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Pathology Flashcards

1
Q

Difference between paralysis, paresis, plegia, palsy

A

Paralysis: weakness so severe that muscle cannot be contracted

Paresis: weakness or partial paralysis

Plegia: severe weakness or paralysis
(Di-, hemi-, quadri-

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2
Q

Lower motor neuron syndrome

A
  1. Weakness/paralysis
  2. Atrophy
  3. Hypo or areflexia
  4. Decreased tone/flaccid paralysis
  5. Fibrillations (as measured by EMG)
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3
Q

EMG signs of denervation when muscle at rest

A

Fibrillation: short duration spontaneous biphasic or triphasic potentials produced by single muscle fibers, which are indicative of denervated muscle

Fasciculations: large potentials caused by spontaneous activity in one or several motor unit; large potentials suggest denervation and reinnervation

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4
Q

ALS

A

Degenerative disease of upper and lower motor neurons

Ventral horn involvement leads to lower motor neuron syndrome, while lateral corticospinal tract involvement leads to upper motor neuron syndrome

Loss of motor neurons in ventral horn cause fasciculations

No sensory loss.

Most are sporadic, but familial cases can be caused by a zinc-copper superoxide dismutase mutation (needed to bind free radicals)

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5
Q

Common causes of lower motor neuron syndrome

A
  1. Lesions in peripheral, spinal, or cranial nerves
  2. Lesions in cauda equina
  3. Strokes or tumors affecting alpha motor neurons in ventral horn or brainstem
  4. Polio
  5. ALS
  6. Guillain Barre
  7. Werdnig-Hoffman
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6
Q

Polio

A

Virus that affects alpha motor neuron’s ventral horn, so can lead to lower motor neuron syndrome

Can see period where patient is neurologically stable for years followed by progressive weakness in same muscles originally affected. This is because sprouting allows for recovery and stable period, but sprouts cannot be sustained.

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7
Q

Spinal Muscle Atrophy

A

Group of diseases caused by degeneration of anterior horns due to abnormalities in chromosome 5

Progressive disease that begins in infancy

4 types; first type is Werdnig-Hoffman

Affects motor neurons in the spinal cord and cranial nerve motor nuclei

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8
Q

Werdnig-Hoffman disease

A

Spinal Muscle Atrophy, Type I, inherited degeneration of anterior motor horn
Aka floppy baby

Autosomal recessive inheritance

Deadly

Symptoms:
Weakness and wasting in limb muscles, respiratory muscles, and bulbar muscles (as shown by sucking, swallowing, and breathing)

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9
Q

Upper Motor Neuron Lesions

A

Spinal shock followed by

  1. Paresis
  2. Hyper-reflexia
  3. Hypertonia
  4. Posturing
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10
Q

Variations on posturing with upper motor neuron syndrome

A

Decorticate when lesion above midbrain (upper limbs flexed, lower limbs extended)

Decerebrate when lesion below the midbrain (all limbs extended)

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11
Q

Babinski reflex

A

Indicates corticospinal tract lesion (upper motor neuron syndrome) if toes curl up (extensor plantar response) instead of down when lateral plantar surface is stroked

Normal in babies (before myelination)

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12
Q

Hoffman’s sign

A

Hold patient’s finger loosely and flick the fingernail downward, which should cause finger to rebound into extension.

If thumb flexes and adducts, it is positive Hoffman’s, indicated upper motor neuron syndrome

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13
Q

Bell’s Palsy

A

Paralysis of half the face due to lesion in CN VII

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14
Q

Common causes of upper motor neuron syndrome

A

Trauma

Stroke

MS

ALS

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15
Q

Cerebral Palsy

A

Non-progressive neurological disorder that appears in infancy or early child

Impacts body movement and muscle coordination; may cause intellectual disability

Can be caused by ischemia at birth, hypo-perfusion, trauma, or hemorrhage

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16
Q

Radiculopathy

A

Damage to spinal nerve, most commonly caused by herniated discs but also caused by osteophytes and spinal stenosis

