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CNS > Pathology > Flashcards

Pathology Flashcards

1
Q

Specific Symptoms Of Demyelinating

A

Unexplained optic neuritis

Ophthalmoplegia (MS)

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2
Q

Genetic Factors Of MS

A

Strong association with a DR (2 and 15 in clinical medicine) haplotype of MHC

Associations with IL-2 and IL-7 receptor genes

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3
Q

Active Plaques On Microscopy

A

Centred on small veins

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4
Q

CSF In MS

A
  • Elevated protein
  • Serum Glucose: Normal
  • Lymphocytes
  • Macrophages
  • Plasma cells
  • Increased IgG
  • Oligoclonal IgG bands on immunoelectrophoresis
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5
Q

Non-demyelinating Ddx Of MS

A
  • Spinal cord neoplasms
  • Sarcoidosis
  • Infarction of spinal cord
  • Vasculitis
  • Arteriovenous fistula
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6
Q

NOM Antibody + Component

A

SEARCH THE ANTIBODY

Aquaporin-4

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7
Q

Subacute Combined Degeneration Of SC Paraesthesia Direction

A

Ascending paresthesias

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8
Q

Tertiary Syphilis Diagnosis

A

Clinical exam
History
Serology

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9
Q

Hypoxic-ischaemic demyelination areas

A

Affects globus pallidus and white matter

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10
Q

Pathophysiology:
Anti-MAG Neuropathy
POEMS Syndrome

A

Anti-MAG Neuropathy - Monoclonal IGM Gammopathy

POEMS Syndrome - Plasma Cell Neoplasm

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11
Q

Selective Vulnerability

A

Neurons are the most vulnerable cells in the CNS to ischemia

◦ e.g pyramidal neurons in the hippocampus, and Purkinje cells in the cerebellum.

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12
Q

Pick body locations

A

These are tau-immunopositive bodies predominantly
located in granular neurons in the hippocampal dentate gyrus,
hippocampal CA1 pyramidal neurons, and layer II of frontal and
temporal cortices.

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13
Q

IgG Index

A
  • IgG index is derived from the following formula:

IgG In= [IgGCSF/albuminCSF]/ [IgGserum/albuminserum]

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14
Q

CNS Tumour Common Types For Age

A

Adults (70% supratentorial – Intrinsic + extrinsic - 65% primary intrinsic):
Astrocytoma
Glioblastoma (COMMONEST IN BOTH AGE GROUPS)
Meningioma
Metastatic
Oligodendroglioma

Children (Children - 70% infratentorial – Intrinsic - all primary intrinsic):
Astrocytoma (COMMONEST IN CHILDREN - 50%)
Medulloblastoma (45%)

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15
Q

Tumours with hydrocephalus in children occur in which cranial fossa usually?

A

Posterior fossa tumours

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16
Q

Diagnosis Of Brain Tumours

A

MRI!!! Higher and better sensitivity, resolution, and three planar views
MRI with gadolinium contrast is the gold standard
MRI better than CT: Tumor of suprasellar, optic path, infratentorial & pituitary region

17
Q

Lumbar puncture indications in tumours

A

Indication:
Medulloblastoma
Ependymoma
Germ cell tumours

Contraindications:
Newly dx hydrocephalous sec. to CSF flow obstruction
Tumour causing supratentorial midline shift
Infratentorial tumours

18
Q

What primary brain tumours are highly malignant?

A

Glioblastoma

Medulloblastoma

19
Q

Factors in the aetiology of CNS neoplasms

A
  1. Sex – gliomas commoner in males
  2. Exposure to ionizing radiation implicated in
    immunodeficiency
  3. Primary CNS lymphoma – is associated with 4. No convincingevidence has linked CNS neoplasms
    with trauma, occupation, diet, electromagnetic
    fields
    meningiomas commoner in females ~ meningiomas ~ gliomas ~ nerve sheath tumors
20
Q

Tumours are now divided based on whether cells have mutations in which genes?

A

Tumors are now divided based on whether the cells have mutations in one of the IDH genes (IDH1 or IDH2). For a specific type of tumor, those with IDH mutations tend to have a better outlook.

21
Q

Primitive neuroectodermal tumours/medulloblastoma (not sure which one she meant) molecular subtypes

A

Wnt pathway activation - gene for β-catenin –good prognosis Hedgehog pathway activation-mutations in PTCH1–intermediate MYC overexpression – poorest prognosis

Wnt and HH lead to personalised therapy

22
Q

How is PCNSL diagnosed?

A

Stereotactic needle

23
Q

DO LAILA’S SUMMARY ON GENES

A

At end of the note

24
Q

Distribution of pus in meningitis

A

Pneumococcal - convexities + near sagittal sinus

H. influenzae - basal (hence the cranial deficiencies)

25
Q

Are fibroblasts part of brain abscesses?

A

NO we have gliosis

26
Q

Which organism shows a spiderweb appearance when the lumbar tap test tube is left standing?

A

TB

27
Q

Basilar meningitis causes

A

H. influenzae
TB
Histoplasma capsulatum

28
Q

Viral meningitis and encephalitis r/shp

A

Encephalitis is accompaniedby viral meningitis whereas aseptic meningitis may occur alone. (unrelated to this card but herpes can reach CNS by olfactory)

29
Q

Viral Neurotropism

A

(1) Neurons – eg. Herpes, polio, rabies, SSPE
(2) Astrocytes – eg. Herpes, SSPE
(3) Oligodendro glial cells – eg. Papova (JC, SV40)

This tropism is influence by :

(1) Viral factors
(2) Host factor

Herpes – HSV1 – temporal lobes
Polio – Anterior horn cells of spinal cord
Rabies – Ammon’s horn (hippocampus), Purkinje cells

30
Q

HSV Diagnosis

A

Polymerase chain reaction — Gold standard - Detects HSV DNA in CSF -sensitivity (98 %),specificity (99%)
Is positive early in the course of illness.
Brain biopsy (not used anymore) — Prior to PCR testing, was only way to diagnose HSVE. Now only role in patients with clinical
deterioration despite antiviral therapy or if alternative diagnosis is considered. Examines for HSV by
Culture
HSV antigens by IHC
Viral DNA by in situ hybridization
Not done routinely as invasive and can lead to sequelae

Viral culture of CSF is rarely positive in the early infection
CSF antigen and antibody determinations — not helpful in early diagnosis

31
Q

Triad of congenital toxoplasmosis

A

Triad of chorioretinitis, hydrocephalus, and intracranial calcifications.

32
Q

Diagnosis of cryptococcus neoformans

A

Microscopic examination

Culture of tissue or body fluids such as blood, CSF, and sputum

Cryptococcal antigen test is a rapid test that can be performed on blood and/or on CSF

33
Q

Which stroke has the most rapid onset?

A

Embolic stroke

34
Q

Where does ICH usually occur?

A

Cerebellum and basal ganglia

35
Q

Berry aneurysm distribution

A
  1. ACA and ant. comm. artery junction (more on comm.)
  2. MCA
  3. ICA and post. comm. junction
  4. Bifurcation of basilar
36
Q

Lacunar infarct cause

A

HT + lenticulostriate arteries of BG, internal capsule, putamen, thalamus, pontine tegmentum,
cerebellum.

37
Q

Recap salah humood

A

Week 5

CNS (8 decks)

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