Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Neurology > Neuropathology II > Flashcards

Neuropathology II Flashcards

(79 cards)

Start Studying
1
Q

What is demyelination?

A

Preferential damage to the myelin sheath = relative preservation of axons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the causes of primary demyelination?

A

Multiple sclerosis, acute disseminated encephalomyelitis, acute haemorrhagic leukoencephalitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the causes of secondary demyelination?

A 
Viral = progressive mulitfocal leukoencephalopathy 
Metabolic = central pontine myelinosis 
Toxins = cyanide, carbon monoxide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most common demyelinating disease?

A

Multiple sclerosis = 2x more common in women, peak incidence in 20-30s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is multiple sclerosis?

A

Auto-immune demyelinating disorder characterised by distant episodes of neurological deficits separated in time and which correspond to spatially separated foci of neurological injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is multiple sclerosis diagnosed clinically?

A 
Two distinct neurological defects occurring at different times 
Neurological deficit implicating one neuro-anatomical site and an MRI appreciated defect at another site
Multiple distinct (usually white matter) lesions on MRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is multiple sclerosis diagnosed supportively?

A

Visual evoked potentials

IgG oligoclonal bands in CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the clinical features of multiple sclerosis with optic nerve lesions?

A

Optic neuritis = unilateral visual impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the features of multiple sclerosis with spinal cord lesions?

A

Motor/sensory deficit in trunk and limbs

Spasticity and bladder dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the features of MS with brainstem lesions?

A

Cranial nerve signs, ataxia, nystagmus, internuclear opthalmoplegia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the disease course like in multiple sclerosis?

A

Acute or insidious onset

Relapsing and remitting, later becoming progressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the brain features of MS?

A

Principally white matter disease
Exterior surface of brain typically appears normal
Cut surface shows plaques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some features of plaques?

A

Well circumscribed and demarcated
Irregular shaped surface
Glossy almost translucent appearance
Vary from small to very large

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What kind of distribution do plaques display?

A

Non-anatomical distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some common areas for plaques to develop?

A

Adjacent to lateral ventricles, corpus callosum, optic nerves and chiasm, brainstem, ascending and descending fibre tracts, cerebellum, spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are shadow plaques?

A

May reflect degree of remyelination = demonstrate thinned-out myelin sheath at edge of lesion which results in less well defined lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some features of active (acute) plaques?

A

Perivascular inflammatory cells, microglia and ongoing demyelination
Demyelinating plaques are yellow/brown with and ill defined edge that blends into surrounding white matter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some features of inactive (chronic) plaques?

A

Gliosis, little remaining myeinated axons and oligodendrocytes and axons reduced in number
Well demarctaed grey/brown lesions in white matter
Classically situated around lateral ventricles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the environmental and genetic factors implicated in multiple sclerosis?

A 
Environmental = associated with latitude and vitamin D deficiency, may have viral trigger
Genetic = 15x risk if affected 1st degree relative, genetic linkage with HLA DRB1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the immune pathogenesis of multiple sclerosis?

A

Lymphocytic infiltration in histology
Oligoclonal IgG bands in CSF
T cell and humeral factors involved
Anti B cell therapies reduce relapses and frequency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some degenerative diseases that affect the cerebral cortex?

A

Alzheimer’s disease, Pick disease, CJD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are some degenerative diseases that affect the basal ganglia and brainstem?

A

Parkinson disease, progressive supranuclear palsy, multiple system atrophy, Huntington’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a degenerative disease that affects the spinocerebellar tract?

A

Spinocerebellar ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What characterises the pathology of degenerative diseases?

