with axonal injury
-swelling of nerve cell body (perikaryon) with dispersion (loss) of Nissl substance and peripheral displacement of the nucleus

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23
Q

Is Chromatolysis reversible ir irreversible

A

reversible degenerative change seen in cell body associated with axonal injury
-swelling of nerve cell body (perikaryon) with despiersion (loss of Nissl substance and peripheral displacement of the nucleus)

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24
Q

is acute neuronal necrosis reversible or irreversible

A

irreversible

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25
What might lead to acute neuronal necrosis
1) Ischemia 2) Hypoxia 3) Hypoglycemia 4) Nutritional deficiency 5) Chemical intoxication 6) Excitatory toxicity - excessive sustained release or reduced clearance of excitotoxic neurotransmitters (e.g glutamate, aspartate)
26
excessive sustained release or reduced clearance of excitotoxic neurotransmitters (e.g glutamate, aspartate)
Excitatory toxicity
27
What do you see on histo after acute neuronal necrosis
shrunken and angular cell bodies with hypereosinophili cytoplasm and pyknotic nuclei
28
________________ cause swelling of the neuronal cell body with finely vacuolated cytoplasm
Lysosomal storage diseases- eg Locoweed
29
What is an example of a toxin that causes swelling of the neuronal cell body with finely vacuolated cytoplasm *lysosomal storage disease
Locoweed (swainsonine) toxicity
30
transmissible spongiform encephalopathy characterized by large discrete cytoplasmic vacuoles
neuronal vacuolization in prion diseases
31
prion diseases cause
transmissible spongiform encephalopathy characterized by large discrete cytoplasmic vacuoles
32
What is the aging pigment seen in aging neurons
Lipofuscin- no harmful effects -orange-brown granular pigment
33
What causes Negri bodies (intracytoplasmic neuronal inclusion bodies)
Rabies virus
34
Are Negri bodies, seen in Rabies, intracytoplasmic or intranuclear?
Intracytoplasmic inclusion bodies
35
______________ bodies are _______________ inclusions seen in Rabies virus
Negri ; intracytoplasmic
36
Are herpes viral inclusion bodies intracytoplasmic or intranuclear?
intranuclear
37
Are Canine distemper viral inclusion bodies intracytoplasmic or intranuclear?
Both - intracytoplasmic and intranuclear
38
_________ virus only causes intranuclear inclusion bodies
Herpes virus
39
Why might injury to the cell body result in axonal changes
the axon is dependent on the neuronal cell body for delivery of nutrients and essential materials (neurofilaments) and removal of debris by active transport
40
the axon is dependent on the ____________ for delivery of nutrients and essential materials (neurofilaments) and removal of debris by active transport
neuronal cell body
41
Why might there be primary axonal injury
1) Trauma 2) Nutrient deficiencies (Vitamin E deficiency in horses) 3) Toxicoses 4) Inherited defects (ie axonopathies)
42
What are the progressive changes of axonal degeneration after injury
Swelling (spheroid) -> fragmentation -> removal by microglial cells (Gitter cells)
43
Cells that eat both the axon and myelin after axon injury/fragmentation. sit in digestion chambers
Gitter cells (microglial cells)
44
What is Wallerian degeneration*
degeneration of the axon and its myelin sheath distal to the site of focal injury (away from cell body). In the spinal cord, it occurs 1) Ascending tracts (tracts heading cranially towards the brain) cranial to the site of focal axon injury- dorsal funiculi and dorsolateral portion of lateral funiculi 2) Descending tracts (tracts heading further caudally towards the axon synapse) caudal to the site of axon injury- ventral funiculi and deep tracts of lateral funiculi
45
degeneration of the axon and its myelin sheath occurs _________ to the site of focal injury (away from cell body).
distal
46
What happens in the neuronal cell body survives following axonal injury
Regeneration from proximal stump can occur Budding axon sprouts "neurites" can grow 2-4mm/day in pNS but much slower in the CNS *Requires intact endoneurium and guiding influences of Schwann cells (PNS) or oligodendrocytes (CNS)
47
Schwann cells are in the
PNS
48
Oligodendrocytes are in the
CNS
49
What does the neuronal cell body need to grow new axons after injury
Requires intact endoneurium and guiding influences of Schwann cells (PNS) or oligodendrocytes (CNS)
50
What is the difference between Astrocytosis vs Astrogliosis
Astrocytosis is hyperplasia after injury Astrogliosis is hypertrophy (increased number, size, and complexity of processes)
51
Gemistocyte
a reactive astrocyte with prominent eosinophilic cytoplasm (really large)
52
Alzheimer type II astrocytes
swollen ,degenerating astrocyte cells with clear cytoplasm and pale staining nuclei -most often with renal or hepatic encephalopathy
53
When are Alzheimer type II astrocytes most commonly seen
with renal or hepatic encephalopathy
54
What are the two types of oligodendrocytes (CNS)
1) Interfascicular (white matter)- formation of maintenance of myelin in CNS 2) Perineuronal "satellite" cells (gray matter)- neuronal metabolism
55
myelinating cell of PNS
Schwann Cell
56
Satellitosis
hyperplasia of satellite cells in response to neurons in distress
57
T/F: if satellite cells die, the injury is irreversible and it leads to primary demyelination
true
58
T/F: Schwann cells have a limited capacity, compared to oligodendrocytes to remyelinate
False- oligodendrocytes are the cells whos damage is irreversible and leads to primary demyelination *limited capacity compared to Schwann cells in PNS
59
degeneration/degradation of myelin sheath, with sparing of axon -direct damage to myelin sheath or damage to myelin-producing cells (Schwann and oligodendrocytes)
primary demyelination due to: toxic (bromethalin), metabolic (hepatic encephalopathy), inherited enzymes defect in myelin metabolism, inflammatory/ immune mediated (canine distemper, caprine artheritis- encephalomyelitis)
60
what toxin might lead to primary demyelination
bromethalin
61
demyelination that is secondary to primary axonal injury (wallerian degeneration) myelin depends on integrity of axon
Secondary demyelination
62
insufficient or absent myelin production -in-utero pestivirus infections
Hypomyelination
63
formation of abnormal or unstable myelin leading to premature demyelination -inherited leukodystrophies
Dysmyelination
64
Hypomyelinogenesis
insufficient or absent myelin production -in-utero pestivirus infections
65
Dysmyelination
formation of abnormal or unstable myelin leading to premature demyelination -inherited leukodystrophies
66
resident mononuclear phagocytes *resident macrophages of the CNS)
Microglial cells
67
Responses of microglial cells due to injury
1) Hypertrophy- activated macrophages with prominent cytoplasm- Rod cells 2) Hyperplasia: clusters of microglia in glial nodules- common with viral infections 3) Phagocytosis of: Lipid/myelin debris = Gitter cells and dead neurons (neuronophagia)
68
Rod cells
activated microglial cells (macrophages) with a prominent cytoplasm
69
Status spongiosis
spongy appearance of parenchyma (non-specific change) that can result from -Postmortem artifact -Intra-myelinic edema -Loss of axons and/or myelin -Vacuolation of neurons, glial cells, or their processes
70
How are small vs large CNS lesions healed
Small: proliferation of astrocytes/ processes Large: astrocyte proliferation cannot occur leading to cavitation or cystic spaces
71
What are the types teratogens that can lead to congenital malformation of the nervous system
1) Physical agents: trauma, radiation 2) Nutritional factors (hypovitaminosis A -> optic nerve hypoplasia or congenital copper deficiency in lambs leads to white matter necrosis/ cavitation) 3) Toxins: eg steroidal alkaloid from veratrum californicum (skunk cabbage) in hseep at day 14 gestation -> synopthalia (failure of the 2 eye globes to separate and holoprosencephaly) 4) Virus e.g feline panleukopenia lead to cerebellar hypoplasia or VBDV leads to cerebellar hypoplasia, hydranencephaly, porencephaly
72
Hypovitaminosis A during gestation leads to
optic nerve hypoplasia
73
Congenital copper deficiency in lambs leads to
Swayback white matter necrossi and cavitation
74
Ingestion of Steroidal alkaloid from Veratrum californicum (skunk cabbage) at day 14 leads to________ in sheep
synopthalia (failure of the 2 eye globes to separate and holoprosencephaly
75
What what day of gestation does ingestion of Veratrum californicum (skunk cabbage) lead to synopthalia and holoprosencephaly in sheep
Day 14
76
Veratrum californicum **
Skunk cabbage that when ingested at day 14 of gestation in sheep leads to synopthalia and holoprosencephaly
77
Feline panleukopenia virus causes newborns to have
cerebellar hypoplasia
78
BVDV causes newborns to have
cerebellar hypoplasia Hydrancephaly Porencephaly
79
Synophthalmia
failure of the 2 eye globes to separate -idiopathic -veratrum californicum
80
Holoprosencephaly
where the two hemispheres of the brain do not separate -idiopathic -veratrum californicum
81
Most congenital malformations of the CNS occur immediately after birth or within the first week of life. When might they not
some may occur later in life (ie Lysosomal storage diseases) *also some malformations are obvious externally while others require sectioning brain/spinal cord
82
Cranium bifidum
cranioschisis -midline bony defect in the cranium may be accompanied by a) Meningocele (sac like protrusion of meninges through defect b) Meingocephalocele (sac-like protrision of meninges and brain parenchyma through defect)
83
-midline bony defect in the cranium may be accompanied by a) Meningocele (sac like protrusion of meninges through defect b) Meingocephalocele (sac-like protrision of meninges and brain parenchyma through defect)
Cranium bifidum (cranioschisis)
84
What might accompany Cranium bifidum
a) Meningocele (sac like protrusion of meninges through defect b) Meingocephalocele (sac-like protrision of meninges and brain parenchyma through defect)
85
What are the different neural tube closure defects
1) Cranium bifidum (Cranioschisis) 2) Spina bifida
86
midline bony defect in vertebral column usually involves lumbar, sacral or caudal vertebrae ranging from failure of closure of vertebral arches (most common) to agenesis of vertebrae may be accompanied by meningocele, meningomyelocele, or myelodysplasia
Spina bifida
87
What vertebrae does spina bifida most commonly affect
lumbar, sacral or caudal vertebrae
88
What may accompany spina bifida (midline bony defect in vertebral column leading to failure of vertebral arches to close or agenesis)
meningocele, meningomyelocele, or myelodysplasia
89
What results in interference with normal migration of neurons during development
genetic defects
90
What is Lissencephaly
agyria- cerebrum has smooth surface without gyri and sulci due to a genetic defect resulting in interference of normal migration of neurons during development
91
What causes Lissencephaly
agyria- cerebrum has smooth surface without gyri and sulci due to a genetic defect resulting in interference of normal migration of neurons during development
92
You see a rat with a smooth brain upon necropsy. You are thinking lissencephaly (agyri). What is significant?
