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Clin Med Neuro Kelley > Neuropathology > Flashcards

Neuropathology Flashcards

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1
Q

REVIEW:

What are the three layers

of the meninges and

what spaces lie between them?

A

Skull

Epidural

Dural

Subdural

Arachnoid

Subarachnoid

Pia

Brain

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2
Q

Review:

What are the primary functions

of each lobe of the cerebrum?

A

Frontal: Motor functions,

behavior, emotions, higher intellect

Parietal: sensory

Temporal: hearing, smelling

Occipital: Visual

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3
Q

REVIEW;
What are the three components

of the brainstem and

what do they do?

A

Midbrain: visual & auditory reflex centers

Pons: connection between cortex, cerebellum and medulla

Controls chewing, biting, swallowing, facial expressions, sensation

Medulla Oblongata: cardiac, vasomotor and respiratory centers

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4
Q

REVEIW:

What does the Cerebellum do?

A

Major regulator of motor activities

Integration of:

Sensory impulses from spinal cord and vestibular organ

Motor impulses of Cerebral Cortex

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5
Q

REVIEW

Where is the gray matter

and white matter

in the brain and spinal cord?

A

Brain: generally gray on the outside, white on the inside (but some gray on the inside as well.

Spinal Cord: gray on the inside, white on the outside

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6
Q

REVIEW:

What are key differences

between neurons and glial cells?

A

Neurons:

Nondividing, postmitotic, permanent cells

Glial Cells:

facultative, mitotic (labile), capable of dividing

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7
Q

What are the six types of cells in the nervous system,

what do they do,

and what do you call their tumors?

A

Neurons: signalling/information, neuroma

Glial Cells: support, glioma

Astrocytes: support, blood brain barrier, astrocytoma

Oligodendrocytes, myelination in brain, oligodendroma

Ependymal Cells: lining ventricles, ependymoma

Schwann cells: peripheral myelination, Shwannoma

Microglia, immune response, NO tumors!

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8
Q

What are the nine major types of diseases

of the nervous system?

A
  1. Developmental, genetic diseases
  2. Malformations
  3. Trauma
  4. Circulatory (vascular) disorders
  5. Infectious diseases
  6. Autoimmune diseases
  7. Metabolic, nutritional diseases
  8. Neurodegenerative and demyelinating diseases
  9. Brain tumors
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9
Q

What is a dysraphic disorder?

A

Incomplete closure

of the embryonic neural tube

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10
Q

What are three types of

dysraphic disorders

occuring at the hind end?

A

Spina bifida: incomplete closing of the backbond and membranes around the spinal cord. Three types:

Spina bifida occulta: outer part of vertebrae slightly open

Myelomeningocele: spinal cord and meninges protruding

Meningocele: meninges protruding

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11
Q

What happens

when the head end of the neural tube

does not close properly?

A

Anencephaly: absense of a major part of the brain and skull

Encephalocele: protursions of the brain through the skull that are coverered with membrane

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12
Q

What are four types of

CNS hemorrhages

and their causes?

A

Epidural Hematoma: middle meningeal artery rupture

Subdural Hematoma: bridging vein rupture

Subarachnoid Hematoma: 1. Trauma, 2. Aneurism

Intercerebral Hemorrhage: 1. Trauma, 2. HTN

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13
Q

What is the fifth leading cause of death in the US?

Hint: it used to be number 3!

A

Cerebrovascular Disease

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14
Q

What are the two types of stroke and their incidence?

A

Ischemic (85%)

atherosclerosis, occlusion of blood vessels

Hemorrhagic (15%)

often a complication of HTN

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15
Q

REVIEW:

What are the three large cerebral arteries?

What part of the brain to they perfuse?

Where do they originate?

A

Anterior Cerebral Artery (ACA) from Internal Carotid,

perfuses medial surface of frontal and parietal lobes

Middle Cerebral Artery (MCA) from Internal Carotid

perfuses lateral surfaces of frontal, temporal, parietal lobes

Posterior Cerebral Arteries (PCA) from Vertebral Artery

perfuses posterior aspect of temporal, occipital lobes

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16
Q

A patient has an MRI

showing an intracerebral hemorrhage

in the basil ganglia.

What is the likely cause?

A

Hypertension

(Trauma is most common cause

of intracerebral hemorrhage though)

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17
Q

What causes cerebral herniations?

A

Cerebral Edema

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18
Q

Where are the four most common locations

for cerebral herniations?