A

Simple neuronal atrophy and subsequent gliosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is dementia?
Acquired and persistent generalised disturbance of higher mental functions in an otherwise fully alert person
26
What is the underlying pathology of dementia?
Progressive loss of neurons typically affecting functionally related neuronal groups
27
What are the primary dementias?
Alzheimer's disease, Lewy body dementia, Pick's disease (fronto-temporal dementia), Huntington's disease
28
What are the secondary dementias?
Multi-infarct dementia, infection, trauma, metabolic causes
29
What are some general causes of dementia?
Drugs and toxins, vitamin B1 deficiency, paraneoplastic syndromes, intracranial space occupying lesions, chronic hydrocephalus
30
What is the most common cause of dementia in the elderly?
Alzheimer's disease = more common in women
31
What are the genetic influences of Alzheimer's disease?
Usually sporadic but familial in 1% = amyloid precursor protein (APP), presenillin 1 and 2 Increased incidence in trisomy 21
32
How does Alzheimer's present?
Insidious impairment of higher intellectual function with alteration in mood and behaviour
33
What are the features of late Alzheimer's disease?
Progressive disorientation | Memory loss and aphasia indicate severe cortical dysfunction
34
What is the prognosis of Alzheimer's disease?
Can result in profound disability, muteness and immobility | Death usually occurs due to a secondary cause
35
What are the macroscopic features of Alzheimer's disease?
Cortical atrophy = decreased brain weight and size Widening of sulci and narrowing of gyri Compensatory dilation of ventricles = secondary hydrocephalus ex vacuo
36
What parts of the brain are usually affected by Alzheimer's disease?
Frontal, temporal and parietal lobes | Occipital lobe brainstem and cerebellum normal
37
What is the extensive neuronal loss that occurs on Alzheimer's associated with?
Astrocyte proliferation = simple neuronal atrophy and gliosis
38
What are the microscopic features of Alzheimer's disease?
Neurofibrillary tangles, neuritic plaques and amyloid angiopathy
39
What are some features of neurofibrillary tangles?
Intracytoplasmic = especially hippocampus and temporal lobe TAU protein = associated with microtubules Non-specific feature
40
Where are neuritic plaques found?
Surround astrocytes and microglia = also called Abeta amyloid plaques
41
What produces amyloid Abeta?
Cleavage of amyloid precursor protein = central element of neuritic plaques
42
Why is Alzheimer's linked with Down's syndrome?
Amyloid precursor protein gene is also located on chromosome 21
43
What do Abeta oligomers promote?
Hyperphosphorylation and mislocation of TAU
44
What are some features of amyloid angiopathy?
Extracellular eosinophilic accumulation Polymerised beta pleated sheets formed by Abeta Stains with congo red
45
What effect does amyloid angiopathy have on the BBB?
Disrupts the BBB = serum leaking, oedema and local hypoxia occur
46
How common is Lewy body dementia?
10-15% of dementias
47
What is Lewy body dementia?
Progressive dementia = hallucinations and fluctuating levels of attention/cognition, severity varies day to day
48
How can Lewy body dementia and Alzheimer's be differentiated?
Memory is affected later in Lew body dementia than it is in Alzheimer's
49
When do features of Parkinsonism present in Lewy body dementia?
Present at onset or develop soon after
50
What are the features of Parkinsonism?
Loss of facial expression, stooping, shiffling gait, slow initiation of movements, stiffness and pill rolling tremor
51
What is type of conditions display Parkinsonism?
Conditions that affect the nigrostriatal dopaminergic pathways
52
What are some conditions that cause Parkinsonisms?
Idiopathic Parkinsons, Lewy body dementia, drugs, trauma, multi-system atrophy, progressive supranuclear palsy, cortico-basal degeneration
53
What is the most common cause of Parkinsonism?
Idiopathic Parkinson's = called Parkinson's disease
54
What causes Parkinson's disease?
Degeneration of the substantia nigra
55
What are the macroscopic features of Parkinson's disease?
Pallor in the substantia nigra = this is where pigmented dopaminergic neurons run
56
What are the microscopic features of Parkinson's?
Loss of pigmented neurons Fewer cortical Lewy bodies Reactive gliosis and microglial accumulation Remaining neurons show Lewy bodies
57
How do Lewy bodies appear?
Single or multiple intracytoplasmic eosinophilic round/elongated bodies = have dense core and surrounding pale halo
58
What are Lewy bodies?
Aggregates of a-synuclein and ubiquitin
59
What is Huntington's disease?
Relentlessly progressive neuropsychiatric disorder = onset usually between age 35-50 but can occur at any time, dementia occurs later in disease
60
What is the triad of Huntington's disease?
Emotional, cognitive and motor disturbance
61
What are the symptoms of Huntington's disease?
Chorea, myoclonus, clumsiness, slurred speech, depression, irritability, apathy
62
What is the inheritance of Huntington's disease?
Autosomal dominant = Huntingtin gene on chromosome 4p
63
What does mutation of the Huntingtin gene cause?
Additional CAG repeats = disease occurs when >35 repeats occur
64
What are the macroscopic features of Huntington's disease?
Atrophy of the basal ganglia in caudate nucleus and putamen | Cortical atrophy occurs later
65
What are the microscopic features of Huntington's disease?
Simple neuronal atrophy of striatal neurons in basal ganglia | Pronounce astrocytic gliosis
66
What is Pick's dementia?
Progressive dementia = characterised by progressive changes in character and social deterioration, onset usually between age 50-60
67
What are the symptoms of Pick's dementia?
Personality and behaviour change, communication and speech problems, changes in eating patterns, reduced attention span
68
What is the prognosis of Pick's dementia?
May last between 2-10 years = average is 7 years | leads to impairment of intellect, memory and language
69
What are the symptoms of Pick's dementia related to?
Damage to the frontal and temporal lobes
70
What are the macroscopic features of Pick's dementia?
Extreme atrophy of the cerebral cortex in frontal and temporal lobes = brain weight <1kg Neuronal loss and gliosis
71
What are the histological hallmarks of Pick's dementia?
Pick's cells = swollen neurons | Pick's bodies = intracytoplasmic filamentous inclusions
72
What is multi-infarct dementia?
Disorder involving deterioration in mental functioning due to cumulative damage to brain through hypoxia or anoxia
73
What causes multi-infarct dementia?
Result of multiple blood clots within the vessels supplying the brain
74
What do successive multiple cerebral infarctions cause?
Increasingly larger areas of cell death and damage = dementia results when sufficient area of brain is damaged
75
What is the epidemiology of multi-infarct dementia?
More common in men Usually occurs after age 60 Also seen in middle aged hypertensives
76
What mental health issues are multi-infarct dementia patients prone to?
Depression and anxiety = they are aware of their mental deficits
77
How do you distinguish multi-infarct dementia form Alzheimer's disease?
Multi-infarct dementia has abrupt onset, stepwise progression, history of hypertension or stroke and evidence of stoke on CT/MRI
78
What are some features of large vessel cerebral infarcts?
More common, scattered throughout hemispheres, atheroma of large cerebral arteries provoke thromboembolism
79
What are some features of small vessel (lacunar) cerebral infarcts?
Rarer, central with subcortical distribution, related to longstanding hypertension and arteriosclerosis of small vessels

Neurology (48 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions