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227 Cards in this Set
- Front
- Back
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Acute Neuronal Injury |
Spectrum of changes that accompany acute CNS hypoxia/ischemia or other acute insults |
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Acute Neuronal Injury |
Earliest morphologic markers of neuronal cell death |
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Acute Neuronal Injury |
Evident by about 12 to 24 hours after an irreversible hypoxis/ischemic insult |
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Acute Neuonal Insult |
Morphologiv features consist of shrinkage of cell body, pyknosis of nucleus, disappearance of nucleolus, and loss of Nissl substance |
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Acute Neuronal Injury |
Intense eosinophilia of cytoplasm as Red Neurons |
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Subacute and Chronic Neuronal Injury |
Neuronal death occuring as a result of progressive disease |
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Subacute and Chronic Neuronal Injury |
Seen in slowly evolving neurodegenerative disease such as amyotrophic lateral sclerosis and Alzheimer's disease |
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Subacute and Chronic Neuronal Injury |
Histologic feature is cell loss often involving functionally related groups of neurons, and reactive gliosis |
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Axonal Reaction |
Change observed in the cell body during regeneration of axon |
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Axonal reaction |
Best seen in anterior horn cells of spinal cord when motor axons are cut or seriously damaged |
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Axonal Reaction |
There is increased protein synthesis associated with axonal sprouting |
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Axonal Reaction |
Reflected in enlargement and rounding up of the cell body, peripheral displacement of the nucleus, enlargement of nucleolus, and dispersion of Nissl substance from the center to periphery |
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Aging |
Intracytoplasmic accumulations of complex lipids, proteins, or carbohydrates |
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Alzheimer's Disease |
Neurofibrillary tangles |
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Parkinson Disease |
Lewy bodies |
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Creutzfeldt-Jakob disease |
Abnormal vacuolization of perikaryon and neuronal cell processes in neutrophil |
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Cowdry body |
Intranuclear inclusions seen in herpetic infection |
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Negri body |
Cytoplasmic inclusions seen in rabies |
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Cytomegalovirus infection |
Both intranuclear and cytoplasmic inclusion |
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Gliosis |
Most important histopathologic indicator of CNS injury |
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Gliosis |
Characterized by both hypertrophy and hyperplasia of astrocytes |
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Alzheimer type II astrocyte |
Seen in long standing hyperammonemia due to chronic liver disease, Wilson disease, or hereditary metabolic disorder |
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Rosenthal fibers |
Thick elongated, brightly eosinophilic, irregular structures in astrocytic processes |
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Rosenthal fibers |
Typically found in regions of long standing gliosis |
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Rosenthal fibers |
Characteristic of pilocytic astrocytoma |
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Alexander disease |
Abundant rosenthal fibers are found in periventricular, perivascular, and subpial location |
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Corpora amylacea |
Occuring in increasing numbers with advancing age and are thought to represent degenerative change in astrocyte |
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Lafora bodies |
Seen in cytoplasm of neurons in myoclonic epilepsy |
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Microglial nodules |
Forming aggregates around small foci of tissue necrosis |
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Neuronophagia |
Congregating around the cell bodies of dying neurons |
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Interstitial Edema |
Occurs around lateral ventricles whan increase in intravascular pressure causes abnormal floe of fluid from intravascular CSF to periventricular white matter |
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Cerebral Edema |
Result of increased fluid leakage from blood vessels or injury to various cells of CNS |
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Vasogenic Edema |
Increase in extracellular fluid caused by blood brain barrier disruption and increased vascular permeability |
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Cytotoxic Edema |
Increase in intracellular fluid secondary to neuronal, glial or endothelial cell membrane injury |
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Cytotoxic Edema |
Encountered in someone with a generalized hypoxic/ischemic insult or with a metabolic derangement |
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Cerebral Edema |
Flattened gyri, narrowed sulci |
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Cerebral Edema |
Widened Robin-Virchow spaces |
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Hydrocephalus |
Accumulation of excessive CSF within ventricular system |
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Herniation |
Displacement of brain tissue past rigid dural folds or opening in skull because of increased intracranial pressure |
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Subfalcine herniation |
Occurs when unilateral or asymmetric expansion of cerebral hemisphere displaces the cingulate gyrus under the falx |
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Subfalcine herniation |
Leads to conpression of the anterior cerebral artery |
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Subfalcine herniation |
Manifestations involve the frontal lobe |
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Transtentorial herniation |
Occurs when medial aspect of the temporal lobe is compressed against the free margin of tentorium |
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Transtentorial herniation |
Increasing displacement of temporallobe compromises third cranial nerve |
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Transtentorial herniation |