Symptoms:

  • Burning, tingling pain that radiates from back along a dermatome
  • Numbness
  • worsening of symptoms with coughing, sneezing, or straining; worsening of symptoms with flexing the head (in case of cervical radiculopathy)
  • muscle weakness
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17
Q

Horner’s Syndrome

A

Interruption of sympathetic pathway to the head, eye, or neck caused by a lesion at T1 or above

Symptoms:

  • miosis
  • anhidrosis of face
  • ptosis
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18
Q

Spinal shock

A

Spinal cord injury that causes immediate flaccid paralysis below the lesion

Usually lasts 1-6 weeks

Due to loss of descending facilitation that keep spinal cord circuits in continuous state of activation/readiness

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19
Q

WHO Grading System for Pathohistological Features of Tumors

A

I: curable with complete surgical resection
II: even complete resection may not be curative (~7-10 years)
III: not surgically curable; may kill on its own or up on version to grade IV (~3-7 years)
IV: not surgically curable; chemo/rad-to can extend life, but response is typically short-lived; quickly kills (~12-18 months)

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20
Q

Glioma

A

Tumor arising from glia

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21
Q

Pilocytic astrocytoma

A

Grade I/IV
Usually in kids, arising below tentorium
Cyst with nodule
Low grade, minimally infiltrative
Elongated cells with hairlike processes; Rosenthal fibers (thick eosinophilic processes)
GFAP+

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22
Q

Diffuse astrocytoma

A

Grade II, III, or IV
Irregular, elongated, crowded nuclei
GFAP+
Infiltrates normal brain to make surgical resection very difficult
The later the onset, the higher the grade

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23
Q

Glioblastoma

A

Astrocytoma
Grade IV
Most common malignant CNS tumor
Malignant, poorly differentiated tumor of glial cells
Application of receptor tyrosine kinases, proto-oncogenes (especially EGFR) which promotes its own growth
Butterfly lesion-crosses corpus callosum
May see microvascular proliferation or palisading necrosis (living cells at the edge of the necrosis)
GFAP+