Lissencephaly is genetic defect resulting in interference with normal migration of neurons during development leading to no gyri and sulci Rats, Mice, and Rabbits normally have a smooth brain so this is not signficiant
93
formation of fluid filled cavities in brain reuslting from destruction of immature neuroblasts preventing appropriate migration and development -usually occurs in utero
Encephaloclastic defects a) Porencephaly: smaller cavities in cerebral hemispheres b) Hydranencephaly: more severe destructive event resulting in massive cerebrocortical necrosis (gray and/whte matter) with almost complete loss of pre-existing tissue -> compensatory expansion of the lateral ventricles
94
Porencephaly
smaller fluid-filled cavities in cerebral hemispheres resulting from destruction of immature neuroblasts preventing appropriate migration and development, usually in utero
95
Hydranencephaly
more severe destructive event resulting in massive cerebrocortical necrosis (gray and/whte matter) with almost complete loss of pre-existing tissue -> compensatory expansion of the lateral ventricles due to destruction of immature neuroblasts preventing appropriate migration and development
96
Encephaloclastic defects
formation of fluid filled cavities in brain reuslting from destruction of immature neuroblasts preventing appropriate migration and development -usually occurs in utero can be Porencephaly or Hydranencephaly
97
Encephaloclastic defects are often associated with
utero viral infections (eg. BVDV, bluetongue virus, Border disease virus)
98
You see several lambs from a flock of sheep in Germany were aborted or stillborn with several neuromuscular congenital malformations. You note porencephaly and arthrogryposis. What are some potential causes
Schmallenberg Virus * Other possible causes: Akabane Virus Cache Valley Virus Bluetongue Virus
99
What are the fetal teratogenic effects of feline panleukopenia virus (parvovirus)
Cerebellar hypoplasia, dysplasia Purkinje cell loss Hydranencephaly
100
What are the fetal teratogenic effects of Classical Swine Fever Virus (Pestivirus)
Dysmyelinogenesis, cerebellar hypoplasia
101
What are the fetal teratogenic effects of BVDV
Hydrocephalus, cerebellar hypo- and aplasia, prosencephaly in calves; hypomyelination ,orencephaly in lambs
102
excessive accumulation of cerebrospinal fluid leading to expansion of ventricular system +/- Subarachnoid spaces
Hydrocephalus
103
What is the most common congenital malformation in Vet med
Hydrocephalus
104
With hydrocephalus there is excessive accumulation of CSF leading to expansion of the
ventricular system +/- subarachnoid spaces
105
What are the different types of Hydrocephalus
1) Non-communicating (most common): fluid within ventricular system, obstruction anterior to lateral apertures of 4th ventricle and (mesencephalic aqueduct) 2) Communicating (rare): excess fluid in ventricular system and subarachnoid spaces leading to malformation of arachnoid villi 3) Hydrocephalus Ex vacuo: loss of brain tissue (eg hydranencephaly) leading to dilation of ventricular system
106
What is the most common site of obstruction in non-communicating hydrocephalus *
Mesencephalic aqueduct
107
Hydrocephalus Ex vacuo
loss of brain tissue (eg hydranencephaly) leading to dilation of ventricular system
108
What are the sequelae to hydrocephalus
1) dilation of ventricles- secondary compression atrophy of white matter 2) May have flattened gyri and shallow sulci 3) Possible herniation through foramen magnum (depending on how rapid obstruction occurs)
109
What breeds is congenital hydrocephalus most common in
toy and bracycephalic breeds of dogs and calves
110
Congenital hydrocephalus is most commonly a malformation of the _____________ **
mesencephalic aqueduct
111
congenital hydrocephalus
associated with enlargement of cranium (doming) and open fontanelles most commonly a malformation of mesencephalic aqueduct most common in toy and brachycephalic breeds and calves
112
How might an animal get acquired hydrocephalus
obstruction of CSF flow due to inflammation, neoplasia or other compressive lesions -location varies
113
obstruction of CSF flow due to inflammation, neoplasia or other compressive lesions -location varies
acquired hydrocephalus
114
abnormal dilation of central canal of spinal cord
hydromyelia
115
What is the most appropriate term for dilation of the ventricular system secondary to an encephaloclastic defect such as hydranencephaly
non-communicating hydrocephalus
116
Hydromyelia
abnormal dilation of central canal of spinal cord -most are congenital (genetic or infectious) -acquired are rare (similar causes to acquired hydrocephalus)
117
which of the following locations of stenosis is most commonly found in congenital hydrocephalus
Mesencephalic aqueduct
118
Syringomyelia
cystic fluid filled tubular cavity (syrinx) within the spinal cord that is not lined by ependyma -congenital or acquired (rupture of ependyma with secondary cavitation) Dogs and calves; Weimaraner and CKCS -associated with Chiari-like malformation)
119
cystic fluid filled tubular cavity (syrinx) within the spinal cord that is not lined by ependyma
Syringomyelia
120
What breeds is syringomyelia most common in
Dogs and calves; Weimaraner and CKCS -associated with Chiari-like malformation)
121
Syringomyelia can be congenital or acquired. How might it be acquired
rupture of the ependyma with secondary cavitation leads to a cystic lfuid-filled tubular cavity (syrinx) within the spinal cord
122
What will you see microscopically in a patient with cerebellar hypoplasia
the cerebellum is decreased in size but microscopically you will see decreased Purkinje cells and granular layer cells- destruction of mitotically active external granular cells
123
What are the causes of cerebellar hypoplasia
1) Viral infections: parvoviruses (feline panleukopenia and canine parvovirsu) or Pestiviruses (BVDV at fetal 100-150 days gestation or classical swine fever, or border disease virus) 2) Inherited genetic defect 3) Toxins: piglets from sows treated with organophsophate insecticide during second half of gestation
124
piglets from sows treated with organophsophate insecticide during second half of gestation will develop
cerebellar hypoplasia
125
At what time frame of gestation do fetal infections of BVDV result in cerebellar hypoplasia
between days 100-150
126
What is cerebellar cortical abiotrophy (CCA)
the lack of vital, nutritive substance necessary for normal cell lifespan -premature degeneration/ necrosis and loss of Purkinje cells and granular layer cells (cerebullum can be smaller or normal size) -Intrinsic metabolic defect susepcted (most autosomal recessive) early onset and progressive (but not as borth) -> cerebllar ataxia with head tremor, truncal ataxia, symmetrical hypermetria, spasticity and broad-based stnace
127
-premature degeneration/ necrosis and loss of Purkinje cells and granular layer cells (cerebullum can be smaller or normal size) -Intrinsic metabolic defect susepcted (most autosomal recessive)
Cerebellar cortical abiotrophy (CCA)
128
How do you differentiate cerebellar hypoplasia from cerebellar cortical abiotrophy *
CCA is early onset and progressive (NOT present at birth) cerebellar ataxia with head tremor, truncal ataxia, symmetrical hypermetria, spasticity and broad-based stanace
129
CCA is inherited in the breeds_______
dogs (Airdale, border collie, gorden setter horses (arabian*, gotland pony cattle (holstein, hereford, angus) sheep (merine, coriedale) pigs (Yorkshire)
130
What breeds get Chiari-like malformations
Cavalier King Charles Spaniel
131
What is Chiari-like malformation
when there is a mismatch between the caudal fossa volume and the brain parenchyma mass leading to caudal herniation of cerebellar vermis and brainstem into the foramen magnum leading to -Alteration in CSF flow between intracranial and spinal compartments and reduced craniospinal compliance can lead to springomyelia common in CKCS
132
when there is a mismatch between the caudal fossa volume and the brain parenchyma mass leading to caudal herniation of cerebellar vermis and brainstem into the foramen magnum leading to -Alteration in CSF flow between intracranial and spinal compartments and reduced craniospinal compliance can lead to springomyelia common in CKCS
Chiari-like malformation
133
what leads to syringomyelia in CKCS that hav chiari-like malformation
when they have chairi-like malformation there is a mismatch between caudal fossa volume and brain parenchyma mass leading to caudal herniation of cerebllar vermis and brainstem into foramen magnum this creates alteration in CSF flow between intracrnail and spinal compartments and the reduced craniospinal compliances leads to syringomyelia
134
most biochemical defects are
lysosomal storage diseases usually autosomal recessive (homozygotes manifest disease, heterozygotes are phenotypically normal by 50% have norma enzume activity
135
Do homozygotes or heterozygotes get lysosomal storage diseases
it is autosomal recessive often gene dose dependent homozygotes- manifest disease while heterozygotes are phenotypically normal but have 50% of normal enzyme activity
136
What do you see histologically of patients with lysosomal storage diseases
neurons +/- other cell types such as glial cells, macrophages, hepatocytes, renal tubular epithelium) with finely vacuolated cytoplasm
137
Ceroid lipofuscinosis
