Pathology Flashcards
(116 cards)
1
Q
- When one cingulate gyrus is pushed underneath the falx
- May result in occlusion of the callosal-marginal branch of the ACA
A
Cingulate (subfalcine) herniation
2
Q
- Results when the medial temporal lobe is pushed between the cerebral peduncles and the tentorium cerebelli
- Stretching of CN 3 produces “fixed dilated pupil” on IPSILATERAL side
- Crushing of the PCA against the edge of the tentorium results in occlusion (explains the cortical blindness that often follows head injury)
- **Secondary brainstem hemorrhage (Duret hemorrhage)
A
Uncal (trans-tentorial) herniation
3
Q
- Results from herniation of the cerebellar tonsils through the foramen magnum, compressing vital respiratory and cardiovascular centers of the medulla
- Duret hemorrhages in pons/midbrain, causing “locked-in” state
A
Tonsillar (cerebellar) herniation
4
Q
- MC type of cerebral edema
- (1) Capillaries may be damaged and are leaking protein (infarcts, infection, contusion, lead poisoning)
- (2) New, leaky capillaries may be forming in an abnormal area (abscess, tumor)
- Increase in the space between cells
- White matter will be soft and wet, and more affected than gray
A
Vasogenic (intercellular) edema
5
Q
Acute mountain sickness is _________ edema.
A
Vasogenic (intercellular)
6
Q
- Excessive intracellular water, indicating cells have been damaged (individual cells)
- Look for this type of edema in early ischemia, acidosis/hypercarbia, Reye’s, and pseudotumor cerebri
- Gray matter will be more affected
A
Cytotoxic edema
7
Q
- Results from obstruction of the flow of CSF (“non-communicating hydrocephalus”)
- Edema surrounds the ventricles
A
Interstitial edema
8
Q
-Happens when the plasma is greatly diluted, as in way-out-of-control ketoacidosis
A
Osmotic edema
9
Q
In edema of any kind, expect to see: (2)
A
- Flattening of the gyri against the skull
- Narrowing of the sulci
10
Q
-Results from blockage within the brain
-May be congenital (stenosis or malformation of cerebral aqueduct, Dandy-Walker, Arnold-Chiari, fetal CMV)
May be acquired (tumors, meningitis, compressing a foramen of Munro)
A
Non-communicating hydrocephalus
11
Q
-Results from over-production of CSF (choroid plexus papilloma), obstruction of subarachnoid space, or problems with the arachnoid villi
A
Communicating hydrocephalus
12
Q
- Brain atrophy from cell loss (infarct or injury
- More room for fluid
A
Hydrocephalus ex-vacuo
13
Q
Radiation injury is _________ edema.
A
Vasogenic (intercellular)
14
Q
- Syndrome seen in older folks caused by diminished absorption of CSF by arachnoid villi
- Gait disturbances
- Urine incontinence
A
Normal pressure hydrocephalus
15
Q
- Increased intracranial pressure first presenting as headache, mental dullness, and N/V
- Papilledema
Think…
A
Herniation
16
Q
- Non-progressive neurologic disability that is attributed to events before or around the time of birth
- Shows as child develops
- Related to low birth weight
A
Cerebral palsy
17
Q
Periventricular leukomalacia (necrosis around the ventricles) is common in:
A
Premature babies
18
Q
Shrinkage of individual gyri, probably from ischemia:
A
Ulegyria
19
Q
- Marbled appearance in the basal ganglia and thalamus
- Result of ischemia, hyperbilirubinemia (infants), other causes
A
Status marmoratus
20
Q
- Extreme result of hypoperfusion (newborns)
- Almost all the fiber tracts for the cortex are gone
A
Multicystic leukoencephalopathy
21
Q
Cerebral laceration and cerebral contusion are similar, but the pia-arachnoid membranes are torn over the site of injury in __________.
A
Laceration
stab wound
22
Q
- Minor type of traumatic brain injury that results from shaking of the brain
- Temporarily alters brain function
A
Concussion
boxers
23
Q
- Traumatic brain injury
- Causes bruising of the brain tissue, resulting in bleeding
A
Contusion
24
Q
____ contusions result from trauma to the brain directly beneath the site of impact.
A
Coup
25
__________ contusions occur primarily when the head is in motion (acceleration) but comes to an abrupt stop (deceleration)
-Brain will be flung back and forth, causing a contusion opposite the point of deceleration
Contrecoup
26
TQ:
-traumatic shearing forces
Petechiae in the corpus callosum
-Demonstrated using amyloid-beta precursor protein or silver stains
-can result in persistent vegetative states, coma, or severe mental disability
Diffuse axonal injury
27
- Results from a second blow to the head sustained by a person who's recently had a concussion that has not been given enough time to heal properly
- Causes disastrous cerebral edema
- Commonly seen in boxers!