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24
Q

Oligodendroglioma

A 
Neoplasm of oligodendroglial cells
Calcified tumor in white matter 
Grade II or III
Usually in cerebral (frontal lobe) hemispheres
Often hemorrhagic; causing seizures
Genetics: co-deletion of 1p an 19q 
Fried egg nuclei 
May see chickenwire vasculature or calcifications
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25
Ependymoma
Tumor of ependymal cells Grade II or III Usually in children beneath tentorium (4th ventricle) Most common in 4th ventricle (very aggressive in children) or spinal cord (low grade and surgically treatable) Perivascular pseduorosettes (tumor cells line up against blood vessels with pink material inbetween)
26
Pituitary adenoma
Low grade neuroendocrine tumor Most common is a null-cell adenoma (not making hormones) Most common hormone productions adenoma=protlactinoma If it presses against optic chiasm can cause superior quadrantonopia Prolactinoma-amenorrhea, galactorrhea Growth hormone-acromegaly ACTH-Cushing's disease
27
Craniopharyngioma
Pituitary tumor in young kids Supra tentorial in child and adult Can cause inferior quadrantonopia Derived from remnants of Rathke's pouch (origin of anterior pituitary) See squamous epi, "wet keratin", and cholesterol clefts Look at root of word!! Crani-, pharyng- Calcifications seen on imagining
28
Schwannoma
Benign tumor; Grade I Caused by bi-allergic inactivation of NF2 gene Symptoms caused by compression of nerves, particularly vestibular nerve, which made lead to tinnitus and deafness Bland-spindle shaped cells Hypercellular=Antoni A Hypocellular=Antoni B Verocay bodies=nuclei lining up together especially at cerebellar pontine angle, involving CN8. S100+
29
Meningioma
Dural based tumor of meningothelial cells Will see dural tail on MRI Grade I-III 50% have NF2 mutation Histo shows whorls and calcifications (psammomatous) Most common benign tumor Tumor expresses estrogen receptor; more common in women
30
Hemangioblastoma
Grade I lesion Occurs from mutation in VHL, allowing for constitutive activation of HIF Usually occurs in cerebellum, but also seen in spine, brainstem, and retina Histo: foamy cells and dense capillary network
31
Medulloblastoma
``` Grade IV Derived form neuroectodermal tissue Most common malignant tumor in children Tumor of primitive neurons Synaptophysin+ In cerebellar/posterior fossa True (Homer-Wright) rosettes ```
32
Analgesia
Los of pain sensation
33
Anesthesia
Loss of touch sensation
34
Paresthesias
Temporary mild pain
35
Neuropathic pain/central pain syndrome
Chronic intense pain
36
Tabes Dorsalis
Caused by tertiary syphilis infection leading to degeneration of dorsal columns Symptoms: impaired sensation, propioception, and progressive sensory ataxia
37
Subacute combined degeneration of dorsal columns and spinocerebellar tract from vitamin B12 or E deficiency
Causes demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebrallar tracts causing ataxic gait, paresthesia, and impaired position and vibration sense
38
Brown-Sequard Syndrome
Hemiplegia caused by damage to one half of spinal cord resulting in loss of ipsilateral proprioception and contralateral pain/temperature loss
39
Phantom Limb
Reorganization of somatosensory cortex in amputees causing neurons that were innervated by the limb no respond to stimulation of other body parts.
40
Syringomyelia
Cystic degeneration of the spinal cord due to trauma or associated with Arnold Chiari malformation Usually at C8-T1, causing "cape or shawl" pattern loss of pain and temperature (due to knock out of white commissure), but spares fine touch and proprioception Syrinx can expand to knock out ventral and lateral horn (affecting motor and sympathetic systems; causing Horner syndrome and lower motor neuron syndrome)
41
Friedeich Ataxia
Degenerative disorder of the cerebellum and spinal cord tract presenting as ataxia with loss of vibratory sense, propioception, muscle weakness in lower extremities, and loss of reflex Autosomal recessive, characterized by trinucleotide repeat in frataxin gene (needed for mitochondrial iron regulation) present in early childhood Can present as hypertrophic cardiomyopathy.
42
Dejerine Roussy Syndrome
Lesion of thalamus causing contralateral burning pain
43
Diabetes
Reduced blood supply to peripheral nerves is cause of sensory neuropathy Usually in glove and stocking pattern (polyneuropathy), but sometimes acute mononeuopathy Small fibers most affected Fascicles show decreased number of myelinated and unmyelinated axons and thickening of walls of blood vessels. Symptoms begin in feet, then move more proximal legs and distal upper limbs Symptoms: paresthesia, dysesthias, numbness, tingling, burning Sometimes there is motor weakness in distal limbs
44
Guillain-Barre