Results in pupillary dilation and impairment of ocular movements on the side of the lesion |
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Transtentorial herniation |
Posterior cerebral artery may be compressed resulting to ischemic injury to primary visual cortex |
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Transtentorial herniation |
Contralateral cerebral peduncle may be compressed, resulting to hemiparesis ipsilateral to side of herniation |
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Transtentorial herniation |
Duret hemorrhages |
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Duret hemorrhages |
Secondary hemorrhagic lesions in midbrain and pons |
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Tonsillar herniation |
Displacement of the cerebellar tonsils through the foramen magnum |
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Tonsillar herniation |
Brainstem compression and compromises vital respiratory and cardiac centers in medulla |
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Neural Tube Defects |
Failure of a portion of neural tube to close or reopening of a region of the tube after successful closure |
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Spina bifida |
Asymptomatic bony defect or severe malformation with flattened, disorganized segment of spinal cord, associated with overlying meningeal outpouching |
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Myelomeningocele |
Extension of CNS tissue through a defect in the vertebral column |
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Encephalocele |
Diverticulum of malformed brain tissue extending through a defect in cranium |
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Encephalocele |
Occurs in posterior fossa and may occur cribriform plate in anterior fossa |
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Anencephaly |
Malformation of anterior end of neural tube with absence of most brain and calvarium |
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Anencephaly |
Forebrain development is disrupted at approximately 28 days of gestation |
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Holoprosencephaly |
Incomplete separation of the cerebral hemisphere across the midline |
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Holoprosencephaly |
Associated with trisomy 13 as well as other genetic syndromes |
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Holoprosencephaly |
Mutations in genes that encode components of the sonic hedgehog signaling pathway |
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Arnold-Chiari Malformation |
Consists of a small posterior fossa, a misshapen midline cerebellum with downward extension of vermis through foramen magnum |
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Chiari Type I Malformation |
Less severe disorder in which low-lying cerebellar tonsils extend down into the vertebral canal |
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Dandy-Walker Malformation |
Enlarged posterior fossa |
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Dandy-Walker Malformation |
Cerebellar vermis is absent or presnt only in rudimentary form in its anterior portio |
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Joubert Syndrom |
Hypoplasia of the cerebellar vermis with apparent elongation of superior cerebellar peduncles and altered shape of brainstem |
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Hydromyelia |
Expansion of ependyma-lined centrak canal of the cord |
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Syringomyelia |
Formation of a fluid-filled cleft-like cavity |
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Cerebral Palsy |
Nonprogressive neurologic motor deficit characterized by combinations of spasticity, dystonia, ataxia/athetosis, and paresis |
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Displaced skull fracture |
A fracture in which bone is displaced into thw cranial cavity by a distance greater than the thickness of bone |
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Diastatic |
Kineticenergy that causes a fracture is dissipated at a fused suture |
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Concussion |
Syndrome of altered consciousness secondary to head injury brought about by a change in momentum of head |
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Concussion |
Instantaneous onset of transient neurologic dysfunction |
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Concussion |
Loss of consciousness, temporary respiratory arrest and loss of reflexes |
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Contusion |
Analogous to bruise caused by blunt trauma |
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Laceration |
Injury caused by penetration of an object and tearing of tissue |
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Coup injury |
Suffers blow to the head may develop a contusion at the point of contact |
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Countercoup injury |
Contusion on the brain surface diaemtrically opposite |
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Paraplegia |
Lesions involving the thoracic vertebrae or below |
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Quadriplegia |
Cervical lesions |
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Above C4 |
Lead to respiratory compromise from paralysis of diaphragm |
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Liquefactive necrosis |
Type of necrosis seen in brain |
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Global Cerebral Ischemia |
Generalized reduction of cerebral perfusion |
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Pyramidal cell layer of hippocampus, cerebellar Purkinje cells and pyramidal nuerons in cerebral cortex |
Most sensitive neurons in the brain |
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Focal Cerebral Ischemia |
Follows reduction or cessation of blood flow to a localized area due to arterial occlusion or hypoperfusion |
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Lacunar Infarct |
Development of single or multiple, small, cavity infarcts |
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Lacunar Infarcts |
Lace-like spaces, arbitrarily defined as less than 15 mm wide |
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Slit Hemorrhages |
Rupture of the small-caliber penetrating vessels and the development of small hemorrhages |
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Slit Hemorrhages |
Hemorrhages resorb leaving skitlike cavoty surrounded by brownish discoloration |
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Slit Hemorrhages |
Focal tissue destruction, pigment-laden macrophages, and gliosis |
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Hypertensive Encephalopathy |
Clinicopathologic syndrome arising in malignant hypertension |