clinical signs are usually seen 1-2 years of age widespread sotrage: moost severe/damaging to neurons of cerebral cortex, retina, and cerebellar Purkinje cells leading to dementia blindness, ataxia Atrophied regions may have brown tinge *Only storage disease with gross lesions
138
What is the only storage disease with gross lesions
Ceroid lipofuscinosis -atrophied regions may be brown tingue
139
widespread storage to severe/damaging to neurons of cerebral cortex, retina and cerebllar Purkinje cells leaves atrophied regions with brown tingue *
Ceroid lipofuscinosis
140
When are the clincial signs of Ceroid lipofuscinosis apparent
typically 1-2 years of age
141
What plants do you see acquired/ induced storage disease due to Swainsonine toxicity
Astragalus and Oxytropis (locoweeds)
142
What happens when sheep, cattle, and horses eat Astragalus and Oxytropis (locoweeds)
1) Indolizidine alkaloid: inhibitor of a-mannosidase enzyme 2) get microscopic lesions idenditcal to genetic alpha-mannosidosis (finely vacuolated cytoplasm) 3)Storage disease *Can be transfered to the fetus if pregnant animals consume it
143
T/F: if animal eats Astragalus and Oxytropis (locoweeds), the storage disease can be transferred to the fetus
True
144
you have a 6yo MN greyhound with peracute (sudden) onset of disorientation behavior changes and head pressing Clinicalsigns after initial onset have no progressed and possibly improved over time. What is ths likely
Stroke or Neoplasia
145
What is the typical clinical presentation of cerebrovascular disease (stroke)
peracute/acute onset of neuro signs (usually indicating a focal lesion) which typically do not progress and may ablate with time
146
the outcome of thrombosis and infarction to nervous system depends on
-Type and size of obstructed vessel -Rapidly of onset of ischemia (gradual to sudden obstruction) -Vulnerability of the area of brain or spinal cord to hypoxia (Neurons > Oligodendrocytes > astorcytes > microglia > vascular endothelial cells
147
What are the susceptibility levels of different cells in the CNS to hypoxia
Neurons > Oligodendrocytes > Astrocytes > Microglia > Vascular endothelial cells
148
What are the two different types of infarcts to the nervous system *
1) Ischemic infarcts: Thrombus or Thromboembolism leading to well circumscribed area of tan to yellow discolaration and softening (malacia), gray matter more susceptible, with chronicity- cavitation (if large region of injury) 2) Hemorrhagic infarct: vascular damage/ rupture leading to leakage of RBCs (venous thrombosis) gross lesion: regional area of parenchymal hemorrhage
149
What gross lesion will you see with ischemic infarcts to the nervous system*
Thrombus or Thromboembolism leading to well circumscribed area of tan to yellow discolaration and softening (malacia), gray matter more susceptible, with chronicity- cavitation (if large region of injury)
150
What gross lesion will you see with a hemorrhagic infarct to the nervous system *
vascular damage/ rupture leading to leakage of RBCs (venous thrombosis) gross lesion: regional area of parenchymal hemorrhage
151
Is gray or white matter more susceptible to ischemic infarcts
gray matter- more vasculature and susceptible cells (neurons)
152
Ischemic infarcts are due to _____________ while hemorrhagic infarcts are due to ___________
vascular (artery/arterioles) obstruction- thrombus or thromboembolism Vascular damage/ rupture leading to leakage of RBCs (venous thrombosis
153
Why might a dog get atherosclerosis
secondary to hypothyroidism
154
you see multifocal acute hemorrhages on a canine brain. What might be the cause
Septicemia Neoplasia
155
common in dogs peracute (usually lateralized) spinal signs without pain exact mechanism is unknown but herniation herniation of degenerative disk material (nucleus pulposus) Hansen type I -> vasculature -> occlusive emboli -> ischemic injury
Fibrocartilaginous emboli
156
Fibrocartilaginous emboli
common in dogs peracute (usually lateralized) spinal signs without pain exact mechanism is unknown but herniation herniation of degenerative disk material (nucleus pulposus) Hansen type I -> vasculature -> occlusive emboli -> ischemic injury
157
Although unknown, why might a dog get fibrocartilaginous emboli
herniation of degenerative disk material (nucleus pulposus) Hansen type I -> vasculature -> occlusive emboli -> ischemic injury
158
excess fluid accumulation in the CNS parenchyma can be associated with most CNS disease processes
Edema
159
What are the types of cerebral edema
1) Vasogenic: most common type, due to increased vascular permeability -> extracellular fluid accumulation. White matter is most affected (spongiosis) common causes- neoplasia, inflammation, trauma, and some toxic/metabolic conditions 2) Cytotoxic Edema: altered cellular metabolism -> intracellular fluid accumulation Low O2 -> interference with ATP dependent Na/K pump in cell membrane leading to swelling of neurons, glial and endothelial cells (gray and white matter) common causes are hypoxia, neoplasia, toxic/ metabolic conditions (ie salt poisoning in pigs, hepatic encephalopathy) 3) Interstitial edema (hydrostatic): accumulation of fluid in the periventricular white matter associated with increased ventricular pressure (hydrocephalus or hydromyelia) 4) Hypo-osmotic edema: osmotic imbalances associated with water intoxication
160
What is the most common type of cerebral edema
Vasogenic edema most common type, due to increased vascular permeability -> extracellular fluid accumulation. White matter is most affected (spongiosis) common causes- neoplasia, inflammation, trauma, and some toxic/metabolic conditions
161
How does vasogenic edema occur *
increased vascular permeability leading to extracellular fluid accumulation white matter is most affected (spongiosis) cause: neoplasia, inflammation, trauma
162
How does cytotoxic edema occur*
altered cellular metabolism -> intracellular fluid accumulation Low O2 -> interference with ATP dependent Na/K pump in cell membrane leading to swelling of neurons, glial and endothelial cells (gray and white matter) common causes are hypoxia*, neoplasia, toxic/ metabolic conditions (ie salt poisoning in pigs, hepatic encephalopathy)
163
How does hypo-osmotic edema occur
osmotic imbalances associated with water intoxication
164
How does interstitial edema occur
(hydrostatic): accumulation of fluid in the periventricular white matter associated with increased ventricular pressure (hydrocephalus or hydromyelia)
165
What gross lesions do you see with CNS edema
-flattened gyri and shallow sulci -clear, watery fluid in leptomeninges -posterior shifting of brain (herniation through foramen magnum) -White matter may be soft, wet, pale yellow
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edema may cause
herniation 1) through the foramen magnum (foramenal herniation) 2) Under tentorium cerebelli (transtentorial herniation) 3) Under the falx cerebri (falcine herniation) 4) Through defect in skull (eg. fracture) calvarial herniation
167
Clostridium perfringens type D (epsilon) may cause ____________ in sheep
focal symmetrical (hemorrhagic) encephalomalacia (internal capsule)
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What causes focal symmetrical (hemorrhagic) encephalomalacia (internal capsule) in sheep
Clostridium perfringens type D (epsilon)
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As the brain swells it can herniate. What are common locations for this to occur
1) through the foramen magnum (foramenal herniation of cerebellar vermis) 2) Under tentorium cerebelli (transtentorial herniation) 3) Under the falx cerebri (falcine herniation) 4) Through defect in skull (eg. fracture) calvarial herniation
170
caudal displacement of the parahippocampal gyri caused by sudden swelling of the brain from severe blunt trauma to head
transtentoral herniation
171
forces that are external to the body (HBC, kicks to head, falls ,gunshot wounds, bites)
external injury
172
what might be cause of intrinsic physical disturbances to the nervous system
disc extrusion,vertebral abscesses, neoplasia, congenital malformations causing compression
173
primary traumatic injuries
from the direct trauma (fractures, hemorrhage, edema, and direct injury to the parenchyma from forces acting on the brain (acceleration/deceleration and rotational forces)
174
How do acceleration/deceleration forces differ from rotational forces in context of traumatic brain injuries
Acceleration/deceleration- superficial gray matter (hemorrhages, contusion, and tearing of neuronal tissue) Rotational forces- deeper white matter (causing concussive injuries and axonal damage)
175
What is second injury to trauma
series of events that can lead to continued injury to the neurons/glial cells Major mediators- oxygen free radicles, excitatory amino acids, nitric oxide
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series of events that can lead to continued injury to the neurons/glial cells Major mediators- oxygen free radicles, excitatory amino acids, nitric oxide
What is second injury to trauma
177
What is seen in acceleration/ deceleration trauma
Acceleration/deceleration- superficial gray matter (hemorrhages, contusion, and tearing of neuronal tissue)
178
What is seen in rotational trauma
Rotational forces- deeper white matter (causing concussive injuries and axonal damage)
179
diffuse but transient brain injury associated with temporary loss of consciousness typically no gross lesions uncommon in animals
Concussion
180
focal brain injury which may (but not usually) results in unconsciousness usually a grossly detectible, superficial area of brain hemorrhage often associated with skull fracture