Which is most serious?

A

Tonsillar Herniation (most serious)

(cerebral tonsil exits skull through foramen magnum)

Transtentorial (uncinate) herniation

(cerebral uncus at cerebral-pontine angle)

Subfalcine herniation

(cingulate gyrus at falx)

Herniation through opening in broken skull

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19
Q

Which is more serious,

a concussion or a brain contusion?

A

A contusion is more serious.

Concussion: transient loss of consciousness

Contusion: disruption of blood supply, can lose consciousness later, produce neurological deficit

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20
Q

What is Coup and Counter Coup?

A

Coup (a “blow” in French) is the damage to your brain near where your head is hit

Counter Coup (on Contre Coup) is the damage where your brain hits the opposite side in response to the coup

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21
Q

What are three ways

an infection can get inside the brain?

A

Penetrating trauma

Hematogenous Spread (blood vessels)

Nearby infections (otitis media, sinuses)

NOTE: if you squeez a pimple, it drains into your sinuses!

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22
Q

What are the four most common organisms

causing as infection

in the nervous system?

A

Bacteria

Viruses

Fungus

Protazoa

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23
Q

What bacteria

can cause an infection

in the nervous system?

A

Neisseria meningitidis,

S. pneumo,
E. coli,

H. influenza,

Treponema pallidum

(Hematogenous Route or Septic Emboli)

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24
Q

What viruses

can cause an infection

in the nervous system?

A

Measles

Rubella

Adenovirus

Herpesvirus

Cytomegalovirus

Rabesvirus

(via Hematogenous Route)