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Hypertensive Encephalopathy |
Diffuse cerebral dysfunction, including headaches, confusion, vomitting, and convulsions, sometimes leading to coma |
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Hypertension |
Risk factor most commonly associated with deep brain parenchymal hemorrhages |
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Intraparenchymal hemorrhages |
Hypertension and cerebral amyloid angiopathy |
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Cerebral amyloid angiopathy |
Risk factor most commonly associated with lobar hemorrhages |
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Chronic hypertesion |
Development of Charcot-Bouchard microaneurysm |
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Subarachnoid Hemorrhage |
Most frequent cause is rupture of a saccular aneurysm in a cerebral artery |
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Saccular aneurysm |
Most common tyoe of intracranial aneurysm |
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Arteriovenous malformation |
Tangled network if wormlike vascular channels has prominent, pulsatile arteriovenous shunting with high blood flow |
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Cavernous malformations |
Distended, loosely organized vascular channels arranged back to back with collagenized walls |
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Capillary telangiectasias |
Microscopic foci of dilated, thin-walled vascular channels separated by relatively normal brain parenchyma occuring in pons |
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Venous angiomas |
Consist of aggregates of elastic venous channels |
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Foix-Alajouanine disease |
Venous angiomatous malformation of spinal cord and overlying meninges |
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Foix-Alajouanine disease |
Most often in lumbrosacral region, asociated with ischemic injury to the spinal cord and slowly progressive neurologic symptoms |
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Acute Meningitis |
Inflammatory process of the leptomeninges and CSF within thw subarachnoid space caused by infection |
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Meningoencephalitis |
Inflammation of meninges and brain parenchyma |
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Escherichia coli and group B streptococci |
Neonates |
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Streptococcus pneumoniae |
Infants |
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Neisseria meningitidis |
Adolescents and young adults |
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Streptococcus pneumoniae and Listeria monocytogenes |
Elderly |
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Acute Aseptic Meningitis |
Absence of organism by bacterial culture in a patient with manifestations of meningitis |
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Acute Aseptic Meningitis |
Meningeal irritation, fever and alterations of consciousness of relatively acute onset |
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Bacterial Meningitis |
Markedly reduced sugar |
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Neutrophilic Pleocytosis |
Bacterial Meningitis |
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Lymphocytic Pleocytosis |
Viral Meningitis |
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Tuberculous meningitis |
Mixed neutrophilic-lymphocytic pleocytosis |
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Bacterial Meningitis |
Gram stain |
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Tuberculous Meningitis |
AFB stain |
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Brain Abscess |
Localized focus of necrosis of brain tissue with accompanying inflammation caused by bacterial infection |
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Brain Abscess |
May arise by direct implantation of organisms, local extension from adjacent foci or hematogenous spread |
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Brain Abscess |
Predisposing conditions include acute bacterial endocarditis, congenital heart disease, chronic pulmonary sepsis |
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Streptococcus and staphylococci |
Most common offending organisms identified in non-immunosuppressed patients |
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Subdural Empyema |
Bacterial infections of skull bones or air sinuses can spread to the subdural space |
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Extradural Abscess |
Commonly asociated with osteomyelitis often arises from an adjacent focus of infection such as sinusitis or following surgical procedure |
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Tuberculosis |
Florid show well-formed granulomas with caseous necrosis and giant cells |
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Tuberculomas |
Well-circumscribed intraparenchymal masses |
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Meningovascular Neurosyphilis |
Chronic meningitis involving the vase of the brain and more variably the cerebral convexities and spinal leptomeninges |
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Paretic neurosyphilis |
General paresis of the insane |
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Tabes dorsalis |
Impaired joint position sense and ataxia, loss of pain sensation leading to Charcot joints, lightning pains |
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Neuroborreliosis |
Lyme disease |
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Neuroborreliosis |
Caused by spirochete Borrelia burgdorferi transmitted by Ixodes tick |
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Herpes-Simplex Type 1 and 2 |
Involves inferior and medial regions of temporal lobes and orbital gyri of frontal lobe |
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Herpes-Simplex Type 1 and 2 |
Perivascular inflammatory infiltrates present, Cowdry type A intranuclear viral inclusion bodies found both neurons and glia |
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Varicella-Zoster Virus |
Reactivation of infection manifests as a painful, vesicular skin eruption confined to one one or several dermatomes |
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Varicella-Zoster Virus |
Shingles |
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Cytomegalovirus |
Immunosuppressed individual commonly causes subacute encephalitis, necrotizing ventriculoencephalitis and a choroid plexitis |
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Polymyelitis |
Mononuclear cell perivascular cuffs and neuronophagia of anterior horn motor neurons of the spinal cord |
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Rabies |