Contusion
181
How does concussion differ from contusion
Concussion: diffuse but transient brain injury associated with temporary loss of consciousness typically no gross lesions uncommon in animals Contusion: focal brain injury which may (but not usually) results in unconsciousness usually a grossly detectible, superficial area of brain hemorrhage often associated with skull fracture
182
Coup contusion
the inside of the cranial vault strikes the stationary brain at the point of impact
183
Contrecoup contusion
lesion occurs on the opposite side due to stretching and tearing of vessels or the brain struck by inside of cranial vault, on opposite side from blow, where there is reduced CSF buffer present
184
How does Coup differ from contrecoup
Coup: the inside of the cranial vault strikes the stationary brain at the point of impact Contrecoup:
185
What is the most common place you see hemorrhage following cranial trauma? **
The subarachnoid space
186
What are the causes of brain hemorrhage
1) Trauma 2) DIC 3) Damage to vessels/ vasculitis (viruses, septicemia, immune complex, neoplasia, parasites)
187
What fractures are common with horses that rear over backwards
fracture of basisphenoid bone displaced bone lacerates large vessels at the base of the brain hemorrhage becomes the dominant lesion
188
Fracture of what bone in horses leads to laceration of large vessels at the base of the brain leading to hemorrhage *
basisphenoid bone
189
The extradural space is greatest in the
cervical vertebral column, cranial thoracic, and caudal lumbar region spinal cord compression is less likely
190
There is a lower risk of intervertebral disc extrusion at the
intercapital ligaments (T2-T10)
191
What does T2- T10 have a lower risk of intervertebral disc extrusion
intercapital ligaments (T2-T10)
192
What might lead to contusion to the spinal cord
Focal hemorrhage associated with fracture, luxation, subluxation, or disc herniation
193
What might lead to compression of the spinal cord *
extramedullary pressures (disc herniation, vertebral/ meningeal neoplasia, vertebral fracture/ subluxation, vertebral malformation
194
What is seen microscopically with spinal cord trauma*
hemorrhage (more prominent in gray matter) axonal/myelin degeneration at site of compression degeneration of axon and myelin sheath distal to site of injury (Wallerian degeneration)
195
Acute spinal cord compression
1) sudden direct impact to spinal cord (contusion) 2) Hypoxia caused by direct injury to vessels leading to hemorrhage or thrombosis compression of vessels without vascular injury (blood stasis) release of local neurotransmitters (norepinephrine) -> vasospasm and vasoconstriction ex: Hansen type I intervertebral disc extrusion
196
acute extrusion of nucleus pulposus through annulus fibrosus and into the canal -usually associated with "chondroid" degeneration/metaplasia of nucleous pulposus genetically programmed and starts early (6months) Chondrodystrophic breeds
Hansen type I disc extrusion, leads to acute compression (contusion)
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Hansen type I disc extrusion
acute extrusion of nucleus pulposus through annulus fibrosus and into the canal -usually associated with "chondroid" degeneration/metaplasia of nucleous pulposus genetically programmed and starts early (6months) Chondrodystrophic breeds
198
chronic spinal cord compression that is slowly developing Low grade hypoxia due to compression of vessels leading to reduced perfusion, vascular stasis, and increased hydrostatic pressure leading to edema
Hansen type II intervertebral disc protusion or cervical vertebral stenotic myelopathy
199
bulging of disc material into the vertebral canal associated with fibrous degeneration of annulus (usually around 8-10 years of age) More common in non-chondrodystrophic dogs
Hansen type II disc protrusion
200
Hansen type II disc protrusion
bulging of disc material into the vertebral canal associated with fibrous degeneration of annulus (usually around 8-10 years of age) More common in non-chondrodystrophic dogs
201
acute and chronic spinal cord compression can lead to
ascending/ descending hemorrhagic myelomalacia more common in type I IVDD 12-24 hours after injury
202
high-velocity-low volume disc extrusion
acute non-compressive nucleus pulpsosus extrusion
203
What is Wobbler's syndrome
cervical vertebral stenotic myelopathy
204
What can be the causes of Wobbler's Syndrome
Cervical Vertebral Stenotic myelopathy caused by: 1) Osseous (young adults) where vertebral malformations often associated with degeneration of facet joint (osteochondrosis dissecans) can be complicated/ exacerbated by hypertrophy of ligamentum flavum or synovial cysts 2) Disc-associated in adult dogs born with congenital vertebral canal stenosis: prone to cord compression because smaller extradural space with secondary hypertrophy of dorsal longitudinal ligament and annulus fibrosis C5-C6 and C6-C7
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What is the osseous form of cervical vertebral stenotic myelopathy
Cervical Vertebral Stenotic myelopathy caused by: 1) Osseous (young adults) where vertebral malformations often associated with degeneration of facet joint (osteochondrosis dissecans) can be complicated/ exacerbated by hypertrophy of ligamentum flavum or synovial cysts
206
What causes the osseous form cervical vertebral stenotic myelopathy
vertebral malformation -degeneration of facet joints (osteochondrossis dissecans)
207
What is the difference between static vs dynamic Wobbler's syndrome in horses
Static >1 year of age - compression regardless of neck position (C5-C6 and C6-C7) Dynamic (typically 8-18 months): flexed neck: C3-C4 and C4-C5
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Glioma
neoplasia of glial cell origin most common type of primary intra-axial CNS neoplasia in dogs and cats (dogs more frequent) major types: Astrocytoma Oligodendroglioma Undefined glioma (both phenotypes in high proportions >30-40%)
209
What is an undefined glioma
when there is both phenotypes (astrocytoma and oligodendroglioma) at high proportions >30-40%
210
What CNS neoplasia are brachycephalic breeds predisposed for
Astrocytoma Oligodendroglioma
211
Where are astrocytomas most commonly located in
temporal and piriform lobes
212
What is the gross appearance of astrocytomas *
firm and tan-gray with indistinct boundaries high grade tumors have more distinct mass with hemorrhage and necrosis
213
What is the gross appearance of oligodendroglioma *
well-demarcated with gelatinous or mucoid texture
214
Where are oligodendrogliomas typically located
Cerebrum- olfactory bulbs and front, temporoal, and piriform lobes
215
How do you diagnose gliomas
immunohistochem A) Glial fibrillary acidic protein (GFAP) for cytoplasm of astrocytes B) Oligodendrocyte lineage transcription factor 2 (Olig2) - labels nucleus of all gliomas C) 2,3' cyclic nucleotide 3'- phosphodiesterase (CNPase): fairly specific of oligodendroglioma (cytoplasmic)
216
Where are choroid plexus tumors located *
Ventnricular location -Hydrocephalus: obstructive or increased CSF production
217
Choroidplexus can lead to
Hydrocephalus: obstructive or increased CSF production
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How do you classify choroid plexus tumors
Papilloma Atypical papilloma Carcinoma
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Where are Ependymoma located*
ventricular system (lateral and third most common) or extraventricular lead to obstructive (acquired) hydrocephalus
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What is sequela of ependymoma
lead to obstructive (acquired) hydrocephalus
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What are the classification of Ependymoma
1) Ependymoma 2) Anaplastic (malignant_ ependymoma
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What is the most common primary CNS tumor of cats and dogs*
Meningioma
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what are the common sites for meningioma in dogs and cats
Dogs: frontal lobes and olfactory lobes Cats: usually solitary (can have multiple) and supratentoral; associated with tela choridea of third ventricle *extra neuronal metastasis is rate
224
What are the gross lesions of meningioma
extra-axial, well circumscribed +/- secondary pressure necrosis of parenchyma commonly amenable to surgical excision
225
Meningiomas are (intra/extra) axial
extra axial
226
neoplasm derived from neuronal precursor cells in olfactory mucosa in the caudal aspect of nasal cavity
Olfactory neuroblastoma (Esthesioneuroblastoma)
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Esthesioneuroblastoma
Olfactory neuroblastoma neoplasm derived from neuronal precursor cells in olfactory mucosa in the caudal aspect of nasal cavity
228
Olfactory neuroblastoma
Esthesioneuroblastoma neoplasm derived from neuronal precursor cells in olfactory mucosa in the caudal aspect of nasal cavity
229
Neoplasm of undifferentiated cells of cerebellum often congenital (calves and young dogs) originate from external granular cell layer
Medullobastoma (a primitive neuroectodermal tumor- PNET)
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Where do Medulloblastomas originate from
a primitive neuroectodermal tumor- PNET Neoplasm of undifferentiated cells of cerebellum often congenital (calves and young dogs) originate from external granular cell layer
231