Second impact syndrome
28
A skull fracture that lacerates the middle meningeal A leads to:
Epidural hematoma
"talk and die"
29
- Associated with traumatic brain injury
- Usually the result of tears in bridging veins that pass through the dura on their way to the dural sinuses
- May cause an increase in intracranial pressure
Subdural hematoma
30
- Subdural hematoma
- Retinal hemorrhage
- Cerebral edema
- Fractures of rib, vertebral and long bones may also be observed
- May present with irritability, alterations in eating habits, seizures, vomiting, bulging or tense fontanelles, altered breathing, and dilated pupils
* *Shaken baby syndrome
| - Probably causes diffuse axonal injury
31
Neurofibrillary tangles are a marker for:
Chronic traumatic encephalopathy
| boxers: dementia pugilistica
32
- Red neurons
| - Neuts beginning to infiltrate
Early infarct (acute hypoxic/ischemic injury_
33
An infarct at 10 days would show:
Macrophages and gliosis
34
Histo:
- Swelling of the dendrites and astrocytes - spongiosis of the neuropil
- Red/dead neurons
- Endothelial hyperplasia
- Microglial reactions
- Dissolution of parenchyma after several days
Ischemia
35
Seen 12-24 hours after insult:
Red neurons
36
Seen 24 hours to 2 weeks after insult:
- Tissue necrosis
- Infiltration of macrophages
- Vascular proliferation
- Reactive gliosis
37
Seen 2 weeks after insult:
Repair phase:
- Macrophages remove the necrotic tissue
- Normal histological organization
- Gliosis also present
38
An abrupt course of focal or global neurological signs and symptoms of greater than 24 hours in duration due to a hemorrhagic or ischemic event:
Stroke
39
A stroke in which the symptoms resolve in less than 24 hours:
Transient ischemic attack (TIA)
40
Laminar necrosis (uncontrolled death of cells in a band-like layered pattern) seen in:
Strokes
41
TQ-Another cause of stroke in which the vessels of the circle of Willis become narrowed (fibrosis of the intima) and may also bleed
- Fairly common in both children and adults
- May occur in syndromes, including Down's and sicklers
Moyamoya Disease "freidlander fav)
42
- Buildup of granular material in the basement membranes between the smooth muscle cells of the arterial walls
- Dx when pathologist examines skin
- PAS (+) granules (glycogen) throughout artery walls
- Gene = Notch-3
- Progressive loss of cognitive function... little strokes and bleeds
CADASIL
| Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
43
Microhemorrhages and slit hemorrhages are characteristic of ____________.
Hypertension
44
- Type of dementia due to white matter atrophy resulting from small vessel disease
- Dementia pts who have been hypertensive
Subcortical leukoencephalopathy (commonly: Binswanger's disease)
45
Caused by:
- Hypertension
- Cerebral amyloid angiopathy (apple green)
Intracerebral hemorrhage
46
Rupture of little Charcot-Bouchard microaneurysms in the brain parenchyma result in ___________ hemorrhages.
Hypertensive
47
55% of "hypertensive" hemorrhages are seen in the:
Putamen
48
- Usually from a ruptured cerebral aneurysm or head injury
| - Rapid onset
Subarachnoid hemorrhage
49
Sites favored by berry aneurysms: (4) TQ
40% ACoA
34% MCA
20% PCoA
4% Bifurcation of basilar A into PCAs
50
People with ADPKD are prone to:
Berry aneurysm
51
- Masses of blood vessels separated by brain
| - May cause neurologic deficits and subarachnoid bleeding
AV malformations
52
Pt has fracture in the skull. This can result in a _____________herniation.
transcalvarial herniation
53
Pt presents in locked-in state: awake and conscious but selectively de-differenced: having no means of producing speech, limb, or facial movements. Conscious but paralyzed.
SLIT hemorrahges. What type of hemorrhage?
Duret hemorrhages
54
Increased intracranial pressure without hydrocephalus can be caused by.... (5)
- Idiopathic
- Increased central venous pressure
- Venous thrombi in the brain
- Vit A toxicity (diet)
- Tetracycline toxicity
55
Germinal plate bleeds occur in low birth weight babies and is due to the fragility of the _______ ______.
Capillary plexus
Can lead to death, cerebral palsy, or mental retardation
56
_________ fractures result from the ability of sutures to move in adults and children.
Diastatic fractures
57
Bleeding into the spinal cord (gunshot wound) is called....