Aka acute inflammatory demyelinating polyneuropathy Acute inflammatory attack on peripheral myelin following a viral infection Causes demyelination and polyneuropathy leading to motor symptoms Decreased nerve conduction velocity and increased protein in CSF Treat with plasmapheresis or IV immunoglobulin therapy
45
Wallerian degeneration
When nerve fiber is injured, causing degeneration of the axon distal to the injury May cause sensory neuropathy
46
Herpes Zoster
Infection of dorsal root ganglion that produces sensory symptoms in corresponding dermatome Increases excitability of sensory neurons in dorsal root ganglion causing lowering of threshold and spontaneous firing Pain sensation will be in dermatomal distribution (usually thoracic; but in immunocomprised, can infect CN V) Treat with antivirals (acyclovir, valcylovir, famcyclovir) Can still have pain after rash has subsided TORCHeS
47
Congenital insensitivity to pain
Recessive mutation in pain receptor Nav 1.7 that cases loss of function of pain
48
Inherited erythromelagia
Dominant mutation causing gain of function pain sensation (so experience increased pain) in temperature
49
Paroxysmal extreme pain disorder
Dominant mutation in Nav1.7 causing increased pain around the mouth and anus
50
Hyperalgesia
Sensitization pathway: When stimuli that are normally considered slightly painful are now significantly more painful
51
Allodynia
The induction of pain by what is normally an non-painful stimulus
52
Neuropathic pain
Pain that develops as a result of damage to the nervous system Can manifest as burning, shooting, or stinging pain mixed with numbness May include changes in pain threshold, quality of pain, and spontaneous pain Treated with antidepressants and anti-epileptic drugs
53
B12 Deficiency
Most common metabolic neuropathy Can affect peripheral nerves, optic nerves, spinal cord, and brain Symptoms include distal limbs, usually starting in upper limb Dorsal columns are most affected; loss of sense of vibration. Followed by corticospinal. Decrease in nerve conduction velocity May see ataxia and spasticity if it has caused subacute combined degeneration
54
Charcot Marie Tooth
Hereditary motor and sensory neuropathy CMT1 is the most common, causing motor sensory neuropathy primarily affecting distal muscles Slow progressive Decreased NCV Onion bulb appearance due to constant demyelination and remyelination
55
Papilledema
Swelling of optic disk due to increased ICP, impairing venous return Usually bilateral Acute or longer onset
56
Scotoma
Smaller visual loss
56
Anopia
Loss of entire eye visual field
57
Potential effect of internal carotid aneurysm
If expanding medially, could press against lateral part of optic chiasm, causing nasal field loss in one eye
58
Middle cerebral branch aneurysm affecting temporal lobe can cause
Meyer's loop lesion, "pie in the sky" vision loss
59
Middle cerebral branch aneurysm affecting parietal lobe can cause
Optic radiation lesion, "pie on the floor" vision loss
60
Lesion before optic chiasm
Defects are ipsilateral and monocular
61
Lesion at optic chiasm
Defects are binocular, bitemporal, heteronymous
62
Lesion past optic chiasm
Defects are binocular, contralateral, homonymous
63
Lesion with abnormal pupillary reflex
Optic nerve and optic tract lesion
64
Lesion with normal pupillary reflex
Optic radiation and visual cortex lesions
65
Posterior cerebral artery infarct
Would affect primary visual cortex in occipital lobe Contralateral homonymous hemianopia WITH MACULAR SPARING
66
Lesion to occipital pole
Macular visual field defect
67
Macular degeneration
Age related vision loss due to deposition of fatty tissue behind the retina (dry macular degeneration) or neovascularization of the retina (wet macular degeneration) Lose vision in the middle of the eye due to macular loss
68
Prosopagnosia
Damage to fusiform gyrus causing inability to recognize people by looking at their faces Damage specifically to area dedicated to face Most commonly caused by closed head trauma or bilateral stroke
69
Cortical blindness
Caused by lesion in V1 affecting all visual inputs
70
Apperceptive Agnosia
Lesion in V2/V3 can affect combination of form and shape inputs (can't copy letters or shapes patient sees)
71
Achromatopsia
Inability to see color because of a lesion in V4
72
Akinetopsia
Inability to see motion because of lesion in V5 Static items are visual but disappear once they start moving Slow moving objects may be detected, but direction of motion may not be obvious
73
Glaucoma
excess aqueous humor leads to optic nerve damage, ocular hypertension, and visual field loss Managed with beta blockers (block ciliary epithelium from producing aqueous humor) Sometimes requires surgery
74
Conjunctivitis
inflammation of conjunctiva, usually bilateral and due to viral infection; can also be caused by bacterial infection, allergy, or autoimmune condition

Neuro 1 (7 decks)

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