Spinal Nephroblastoma *
thoracolumbar spinal cord tumor of young dogs Between T10-L2 Young <1 year 2 cell populations (embryonic blastemal cells and epithelial cells)
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Where does spinal nephroblastoma typically occur *
T10-L2 in young dogs (<1yr) thoracolumbar spinal cord tumor of young dogs
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What age of dog does spinal nephroblastoma typically affect *
T10-L2 in young dogs (<1yr) thoracolumbar spinal cord tumor of young dogs
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What are the cells of origins of nerve sheath tumors
1) Schwannoma- Schwann cells 2) Neurofibroma- fibroblasts 3) Perineurioma- perineural cells 4) Malignant nerve sheath tumor
235
What are the common sites of nerve sheath tumors in dogs, cattle, horses, and cats
Dog: brachial plexus >> lumbosacral plexus distal peripheral nerves/skin trigeminal (most common cranial nerve) Cattle: Multicentric (Neurofubromatosis): ANS, heart, mediastinum, 8th cranial nerve, intercostal nerves, brachial plexus Horses/Cats: Skin
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What do nerve sheath tumors look like grossly
nodular subcutaneous mass or thickening of nerves fusion with adjacent nerves
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What is the most common spinal cord tumor and second most common intracranial tumor in cats
Multicentric lymphoma
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Leukocytic tumors (lymphoma) in canine and feline are mostly (B or T cell)
T cell lymphoma (90%)
239
What causes lymphoma in cattle **
Bovine leukemia virus associated (intradural and extramedullary in caudal equina)
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Where in the nervous system is bovine leukemia virus associated with *
intradural and extramedullary in caudal equina
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What is Cholesteatoma
a tumor like lesion that is common in 15-20% of old horses suspected chronic intermittent hemorrhage or congestion/edema of choroid plexus usually incidental (unless large)
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a tumor like lesion that is common in 15-20% of old horses suspected chronic intermittent hemorrhage or congestion/edema of choroid plexus usually incidental (unless large)
Cholesteatoma
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A cholesteatoma in older horses is thought to be due to _________________ of the _____________
chronic intermittent hemorrhage or congestion/edema of choroid plexus
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Secondary tumors of the CNS are ________ common than primary tumors
less
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How might an animal get secondary tumors of the CNS
1) Direct extension: a) bony tumors of cranium or vertebrae (osteoma, osteosarcoma, osteochondrosarcoma, multiple myeloma) b) Carcinomas of nasal and paranasal sinuses c) Ocular tumor 2) Hematogenous metastasis: mammary and pulmonary tumors, melanoma, hemangiosarcoma, and multicentric lymphoma
246
What tumors might spread hematogenously to the CNS
Hematogenous metastasis: mammary and pulmonary tumors, melanoma, hemangiosarcoma, and multicentric lymphoma
247
What tumors might spread via direct extension to the CNS
a) bony tumors of cranium or vertebrae (osteoma, osteosarcoma, osteochondrosarcoma, multiple myeloma) b) Carcinomas of nasal and paranasal sinuses c) Ocular tumor
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What is the blood brain barrier
tight junctions between capillary endothelial cells *inflammation can readily develop in the brain and spinal cord -cytokines or local mast cells products (eg histamine) -> increase permeability of vascular endothelium
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What will a dog with multilobular osteochondrosarcoma look like
a large lump on they head
250
how might the capillary endothelial cells become leaky
-cytokines or local mast cells products (eg histamine) -> increase permeability of vascular endothelium
251
Once CNS infection occurs __________
it tends to persist -drainage of exudate from CSF is poor (lack of lymphatic vessels in CNS) -diffucult to treat because of poor penetration of blood brain barrier by drugs
252
Why does CNS infection typically persist
-drainage of exudate from CSF is poor (lack of lymphatic vessels in CNS) -difficult to treat because of poor penetration of blood brain barrier by drugs -No fibroblasts to wall off the area
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Many agents have no neurotropism and you really only see brain involvement with systemic infection but what are some agents that are neurotropic
Rabies- neurons of grey mater Prions- medulla Listeria monocytogenes- Pons and medulla
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Rabies targets neurons of (white/grey) matter
grey matter
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Most viruses target the (white/grey) matter
grey matter
256
Where do you sample for prions disease
obex of the medulla (dorsal motor nucleus of the vagas nerve)
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inflammation of the brain
encephalitis
258
inflammation of the spinal cord
myelitis
259
inflammation of the pia-arachnoid *
leptomeningitis
260
inflammation of the dura mater*
pachymeningitis
261
pachymeningitis
inflammation of the dura mater
262
inflammation of the ependyma
ependymitis
263
inflammation of the choroid plexus
choroiditis
264
inflammation of the ventricles
ventriculitis
265
What are the different routes of CNS infection *
1) Direct extension/implantation- penetrating trauma (stab wound, gun shot, skull fracture), middle/inner ear infections, nasal cavity/sinus infections through the cribriform plate along olfactory nerve, osteomyelitis, neoplasia 2) Hematogenous- localization within capillary beds of meninges or choroid plexus (eg. neonatal septicemia) 3) Via peripheral nerves (retrograde axonal transport) via axoplasmic flow from PNS to CNS (rabies virus and Listeria monocytogenes) 4) Leukocyte trafficking- macrophages or lymphocytes containing microbes during their transit through CNS (retroviruses)
266
What virus infects the ventricles of the brain
FIP- feline infectious peritionitis virus
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How might the CNS get infected through direct extension
1) penetrating trauma (stab wound, gun shot, skull fracture), 2) middle/inner ear infections 3) nasal cavity/sinus infections through the cribriform plate along olfactory nerve 4) osteomyelitis 5) neoplasia
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How might a sheep get a frontal lobe abscess from direct extension from the nasal cavity
Oestrus ovus (nasal bot) or dehorning
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What is the most common route of CNS infection
Hematogenous- localization within capillary beds of meninges or choroid plexus (eg. neonatal septicemia)
270
What are examples of pathogens that infect the CNS via retrograde axonal transport
Via peripheral nerves (retrograde axonal transport) via axoplasmic flow from PNS to CNS (rabies virus and Listeria monocytogenes)
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What is a common site to see CNS infection through hematogenous spread
pituitary abscess
272
you have several piglets (5-8 weeks), some sudden deaths that are all paddling. some develop neurologic abnormalties, swollen joints or cutaneous lesions- incoordination, tremors, lateral recumbency, padlding, and opisthonos. Upon necropsy you see suppurative meningitis. What might have causes this
Major causes of meningitis in pigs (as part of polyserotis) 1) Steptococcus suis 2) Glasseurella parasios (Glasser's disease) 3) Mycoplasma hyorhinis (does not cause meningitis) 4) Other gram negative septicemia (e.g Salmonella)
273
What are major causes of meningitis in pigs (as part of polyserositis)
Major causes of meningitis in pigs (as part of polyserotis) 1) Steptococcus suis 2) Glasseurella parasios (Glasser's disease) 3) Mycoplasma hyorhinis (does not cause meningitis) 4) Other gram negative septicemia (e.g Salmonella)
274
Meningitis is most often ____ *
part of systemic bacterial infection (septicemia) also can result from direct extension (ie. fractures, otitis, sinusitis) a common finding in neonatal septicemia
275
What are the gross lesions of meningitis *
*Opaque leptomeninges (look at ventral aspect of brain) +/- thickening of choroid plexus and roughening of ependymal surface +/- other lesions of septic animals - peritonitis, pericarditis, endophthalmitis, polyarthritis
276
Why do you need to look at the ventral aspect of the brain when necropsy of an animal with menigitis *
*Opaque leptomeninges (look at ventral aspect of brain)
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What is the possible causes of bovine neonatal septicemia that can lead to CNS infection
*Coliforms Strep Pasteurella Salmonella Klebsiella Staphyococcus Actinpbacillus equi (foals)
278
Where in the nervous system do you typically see empyema
epidural -vertebral canal (tail docking or other traumatic injuries -cranium (secondary to infection following skull fracture
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Oestrus ovis infection in sheep can lead to *
direct extension through cribiform plate to cause a frontal abscess of the brain
280
What can thermal injury from dehorning result in?
