Week 5

Question 1

Infection that often affects cranial nerves & other structures at brain base

Answer 1

Tuberculous meningitis (Mycobacterial infection)

Question 2

3 bacterial meningitis species (~80% of cases)

Answer 2

Streptococcus pneumonia, Nisseria Meningiditis, H. Influenzae

Question 3

Infection associated with Bell’s palsy

Answer 3

Neuroborreliosis (lyme disease)

Borrelia burgorferi

Question 4

Account for 80% or more of viral meningitis

Answer 4

Enteroviruses

Question 5

Herpetic encephalitis classical pathologic manifestation

Answer 5

HSV-1 infection of usually temporal lobes

Often associated with seizures

Question 6

3 pathologies seen in viral encephalitis (and poliomyelitis)

Answer 6

Perivascular inflammation, microglial nodules, neuronophagia

Question 7

Grocott (Silver) Stain associated with what infectious agent

Answer 7

Aspergillosis (fungus)

Question 8

Three fungal CNS infectious agents

Answer 8

Aspergillosis, zygomycosis, cryptococcus neoformans (most common)

Question 9

Multiple ring enhancing lesions

Answer 9

Toxoplasmosis (Toxoplasma gondii)

Heavily associated with brain abscesses

Question 10

Common HIV encephalitis associated pathology

Answer 10

Multinucleated giant cells (not granulomatous)

Question 11

Infectious agent with tropism for oligodendroglia

Answer 11

JC Virus (Polyoma virus) mediated Progressive Multifocal Leukoencephalopathy

Question 12

Protein that stabilizes microtubules; associated pathological sign

Answer 12

Tau protein creates intracellular neurofibrillary tangles during CTE and AD

Question 13

Amyloid precursor protein (APP) role in pathology of injury

Answer 13

1) Upregulated in neurons following injury

2) Cleavage at axon bulbs (post-injury) causes release of beta-Amyloid

Question 14

Role of Calpain

Answer 14

Protease activated by calcium. Calpain cleaves Na inactivation gate in traumatic axonal injury

Question 15

NaChO and significance

Answer 15

Sodium induced channelopathy
Increase in Na channels in axon membrane following mild traumatic brain injury
*Source of increased vulnerability to mTBI

Question 16

Disease/disorder associated with TDP-43 protein aggregates

Answer 16

Frontotemporal dementia

Also ALS apparently

Question 17

Classification of primary vs. secondary GBMs

Answer 17

Primary –> EGFR overexpression (gene amplification from loss of chrom 10)
Secondary –> IDH1 and p53 mutations (progression from lower grade astrocytomas)

Question 18

Glomeruloid Tufts associated with what disease and what are they?

Answer 18

Associated with GBM (WHO IV)

Proliferation of cells around neurovascularization in middle of tumor

Question 19

Common genetic profile of secondary GBM

Answer 19

• Often (60%) have p53 mutation; often have IDH1/IDH2 mutation; rarely have EGFR overexpression
• Usually progresses from an astrocytoma (grade II)

Question 20

Common genetic profile of primary GBM

Answer 20

EGFR overexpression, rarely (<10%) have p53 mutation, rarely have IDH1/IDH2 mutation

Question 21

Cancer occurring mainly in children and young adults

Answer 21

• Pilocytic astrocytoma (WHO I)

- Medulloblastoma

Question 22

Rosenthal fibers and eosinophillic granules associated with what

Answer 22

Pilocytic astrocytoma

Corkscrew shaped fascicles of eosinhophilic cells

Question 23

Biphasic cellular/histological architecture associated with what

Answer 23

Pilocytic astrocytoma

Compact architecture vs. cystic/spongy architecture adjacently

Question 24

“Chicken-wire” and “Fried egg” appearance associated with what

Answer 24

Oligodendrogliomas
Chicken wire from branching capillaries
Fried egg from oligodendrites

Question 25

Genetics of oligodendrogliomas

Answer 25

Loss of heterozygosity at chromosomes 1p and 19q (80% of cases) Favorable prognostic factor: respond to chemo and radiation better

Question 26

Pseudorosettes

Answer 26

Ependymoma cells cluster around blood vessels (perivascular)

Question 27

Two grade IV CNS tumors (by definition)

Answer 27

GBM, embryonal tumors (e.g. Medulloblastoma)

Question 28

What is the external granular layer of cerebellum and its significance

Answer 28

Only present in embryo and young infants | Presumed to be source of medulloblastoma proliferation

Question 29

Cancer where o Vestibulocochlear nerve (CN VIII) most commonly affected

Answer 29

schwannomas

Question 30

NF1 vs. NF2 genes associated with what

Answer 30

NF1 --> a more severe neurofibroma (multiple tumors) | NF2 --> schwanomas (sometimes meningiomas as well)

Question 31

Homer Wright (neuroblastic) Rosettes association and description

Answer 31

Associated with medulloblastoma (embryonal tumor) | Collection of tumor cells around neuropil

Question 32

Cancer type with higher incidence in women

Answer 32

Meningioma

Question 33

Duret Hemorrhages

Answer 33

- Brainstem hemorrhage caused by transtentorium herniation - Tearing of pontine perforating arteries from basilar causes herniation - Universally fatal

Question 34

Lumbar Puncture Indications

Answer 34

- CNS infection - Subarachnoid hemorrhage - CNS malignancy (Think opening pressure for increased intracranial pressure) - Demyelinating disease (e.g. MS)

Question 35

Normal LP opening pressure

Answer 35

Below 200mm water | 90-200

Question 36

Primary differences between plasma and CSF

Answer 36

oMuch lower protein, amino acids | oSomewhat lower glucose, potassium (K)

Question 37

o Pleocytosis of CSF

Answer 37

 elevation of total cell counts in CSF; usually indicates infection

Question 38

• 5 Meningitis symptoms in order of commonness

Answer 38

``` o Stiff neck o Headache o Photophobia o Fever o Altered mental status ```

Question 39

2 Herpes viruses and encephalitis vs menigitis

Answer 39

o HSV-1: more common encephalitis (Temporal lobes) | o HSV-2: more common meningitis

Question 40

Compound fracture

Answer 40

Bone breaks through the skin

Question 41

Contrecoup fracture

Answer 41

Fracture at a distant part from the point of injury