Hematomyelia
58
Years after spinal cord injury, the old gliotic site of trauma will still be obvious. This is called___________ and is associated with Wallerian degeneration of the tracts (esp post. column and corticospinal tracts)
Myelomalacia
59
Glial scars can lead to post-traumatic ______.
epilepsy
60
Ischemic damage to brain causes __________, only if ischemia has lasted long enough to cause the glia and neurons to die. Pts in irreversible coma following shock or hypoxia may have brains that look normal.
liquefaction
61
Infarction is a result of lack of oxygen to the brain. This can be stained with H&E with Luxol fast blue stain, which stains the..
myelin
62
Early_____ (red neurons + neuts infiltrating)-->10 days-->macropahges and gliosis-->separation of nerve fibers and loss of myelin.
infarct
63
```
_______respond to injury by:
Proliferation (stroke/trauma)
Phagocytosis of debris (stroke/trauma)
Develop elongated nuclei (syphilis)
Form microglial nodules (viruses and rickettsia)
Neuronphagia (viral enceph., polio)
```
Microglia
64
Watershed infarcts between the ACA and MCA are in the _______ border zone.
Cortical
65
Watershed infarcts between the LCA and MCA are in the _______ border zone.
Internal
66
Watershed infarcts between the MCA and PCA are in the _______ border zone.
Cortical
67
______ ______ is due to occlusion of a vessel, usually an artery due to cholesterol embolus.
Focal ischemia (stroke)
68
In ______ ______ gyri widen, sulci narrow as the brain swells. Depends on length of time, age, body temp, vascular dz, cardiac output.
Global ischemia
69
Infarct overtime....
12-24 hrs: ____ ______
24 hrs-2 wks: tissue necrosis, macrophages, vasc. prolif and gliosis
2 wks +: macrophages remove necrotic tissue causing cavities
red neurons
70
Hyperglycemia may cause hyperosmolar coma, causing dehydration. Fluid correction must be slow or _____ _____ ______ may occur.
Central pontine myelinolysis (osmotic demyelination syndrome)
71
HVLA of the neck puts a pt at risk for _______ artery rupture
Vertebral
72
- Most abundant in the gray matter (Protoplasmic type)
- Play a role in regulation of electrolyte balance, NT metabolism, GABA, serotonin, glutamate
- Phagocytic, role in repair of brain
- cytoplasmic processes are GFAP (+)
Astrocytes
73
- Reactive astrocytes
- Hypertrophic, eosinophilic cytoplasm
- Increase in # during gliosis
- Strongly GFAP (+)
Gemistocytes
| swollen astrocytes
74
Cytoplasmic inclusions that are:
- Eosinophilic twisted rod or sausage shape
- Found in astrocytic processes
- GFAP (+), alpha-beta crystallin (+), ubiquitin (+)
- Ultrastructure
Rosenthal fibers
75
Specialized ependymal cells that have processes extending to the pial surface:
Tanycytes
| -3rd ventricle region
76
Cells that are found around dying neurons (seen in viral infections):
Microglia
77
Hypertrophy and proliferation of astrocytes at sites of injury, the counterpart of "scarring" elsewhere in the body:
Gliosis
78
Red neurons are indicative of:
Acute necrosis due to ischmia
79
- Non-specific response to axonal injury
- Axonal transection
- Metabolic conditions
- Pellagra
- When the axons are cut, the neurons respond by clumping cytoplasmic material due to increased protein synthesis
Central chromatolysis axonal reaction
80
When microglia proliferate, a process of microgliosis, they may form _______, which are often associated with _____ ____________.
- Nodules
| - Viral encephalitis
81
Gitter cells (the result of microglia phagocytosing infectious material or cellular debris) are present in: (2)
- Destructive lesions
| - Demyelination
82
Macrophages that form microglial ("typhus") nodules. Think...
Viral infection
| -In USA, think "West Nile"
83
- Meninges (dura, arachnoid) herniate through skull or vertebral column
- A form of spinal bifida
Meningocele
84
- Herniation of both the leptomeninges (neural tissue) and spinal cord through a vertebral defect
- Assoc with hydrocephalus, Chiari type 2, other spinal cord anomalies
- A form of spinal bifida
Meningomyelocele
| "myelocele"
85
A neural tube defect characterized by sac-like protrusions of the brain and the membranes that cover it through openings in the skull:
Encephalocele
| "cranium bifidum"
86
Congenital fissure of the skull and spine:
Craniorachischisis
87
- Absence of convolutions (gyri and sulci), except for the hemispheric and sylvian fissures
- Widening of the cortical thickness
Agyria
| "Lissencephaly type 1"
88
The formation of abnormal tissue or of normal tissue in an abnormal location:
Heteroplasias / Heterotopia
89
Between what ages do neuroepithelial (colloid) cysts develop?