frontal abscess
281
What can inner ear infection result in
cerebellopontine abscesses from direct extension from adjacent tissues
282
What are common isolates of bacterial abscesses to nervous system
Trueperella pyogenes Streptococcus Pasteurella
283
What might cause chronic cerebral abscess in sheep
Corynebacterium pseudotuberculosis
284
Direct extension of bacteria from middle/inner ear can lead to
cerebellopontine abscess (look at the ears/ typanic bullae
285
What is the most common cause of middle/inner ear infections in cattle leading to cerebellopontine abscess *
Mycoplasma bovis
286
_____________ in the middle/inner ear of cattle can lead to __________ via direct extension *
Mycoplasma bovis ; cerebellopontine abscess
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you have a circling adult ewe, depressed, right sided head tilt, stumbling/circling to the right, right sided facial paresis, several animals affected. What might be the differential
Listeria monocytogenes or Inner ear infection
288
Listeria monocytogenes is associated with *
spoiled silage
289
What is the pathogenesis of Listeria monocytogenes *
1) Spoiled silage 2) Oral wound allows bacterial invasion of mucosa 3) Bacteria invade trigeminal (other nerves possible) 4) Travel to brainstem via axons (retrograde) 5) Gross lesions typically absent but causes microabscesses in brainstem (pons and medulla)
290
What are the typical gross lesions you see with Listeria monocytogenes infection *
Gross lesions typically absent but causes microabscesses in brainstem (pons and medulla)
291
How do you diagnose Listeria monocytogenes
culture, IHC, Gram stain
292
What will you see on histology of animal with Listeria *
**microabscesses in brainstem (pons and medulla)
293
What nerve does listeria invade
tirgeminal and travels to the brainstem via axons (retrograde)
294
What is the pathogenesis of Histophilus somni
1) Normal genital and nasal flora of cattle and sheep 2) Respiratory tract -> septicemia 3) Thrombotic meningoencephalitis (and lesions in other tissues such as bronchopneumonia and myocarditis)
295
How does Histophilus somni cause multifocal hemorrhages and necrosis (malacia) *
Septicemia leads to thrombotic meningoencephalitis gross lesions: multifocal hemorrhages and necrosis (malacia)- brain and spinal cord Primary histological lesion -Vasculitis -> thrombosis +/- infarcts with gram positive bacteria within thrombi and vessel walls
296
What lesions do you see with Histophilus somni infection
gross lesions: multifocal hemorrhages and necrosis (malacia)- brain and spinal cord Primary histological lesion -Vasculitis -> thrombosis +/- infarcts with gram positive bacteria within thrombi and vessel walls
297
What is the primary lesion you see with Histophilus somni
multifocal hemorrhages and necrosis (malacia)- brain and spinal cord caused by thrombotic and vasculitis
298
What causes focal symmetrical encephalomalacia
Clostridium perfringens type D epsilon toxin
299
What is the pathogenesis of Clostridium type D leading focal symmetrical encephalomalacia (FSE) *
1) Food animals eat lots of highly fermented carbs 2) Overgrowth of Clostridium perfringes type D producing epsilon toxin 3) Degeneration of vascular endothelial tight junctions 4) Swelling and rupture of perivascular astrocyte processes 5) Leakage of fluid and increased intracerebral pressure 6) Parenchymal necrosis
300
How does epsilon toxin cause focal symmetrical encephalomalacia
1) Degeneration of vascular endothelial tight junctions 2) Swelling and rupture of perivascular astrocyte processes 3) Leakage of fluid and increased intracerebral pressure 4) Parenchymal necrosis Sheep: thalamus, cerebellar peduncles,internal capsule with acute protein rich perivascular edema Goats: can be acute or chronic fibrinohemorrhagic colitis)
301
What is the pathogenesis of botulism (limber neck)
1) Clostridium botulinum (type A, B or C) in soul 2) Botulinum toxin blocks the release of acetylcholine, inhibiting contraction 3) Flaccid paralysis 4) Diaphragm -> death *NO gross or microscopic lesions
302
What lesions do you see with botulism
no gross of microscopic lesions diagnosis: history plus toxin detection in clinical samples collected for lab analysis (intestinal contents, serum, liver)
303
What is the pathogenesis of tetanus (lockjaw)
1) Clostridium tetani toxin 2) Motor end plate, blocks release of glycine (inhibitory neurotransmitter) 3) Symptoms: stiffness of jaw, severe muscle spasms, sweating, fever, stiffness of abdominal muscles, difficulty swallowing *No gross of microscopic lesions
304
What lesions do you see with tetanus
No gross of microscopic lesions
305
What is the mechanism of action of tetanus toxin?
binds to the motor end and blocks the release of glycine (inhibitory neurotransmitter) leading to rigid paralysis (lockjaw, severe muscle spasms, fever, sweating)
306
you have a 10yo gelding that is ataxic, fever, and depression, headpressing, muscle fasciculations, hind limb weakness, progression to parlaysis, convulsions and death prior to death, CSF showed mononuclear pleocytosis with predominance of lymphocytes upon necropsy, grey matter is affected, neuronal necrosis, glial nodules, and non-suppurative perivascular cuffs. What might be the cause
Viral infections of the CNS in horses 1) West Nile Virus 2) Equine Encephalitis Virus (Eastern- neutrophils), Western, and Venezuelan encephalitis 3) Equine herpesvirus -1 (myeloencephalopathy)- primarily causes vasculitis (does not specifically target gray matter) 4) Rabies virus
307
What are the different viral infections of the CNS in the horse
1) West Nile Virus 2) Equine Encephalitis Virus (Eastern- neutrophils), Western, and Venezuelan encephalitis 3) Equine herpesvirus -1 (myeloencephalopathy)- primarily causes vasculitis (does not specifically target gray matter) 4) Rabies virus
308
Eastern Equine Encephalitis virus causes
neutrophilic infiltration- dies fast enough where neutrophils do not go away)
309
How does Equine herpesvirus-1 cause myeloencephalopathy
primary causes vasculitis (does not specifically target gray matter)
310
What are important viral infections of the CNS in dog
1) Canine distemper * 2) Rabies virus 3) Canine adenovirus- vascultis 4) Canine herpesvirus-1
311
What are characteristic lesions of viral infections of the nervous system *
usually no gross lesions Histopathology: lesions most prominent in the gray matter (polioencephalitis) 1) Nonsuppurative inflamamtion (lymphocytes and plasma cells) - perivascular cuffs, mild meningitis) 2) Gliosis/ glial nodules 3) Injury to neurons (chromatolysis and necrosis) with neurophagia other viral associated lesions: demyelination (immune destruction), meningitis/ventriculitis (FIP) viral inclusion bodies
312
When might you see intracytoplasmic negri bodies
Rabies virus
313
when might you see both intracytoplasmic and intranuclear inclusion bodies
Canine distemper virus
314
What kind of inclusion bodies do you see with pseudorabies
it is a herpesvirus so you will see intranuclear
315
What virus can cause ventriculitis
feline infectious peritionitis virus
316
What viruses can cause demyelination through immune destruction or viral infection of oligodendrocytes
Canine distemper virus or small ruminant lentiviruses (caprine arthritis- encephalitis virus and vesna)
317
What are important viral infections of the CNS in cats
1) FIP 2) Rabies virus
318
What are the important viral infections of the CNS in cattle
1) Bovine herpesvirus-5 (and less commonly BHV-1) 2) Malignant catarrhal fever (MCF)- vasculitis 3) Rabies virus 4) West Nile Virus
319
What are the important viral infections of the CNS in sheep/goats
1) Lentivirus (Caprine arthritis- encephalitis virus in goats, visna in sheep) 2) Rabies virus 3) West NIle Virus
320
What causes granulomatous/ pyogranulomatous inflammation focused on meninges and ventricular system
Feline Infectious Peritonitis virus
321
Feline Infectious Peritonitis virus causes
granulomatous/ pyogranulomatous inflammation focused on meninges and ventricular system
322
Which of the following is the primary histologic lesion seen with locoweed toxicity? Neurons with large discrete intracytoplasmic vacuoles Neurons with finely vacuolated cytoplasm Acute neuronal necrosis Lipofuscin accumulation in the cytoplasm of neurons
Neurons with finely vacuolated cytoplasm
323
Which of the following conditions exhibits autofluorescence of the neuropil when examined under a black light?
Polioencephalomalacia
324
Which of the following is a cause of polioencephalomalacia in ruminants? A) Thiamine deficiency B) Sulfur deficiency C) Moldy corn poisoning D) Selenium toxicity
A) Thiamine deficiency
325
Which of the following is a cause of cerebellar aplasia or hypoplasia in pigs?
Classical swine fever
326
What lesion is shown in the nucleus pulposus of the image and what type of intervertebral disc disease would this patient be predisposed to develop?
Chondroid degeneration/metaplasia; Hansen type I disc extrusion
327
What is the most common location of stenosis with congenital hydrocephalus?
Mesencephalic aqueduct
328
Which of the following would cause an ischemic infarct (and not a hemorrhagic infarct)? A) Thrombus of an artery B) Thrombus of a vein C) Traumatic rupture of a blood vessel D) Vasculitis leading to leakage of RBCs
A) Thrombus of an artery
329
What type of hydrocephalus can occur following in utero destruction of the cerebrocortical parenchyma (i.e., hydranencephaly)
Hydrocephalus ex vacuo
330
exposure to organic and inorganic compounds- pesticides, heavy metals, plants, microbial products, etc.