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25
What fungi can cause an infection in the nervous system?
Candida albicans Aspergillus flavus Cryptococcus neoformans (Hematogenous route)
26
What protazoa can cause an infection in the nervous system?
Toxoplasma gondii (Hematogenous route)
27
Name four types of infections of the Nervous System
**Encephalitis:** inflammation of the brain parenchyma, usually viruses **Myelitis:** inflammation of the spinal cord, usually viruses **Cerebral Abscess:** suppurative cavitary lesion from pyogenic bacteria, fungi or both **Meningitis:** Inflammation of meninges, viral or bacterial
28
What is Multiple Sclerosis? What is its incidence, signs/Sx and disease course?
Chronic, degenerative demyelinating disease **Incidence**: women 2x men, genetic factors **Signs/Sx**: loss of sense of touch, muscle weakness, unsteady gait, sphincter abnormalities **Course**: exacerbation and remission
29
What is the difference between and early and late lesion in MS?
**Early:** Lymphocytes attack myelin, macrophages consume the debris. **Late:** Astrocytes and surviving axons
30
What are two congenital metabolic disorders of enzymatic deficiency?
Tay-Sachs Disease Neimann-Pick Disease
31
What is a common cause and result of a Vitamin B1 defiency?
Vitamin B1 (Thiamine) deficiency: excessive, chronic **alcohol** intake can cause **Wernicke-Korsakoff Syndrome** (uncoordinated movements, progressive mental deterioration, memory and concentration loss, irritability, confusion)
32
What are the signs and symptoms of Vitamin B12 (Cobalamin) deficiency?
Uncoordinated movements Sensorimotor peripheral neuropathy spinal cord disease abnormal gait psychiatric sx
33
What are the signs/sx of nicotinic acid deficiency?
Dermatitis Diarrhea Delirium (The three "D"s)
34
What are the effects of alcholism and B1 deficiency?
Wernicke Korskoff Syndrome Subdural hematomas from falling Pontine myelinolysis Delirium tremens upon withdrawal Degenerative changes to hypothalmus and mammillary bodies Neuropathy Myopathy
35
Name four neurodegenerative Diseases
Alzheimer's disease Parkinson's Disease Huntingon's Disease Amyotrophic Lateral Sclerosis (ALS)
36
Of the four key neurogenerative disorders, what parts of the brain do they impact?
**Alzheimer's disease**: diffuse (all over) **Parkinson's Disease**: substantia nigra **Huntingon's Disease**: cortex and subcortical nuclei (caudate, putamen) **Amyotrophic Lateral Sclerosis (ALS)**: motor neurons in the cerebral cortex, midbrain and spinal cord (lateral cerebrospinal pathways)
37
What is Alzheimer's Disease?
Progressive loss of cognitive functions and memory due to diffuse cortical atrophy caused by deposits of **beta-amyloid**. Genetic factors include **Chromosomes 19 and 21** (Recall that Down's Syndrome is Trisomy 21) Note: serious diagnosis with no cure so be sure to rule out other causes of Sx.
38
What are the **gross** and **histologic** changes in the brain of an Alzheimer's patient?
**Gross**: atrophic, narrowing gyri, widening sulci **Histologic**: neuritic plaques, neurofibrillary tangles, granovacuolar degeneration, amyloid deposits
39
What is Parkinson's Disease?
Subcortical neurodegenerative disorder affecting mainly the elderly Decreased dopaminergic neurons in the substantia nigra
40
What are the Signs/Sx of Parkinson's Disease?
Tremor/twitchin muscles Cogwheel rigidity Unstable walking Depression Dementia (10%)
41
What are the **gross** and **histologic** changes to the brain of a patient with Parkinson's
**Gross**: substantial nigra is pale (not black) **Histologic**: loss of melanin rich neurons, presence of Lewy bodies
42
What is Huntington's Disease?
Autosomal dominant neurodegenerative disease affecting men more than women
43
What are the signs/sx of Huntington's Disease?
Involuntary, gyrating movements Progressive dementia First Sx do not appear until midlife Most are mentally incapacitated by 50-60 yo
44
What are the gross and histological changes to the brain of a patient with Huntington's
Gross: Atropy of cortex and subcortical nuclei, especially the caudate and putamen Enlarged and rounded ventricle Histological: atrophy, degeneration, loss of neurons, reactive gliosis
45
What is Amyotrophic Lateral Sclerosis (ALS)
Rare neurodegenerative disease of motor weakness and progressive wasting affecting older men and women
46
What are the symptoms of ALS?
Motor weakness progressive wasting in extremities (small hand muscles) fasciculations slurred speech intact intellect! Death in a few years.
47
What are the gross and histological changes in the nervous system of someone with ALS ?
Loss of motor neurons in the cerebral cortex, midbrain and spinal cord (loss of lateral cerebrospinal pathways)
48
Brain tumors occur at what age range?
Any age
49
What are the most common **malignant** and **benign** brain tumors in children?
**Malignant**: Medullablastoma **Benign** (low grade): pilocytic astrocytoma
50
What are the most common **malignant** and **benign** brain tumors in adults?
**Malignant**: Glioblastoma **Benign**: Meningioma
51
What are the primary **locations** of brain tumors in **adults** and **children**?
Adults: supratentorial Children: infratentorial
52
What is the difference in the **impact** on the brain of gliomas versus meningiomas?
Gliomas invade brain tissue Meningiomas compress brain tissue
53
What is a glioblastoma?
**Most common CNS tumor** Peak: 65 y.o. Lateral hemispheres **Crosses corpus collosum!!** Highly variegated appearance (yellow, red, white, irregular shape)
54
What are the histologic characteristics of a glioblastoma?
Anaplastic astrocytic cells Enlarged, multinucleated cells w abundant cytoplasm Mitoses Necrosis
55
What is the AMEN criteria for staging CNS tumors?
A - nuclear Atypia M - mitosis E-endothelial proliferation N - necrosis
56
What is an oligodendroma?
Occurs in cerebral hemispheres Middle-aged adults Well circumscribed Well differentiated Can progress to glioblastoma
57
What is an ependymoma?
From ependymal lining of ventricles Tumor cells form "pseudo-rosettes" around papillary structures
58
What is a meningioma?
Arises from meninges Can be benign or malignant Compression can cause seizures or motor deficits Excellent prognosis if benign
59
What is a Medulloblastoma
Most common malignant tumor in children Cerebellum Poor prognosis
60
What is the difference between a Schwannoma and a Neurofirbroma?
**Both** can be solitary or multiple. **Neurofibromas** are infiltrative. **Schwannomas** are compressive (easy to resect) **Bi**lateral Schwannoma think Neurofibromatosis Type **II**
61
What is the most common malignant tumor in the brain?
Metastasis (so look for the primary tumor!) Commonly from: lungs, breast, melanoma
62
What are the five most common **PRIMARY** brain tumors?
Glioma (75%) Meningioma (15%) Cranial/Spinal Tumors (neuroma/schwannoma)(5%) Neural Cell Precursors (Medulloblastoma)(2%) Others (3%) (Hemangioma, cerebral lymphoma, pinealoma) **50% of ALL brain tumors are metastatis**

Clin Med Neuro Kelley (1 decks)

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