20-50 years of age
90
- Hypoplasia or aplasia of cerebellar vermis
- Cystic dilatation of 4th ventricle (fills enlarged posterior fossa)
- Assoc with hydrocephalus and spina bifida
- 20-50% have mental retardation
Dandy-Walker syndrome
91
- Seen in adults
- Downward herniation of cerebellar tonsils
- Usually asymptomatic in childhood
- Assoc with syringomyelia (50% of cases
Arnold-Chiari, Type I
92
- Seen in infants
- Malformed baso-cranial bones
- Significant herniation of cerebellar tonsils and vermis through foramen magnum with aqueductal stenosis and hydrocephalus
- Often presents with lumbosacral myelomeningocele and paralysis below defect
Arnold-Chiari, Type II
93
Classic triad:
- Adenoma sebaceum
- Seizures*
- Mental retardation
Tuberous sclerosis
| -Seen grossly as tuber or potato-like growth on the brain that may calcify with age (become sclerotic)
94
- Cortical scarring in the deep regions of the sulcus that leads to distortion of the gyri
- Due to hypoxic ischemic injury in the perinatal period
Ulegyria
95
- Cysts, usually found in the temporal lob region
| - EMA (+) by IHC
Arachnoid cysts
96
The dreaded "brain damage" of preemies:
Periventricular leukomalacia
97
Negri bodies. Think...
Rabies
98
Abnormal carbohydrate metabolism accumulation of polyglucosan:
Lafora body disease
99
What would you seen in neuronophagia?
Microglial aggregates around dying neurons
| -Viral infections
100
- Round inclusions with a dense, eosinophilic core and peripheral halo
- Ubiquitin(+), a-synuclein(+), Tau protein(–), Actin(–)
- Seen in normal aging, as well as in Parkinson's dz
- Common location of Substantia nigra
Lewy bodies
101
Abnormally broad gyri, usually occurring in areas of lissencephaly or polymicrogyria
Pachygyria
102
- A smooth brain without cortical gyri
| - May be partial or complete
Lissencephaly
103
Numerous narrow convolutions in a complex pattern:
Polymicrogyria
104
Well-demarcated, round, slightly basophilic inclusions
- Silver(+), Ubiquitin, tubulin, Tau-protein, Neurofilament protein, and chromogranin (+)
- Common locations: Dentate granule cells, amygdala, cerebral cortical laminae II & III
Pick bodies
105
- Monstrously enlarged astrocytes with huge, dark nuclei
| - Seen in Subacute Sclerosing Panencephalitis (SSPE) and Progressive Multifocal Leukoencephalopathy (PML)*
Alzheimer I astrocyte
| Alzheimer Glia, Type 1
106
- Astrocytes with edematous-looking, swollen nuclei
| - Seen in liver failure and other states with *high blood ammonia*
Alzheimer II astrocyte
| Alzheimer glia, Type 2
107
- Small vacuoles containing small, dense round granules
- Most often found in CA1 region of hippocampus
- Seen in normal aging, Alzheimer's dz, and Picks dz
- Ubiquitin(+), Tau-protein(+)
Granulovacuolar degeneration
108
- Rod-shaped, eosinophilic cytoplasmic inclusions
| - Assoc w/ neurodegenerative disorders - Alzheimer's and Creutzfeldt-Jakob dz
Hirano bodies
109
Kuru plaques in _____ dz.
Prion
| -Spongiform change
110
Plaques adjacent to superolateral angle of the lateral ventricles suggests:
Multiple sclerosis (MS)
111
- Round, basophilic, PAS(+) inclusions that resemble corpora amylacea
- Composed of polyglucosans
- Common locations: CNS, sweat glands, liver, sk muscle
Lafora bodies
112
- Absence of major portion of brain, skull, and scalp
- "Frog-like appearance"
- Malformation of rostral end of the neural tube, usually btw days 23-26 of conception
Anencephaly
113
- Failure of L and R hemispheres to separate
- Usually occurs during weeks 5-6
- Mutations in sonic hedgehog signaling pathway
- Moderate form = cleft lip/palate
- Severe form = cyclopia
Holoprosencephaly
114
Berry aneurysm is an example of what type of hemorrhage?
Subarachnoid hemorrhage
115
Too few gyri in _________ syndrome.
-Zellweger
116
JC papovavirus inclusions in oligodendroglia in:
PML