Intoxication
331
inadequate levels of minerals, vitamins, metabolites
deficiency
332
What are the clinical features of toxic/ metabolic CNS disease
peracute to acute (headpressing, disorientation, recumbency, tonic-clonic seizures, partial seizures) age is not a generalized feature- certain toxins/deficiencies do express predilections commonly an outbreak
333
Know this: Toxic and Metabolic Diseases are of often (bilateral/unilateral) and (symmetrical/asymmetrical) *
Bilateral and Symmetrical
334
True/False: Toxic and Metabolic Disease of the CNS target specific anatomic areas and cell types of the CNS *
true it is dependent on vascular geography and concentration of receptors
335
Why do toxic and metabolic diseases of the CNS target specific anatomic areas and cell types of the central nervous system *
1) Vascular geography 2) Concentration of receptors
336
What are the major patterns of toxic/metabolic disease
1) Malacia (softening- common pathway) +/- hemorrhage 2) Selective necrosis- neurons, axons, myelin 3) Spongiform state (status spongiosis- irregular cavities within the neuropil secondary to neuronal loss
337
irregular cavities within the neuropil secondary to neuronal loss
Spongiform state (status spongiosis-
338
What are the 4 causes polioencephalomalacia in large animals *
1) Sulfur toxicity 2) Thiamine deficiency 3) Water deprivation encephalopathy 4) Lead toxicity
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Polioencephalomalacia in large animals
cerebrocortical necrosis (CCN) to the cerebral cortex- basal/thalamic nuclei, colliculi, and cerebellar cortex caused by: 1) Sulfur toxicity 2) Thiamine deficiency 3) Water deprivation encephalopathy 4) Lead toxicity Diagnosis: postmortem: gross and histological findings
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What does sulfur toxicity in large animals lead to *
Polioencephalomalacia
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What does thiamin (B1) deficiency in large animals lead to
Polioencephalomalacia
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What is the pathogenesis of sulfur toxicity in ruminants
1) Sulfur ingested in excess (feed or water) 2) Rumen microbes produce excess hydrogen sulfied (H2S) where it accumulates in ruminal gas cap and 3) soluble hydrosulfide anions accumulate in ruminal fluid and diffuse across the rumen wall 3) H2S decreases mitochondrial respiration- inhibits cytochrome oxidases * 4) Brain has a high demand for oxygen, glucose, and energy metabolites and leads to neuronal dysfunction, degneration, and necrosis 5) Polioencephalomalacia
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What do the soluble hydrosulfide anions (H2S gas) that accumulate in ruminal fluid due in cattle with sulfur toxicity **
they diffuse across the rumen wall and decrease mitochondrial respiration via inhibiting cytochrome oxidases causing neuronal dysfunction, degeneration, and necrosis
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How does sulfur toxicity cause polioencephalomalacia *
H2S diffuses across rumen wall decrease mitochondrial respiration via inhibiting cytochrome oxidases causing neuronal dysfunction, degeneration, and necrosis
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What is the pathogenesis of thiamin deficiency in cattle *
1) High carbohydrate diets lead to overgrowth of thiaminase producing bacteria (Cl. sprogenes and Bacillus thiaminoolyticus) or grazing of thiaminase containing plants (Bracken fern, Nardoo) or Amprolium 2) Insufficient thiamine leads to neuronal dysfunction, degeneration, and necrosis
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a vitamin that is a crucial cofactor for glucose metabolism and glial-neuronal membrane interactions
Thiamin (B1)
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What diet causes cattle to develop a thiamin deficiency *
High carbohydrate diet- overgrowth of thiaminase producing bacteria (Cl. sprogenes and Bacillus thiaminoolyticus) or grazing of thiaminase containing plants (Bracken fern, Nardoo) or Amprolium
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How might cattle get thiamin deficiency *
1)High carbohydrate diet- overgrowth of thiaminase producing bacteria (Cl. sprogenes and Bacillus thiaminoolyticus) * 2) Thiaminase containing plants (Bracken fern, Nardoo) 3) Amprolium
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What are gross findings of polioencephalomalacia in large animals
1) Gyri are flattened 2) Sulci are less sistinct 3) Multifocal to coalescing yellow foci (necrosis) 4) Cerebellar hemorrhage suggestive of herniation 5) Deep laminar necrosis resulting in perisulci cystic cavities *** 6) Tan to yellow discolored cortex with shrunken to absent grey matter
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Deep laminar necrosis resulting in perisulci cystic cavities is seen in_________ **
polioencephalomalacia in large animals
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What tool on necropsy floor can you use to diagnose polioencephalomalacia **
UV/Woods lamp *autofluorescent of the necrotic areas when neurons die they release lipofuscin and the macrophages pick that up
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What do you see on histology in large animals with polioencephalomalacia *
1) Spongy change (edematous) 2) Neuronal necrosis- band like "Pseudo laminar" *** 3) Gliosis- reactive astrocytes, increased microglia 4) Vascular proliferation 5) Infiltration of the neuropil by macrophages with phagocytic ability "Gitter cells"
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How does neuronal necrosis with polioencephalomalacia present itself on histology **
In a band like "pseudolaminar" form
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How do carnivores get thiamin
through dietary intake ruminants have bacteria to rpduce it
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How is the topography of thiamin deficiency in carnivores different from ruminants *
In carnivores: caudal colliculi, medial vestibular nuclei and lateral geniculate bodies (often hemorrhagic) *
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What are the etiologies of thiamin deficiency in carnivores *
1) Starvation (cats) 2) Raw fish 3) Thiamin inactivation - thiamin levels are measured and addressed in commerical dog foods
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What are the most commonly affected regions in thiamin deficiency in carnivores *
caudal colliculi, medial vestibular nuclei and lateral geniculate bodies (often hemorrhagic) Bilateral and symmetrical
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How are water deprivation encephalopathies caused
1) Pigs fed a high salt ration 2) occurs in other animals as a result of water deprivation. arid environments, broken water pipes, frozen water, neglect *Pathogenesis revolves around osmotic gradients between the blood stream and CNS *PEM/CCN lesions
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What species is salt toxicity common in? *
Pigs
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What is the pathogenesis of salt toxicity (common in pigs) *
1) Water intake restriction in pigs being fed a high salt diet 2) Blood becomes hypernatremia 3) Following osmotic gradient, fluid from brain moves into vessels 4) Brain becomes dehydrated 5) Equilibration of NaCl between plasma and extracellular space if the CNS is slow 6) Development of PEM is unclear but not hypothesized to be secondary to compression and anorexia *When water is provided the blood becomes hypotonic in comparison to the brain. Excess fluid from blood moves into the dehydrated brain
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What lesions do you see on necropsy of an animal with salt toxicity
Gross: Tonsillar Cerebellar Herniation Histologic: Perivascular infiltrate of eosinophils is essentially pathognomonic
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Water Toxicity
Causes PEM/CCN excess water consumption following deprivation following the osmotic gradient, IV fluid moves into brain Similar necropsy findings but eosinophilic perivascular infiltrates are not a feature
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Salt toxicity has similar necropsy findings from water toxicity. What is not seen in water toxicity but is seen in salt toxicity
Eosinophilic perivascular infiltrates on histology
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Lead toxicity
Causes PEM/CN young animals: milk substitutes, paint, plumbing, batteries birds: leadshot, fishing, coin oxidative stress leads to erythrocytic and vascular damage-> generating edema can occur with other heavy metals
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What causes Equine Nigropallidalencephalomalacia *
Ingestion of the yellow star thistle or Russian knapweed -dry summer pastures -chronic exposure, acute onset of disease *Repin is suspected toxic compound
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What plants cause Nigropallidalencephalomalacia *
Yellow Star Thistle (Centaurea solstitalis) Russian Knapweed (C. repens)
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What is Equine Nigropallidalencephalomalacia *
caused by Yellow Star Thistle or Russian knapweed (dry summer pastures and chronic exposure with acute onset) Signs: Abnormal tongue movement, difficulty with prehension, swallowing, and drinking Gross/Histologic lesions- bilaterally symmetrical malacia of substantia nigra and globus pallidus effecting conscious proprioception and movement *Pseudolaminar necrosis is not a feature
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What causes Equine Leukoencephalomalacia
Mycotoxic (Moldy corn disease) producing Fumoninsin B1* acute onset with chronic exposure
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What is the pathogenesis of Moldy Corn Disease *
1) Ingestion of moldy corn contamined with Fusarium moniliforme 2) Fumonisin B1 causes vascular damage selectively in the white matter with secondary encephalomalacia 3) Bilateral asymmetrical, centrum semiovale, corona radiata *Leukoencephalomalacia may also cause concurrent hepatic necrosis
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Fumoninsin B1 *
produced by Fusarium moniliforme that grows in moldy corn causes vascular damage selectively in the white matter with secondary encephalomalacia Causes Equine Leukoencephalomalacia
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What lesions do Fumoninsin B1 from Fusarium moniliforme cause
Bilateral asymmetrical * damage to the centrum semiovale and corona radiata (occasionally in the brainstem and cerebellar white matter) via vascular damage to white matter with secondary encephalomalacia Equine Leukoencephalomalacia
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What are the general characterisics of degenerative disease
1) Selective degeneration and loss of cells or cell components 2) Bilaterally symmetric 3) Individual animals
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How are degenerative diseases named?
by their main cellular target and/or lesion patterns
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What are major patterns with degenerative disease
-Loss of neurons, axons and/or myelin. compare with normal animal, swollen axons (primary axonal pathology) -Pallor of white matter -Spongy state -Intracellular storage: most easily recognizable, accumulatio of abnormal material, malacia
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Degeneration of neurons is often
degeneration and loss of neurons in a specific anatomic structure often polyphasic can lead to anterograde or retrograde axonal lesions
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What is one of the most common and important degenerative diseases (neuronal)
Motor Neuronal Diseases -Hereditary Canine Spinal Muscular Atrophy -Bovine Motor Neuron Disease with neurofilamentous accumulation Clinical: weakness of limb, spinal and head muscles with progressive atrophy and eventual paresis and paralysis
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Spongiform Encephalopathies
Transmissible degenerative diseases 1) TSEs 2) Prions Normal prion protein exposed to scrapie related protein (abnormally conformed prior protein) serves as a template to influence a geometric conformation change in exposed animal Disease examples: BSE, FSE, Scrapie, SWD, Creutzfeldt-Jakobs Disease, fatal insomnia
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What is the pathogenesis of Spongiform Encephalopathies *
Normal prion protein exposed to scrapie related protein (abnormally conformed prior protein) serves as a template to influence a geometric conformation change in exposed animal
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What are the clinical signs of Spongiform Encephalopathies
slowly progressive deteriration long incubation period (years) -> disease of adult animals almost always fatal changes in behavioral or temperament progressive ataxia (+ other neurologic signs) and weight loss
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Where do you submit samples for prion diseases/ chronic wasting disease *
Medulla oblongata - obex
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What is the etiology of equine degenerative myeloencephalopathy *
hereditary defect that predisposed to pathology related to environmental or nutritional factors -Vitamin E deficiency has been demonstrated **
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Equine Degenerative myeloencephalopathy *
occurs sporadically in many breeds hereditary defect that predisposed to pathology related to environmental or nutritional factors *Vitamin E deficiency* Clinical: onset at around 6 months, ataxia and tetraparesis Pathology: Dystrophic axons and neuronal degernation, lipofiscin accumulation in endothelial cells, neurons, and macrophages in affected nuclei
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Does normally the dry or wet form of FIP affect the CNS and eyes
dry form
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FIP causes:
granulomatous and exudative ventriculitis and periventricular encephalitis obstructive lesion with secondary hydroencephalus
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Does canine distemper virus cause grey or white matter lesions
BOTH grey matter- similar to other viruses but also white matter (more common)- causing demyelination (primary)
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Distemper causes
1) White matter lesions -primary demyelination leading to spongy changes that can progress to necrosis 2) Intranuclear and intracytoplasmic inclusion bodies
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Post-vaccinal distemper
occurs 1-2 weeks after vaccination aggressive behavior, progressive ataxia, paresis and death within a few days *Disseminated lesions in gray matter associated with MLV
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old dog encephalitis
rare manifestation- thought to be subclinical persistent infection of canine distemper infections lesions in gray and white matter of forebrain (including demyelination)
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What age does caprine arthritis encephalitis virus typically affect
2-4 month old kids
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What is the pathology of small ruminant lentiviruses like CAEV and Visna *
Demyelinating leukoencephalomyelitis CAEV: 2-4 month old kids Visna: sheep >2 years old
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What age of visna typically affect sheep
usually older animals >2 years
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What might cause demyelinating leukoencephalomyelitis in small ruminants
Caprine arthritis encephalitis virus or visna
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10 yo MC cat with several week history of sneezing, nasal discharge and firm swelling over bridge of nose. 2 day history of depression, disorientation, and seizures. What additional diagnostic tests would you perform?
Advanced imaging to rule out some sort of mass Cytology
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Fungal and algae infections of the CNS
mostly isolated occurences and often opportunisitc infection in immunocompromised animals pathogenesis: 1) mostly hematogenous (systemic) - Blastomyces dermatitidis 2) Extension from nasal cavity- Cryptococcus sp.- direct extension through the cribiform plate Gross legions: regions of parenchymas discoloration or a mass like lesion Histopathology: granulomatous to pyogranulomatous inflammation with organisms histologically
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What lesions do you see with fungal and algae infections of the CNS
Gross legions: regions of parenchymas discoloration or a mass like lesion Histopathology: granulomatous to pyogranulomatous inflammation with organisms histologically
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How does Cryptococcus sp. typically infect the CNS
through direct extension through the cribiform plate
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How does Blastomyces dermatitidis typically infect the CNS
mostly hematogenous (systemic)
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How does fungi and algae infect CNS
1) mostly hematogenous (systemic) - Blastomyces dermatitidis 2) Extension from nasal cavity- Cryptococcus sp.- direct extension through the cribiform plate
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What is the pathogenesis of Feline Cryptococcosis
1) Inhalation into nasal cavity 2) Invasion through cribiform plate or along olfactory nerve 3) Meningoencephalitis - granulomatous to pyogranulomatous inflammation with regions of parenchymal discoloration in a mass like lesion
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You have a 3yo QH mare with chronic history of gait abnormalities (ataxia, knuckling, crossing over) and progressive unilateral muscle atrophy of right pelvic limb Upon CSF you see eosinophilic pleocytosis. What might have caused this?
EPM Infarction EHV-1 Parasite
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Equine protozoal myeloencephalitis (EPM)
Asymmetrical foci of hemorrhage and malacia caused by Sarcocystis neurona have a distribution of lesion- typically the spinal cord +/- brainstem predilection for cervical and lumbar intumescences
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What causes Equine Protozoal Myeloencephalitis
Sarcocystic neurona
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What protozoa has a predilection for the CNS of horses
Sarcocystic neurona - asymmetrical foci of hemorrhage and malacia
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What gross lesions are seen with Equine protozoal myeloencephalitis (EPM) *
asymmetrical foci of hemorrhage and malacia
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What protozoa cause CNS signs due to sludging of parasitized erythrocytes in the cerebral capillaries
Babesia sp infection in cattle, dogs and horses Trypanosoma sp in cattle
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What lesions are seen with protozoal infections of the NS *
Gross: random regions of parenchymal discolaration and malacia Histo: Pyogranulomatous/ granulomatous inflammation +/- eosinophils in a random pattern (asymmetrical) Necrosis see organisms histologically
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What protozoa cause midterm abortion in cattle
Neospora caninum
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Neospora caninum affct what two species
Dogs- young dogs infected in-utero leading to polyradiculoneuritis, polymyositis, and meningoencephalomyeltis Cattle- abortion (midterm) with lesions in the fetus of encephalitis, myositis/myocarditis
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How are dogs typically infected with Neospora caninum
in-utero cause polyradiculoneuritis, polymyositis, and meningoencephalomyeltis
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What is the typical signalment of dogs with neospora caninum
young puppies (infected in utero) with weakness progressing to paralysis
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What lesions are seen in Neospora caninum infection of puppies *
1) Polyradiculoneuritis - inflammation of multiple nerves and spinal nerve roots 2) Polymyositis- inflammation of multiple muscles 3) Meningoencephalomyelitis *Granulomatous and eosinophilic encephalitis
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you have a 2.5 yo female llama from indiana with a two week history of dragging the left pelvic limb. the clinical signs progressed to ataxia and tetraparesis with loss of superficial pain in the pelvic limbs. bright and alert with normal appetite CSF- elevated protein content and an increased white blood cell count with a predominance of eosinohphils. What classes of organisms would you suspect
Parasite - Parelaphostrongylus tenuis
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What lesions do you see with cattle with neospora caninum
Abortion (midterm) lesions: encephalitis and myositis/myocarditis of the fetus
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Parelaphostrongylus tenuis
Meningeal worm Definitive host: White tailed deer- typically no clinical signs (reside in subdural space) Camelids: ingest infected mollusks (intermediate host) which result in aberrant migration in the CNS parenchyma *Granulomatous and/or eosinophilic inflammation with linear tracts of hemorrhage and necrosiss can see organisms (larva or adults)
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What lesions do you see with parasitic infections of the CNS*
Granulomatous and/or eosinophilic inflammation with linear tracts of hemorrhage and necrosiss can see organisms (larva or adults)
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What species do you typically see Parelaphostrongylus tenuis in
Camelids- ingest infected mollusks (intermediate host) which results in aberrant migration in the CNS parenchyma
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insect larvae live in nasal cavity of sheep and penetrate the cribriform plate
Oestrus ovis
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insect that affects the spinal cord of cattle
Hypodermis bovis
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insect that causes feline ischemic encephalopathy
Cuterebra sp.
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What does Cuterebra cause
feline ischemic encephalopathy- regionally extensive encephalomalacia with cuterebra larva
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Cestode infection of the CNS*
Adults (intestine of final host)- larva can infect CNS of intermediate host* Pathology: Single or multiple cysts (space occupying mass)* Coenurus cerebralis (Taenia multiceps- dogs) sheep Cysticercus cellulosae (Taenia solium- humans) pigs and dogs
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What are the different types of canine meningoencephalitis of unknown origin (MUO) *
1) Granulomatous meningoencephalitis (GME) 2) Necrotizing meningoencephalitis (NME) 3) Necrotizing leukoencephalitis (NLE)
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What is canine meningoencephalitis of unknown origin (MUO) *know this to memory
1) Granulomatous meningoencephalitis (GME) - angiocentric granulomatous inflammation of white matter 2) Necrotizing meningoencephalitis (NME) 3) Necrotizing leukoencephalitis (NLE)- gross large asymmetric malacic foci confined to deep white matter immune mediated mechanism? Most cases in young adults (6 months to 3 years) usually multifocal disease
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What age of dog does MUO typically affect
young adult dogs (6 months to 3 years)
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Is MUO focal or multifocal disease? *
Multifocal disease
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Coonhound paralysis
polyradiculoneuritis in dogs that affects spinal nerve roots/ peripheral nerves ascending paresis- paralysis of limbs suspected immune mediated reaction suspected (hypersensitivity to raccoon saliva)
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polyneuritis equi
neuritis of the cauda equina autoimmune or post infectious? see swollen nerves with adhesions (can see cranial nerve involvement) chronic progressive tail and sphincter paralysis, urinary incontinence, fecal retention, perineal paresthesia/ analagesia
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Beagle pain syndrome *
Steroid-responsive meningitis arteritis that occurs in young adult dogs acute fever, neutrophilia, neck pain see subarachnoid hemorrhage in the brainstem/cervical spinal cord Histologically: meningitis and necrotizing arteritis
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