Severe encephalitis transmitted to humans by the bite of rabid animal |
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Negri bodies |
Cytoplasmic, round to oval, eosinophilic inclusions that can be found in pyramidal neurons of hippocampus and Purkinje cells of cerebellum |
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Human Immunodeficiency Virus |
Chronic inflammatory reaction associated with widely distributed microglial nodules often containing macrophage-derived multinucleated giant cells |
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Progressive Multifocal Leukoencephalitis |
Encephalitis caused by the JC polyomavirus infecting oligodendrocytes, demyelination |
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Subacute Sclerosing Panencephalitis |
Rare progressive clinical syndrome characterized by cognitive decline, spasticity of limbs, and seizures |
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Subacute Sclerosing Panencephalitis |
Occurs in children or young adults, months or years after an initial, early-age acute infection with measles |
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Vasculitis |
Most frequently seen with Mycormycosis and Aspergillosis as well as Candida |
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Candida and Cryptococcus |
Fungi that invade the brain |
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Mucormycosis |
Fungi by direct extension |
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Chronic Meningitis |
Seen in Cryptococcal meningitis which stains positive for India Ink |
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Cryptococcal meningitis |
Gelatinous material within subarachnoid space and small cysts within the parenchyma |
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Creutzfeldt-Jakob Disease |
Most common prion disease manifests clinically as a rapidly progressive dementia |
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Multiple Sclerosis |
Autoimmune demyelinating disorder characterized by distinct episodes of neurogic deficits |
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Multiple Sclerosis |
Lesions are firmer and appear as well circumscribed, depressed, glassy, gray-tan, irregularly shaped plaques |
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Active Plaque |
Ongoing myelin breakdown associated with abundant macrophages containing lipid-rich, PAS-positive debris |
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Inactive Plaques |
Little to no myelin i found, and there is a reduction in the number of oligodendrocyte nuclei |
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Neuromyelitis Optica |
Syndrome with synchronous bilateral optic neuritis and spinal cord demyelimation |
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Acute Disseminated Encephalomyelitis |
Diffuse monophasic demyelinating disease that follows either a viral infection, a viral immunization presents with headache, lethargy, and coma |
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Acute Necrotizing Hemorrhagic Encephalomyelitis |
Fulminant syndrome of CNS demyelination, young adults and children, recent episode of upper respiratory infection |
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Central Pontine Myelinolysis |
Acute disorder characterized by loss of myelin in the basis pontis ans portions of the pontine tegmentum in symmetric pattern |
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Alzheimer Disease |
Most common cause of dementia in older adults with increasing incidence as a function of age |
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Alzheimer Disease |
Accumulation of two proteins (Ab and tau) in specific brain regions |
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Alzheimer Disease |
Cotical atrophy, neuritic plaques, neurofibrillary tangles, cebral amyloid angiopathy, granulovascular degeneration, Hirano bodies |
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Frontotemporal Lobar Degenerations |
Heterogenous set of disorders associated with focal degeneration of frontal and temporal lobes |
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Frontotemporal Lobar Degeneration |
Alterations in personality, behavior and language and precede memory loss |
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Pick Disease |
Knife edge thinning of gyri in frontoparietal lobe |
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Parkinson Disease |
Neurodegenerative disease marked by a prominent hypokinetic movement disorder that is caused by loss of dopaminergic neurons from the substantia nigra |
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Parkinsonism |
Diminished facial expression, stooped posture, slowing of voluntary movement, festinating gait, rigidity, and pill-rolling tremor |
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Parkinson Disease |
Damage to the nigrostriatal dopaminergic system |
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Parkinson Disease |
Central triad of tremor, rigidity, and bradykinesia |
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Parkinson Disease |
Pallor of substantia nigra and locus ceruleus due to loss of pigmented, cathecolaminergic neurons |
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Lewy Bodies |
Single or multiple cytoplasmic, eosinophilic, round to elongated inclusions that often have a dense core surrounded by a pale halo |
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Lewy bodies |
Filaments are composed of a-synuclein |
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Multiple System Atrophy |
Sporadic disorder that affects several functional systems in brain nd is characterized by cytoplasmic inclusions of a-synuclein in oligodendrocytes |
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Multiple System Atrophy |
Degeneration of white matter tracts in glial cells |
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Multiple System Atrophy |
Striatonigral circuit, olivopontocerebellar circuit, autonomic nervous system |
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Huntington Disease |
Autosomal dominant disease characterized by progressive movement disorders and dementia caused by degeneration of striatal neurons |
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Huntington Disease |
Prototype of the polyglutamine trinucleotide repeat expansion disease |
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Huntington Disease |
Brain is sma and shows striking atrophy of the caudate nucleus |
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Huntington Disease |
Jerky, hyperkinetic, sometimes dystonic movements involving all parts of the body |
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Huntington Disease |
Affected individuals may later develop bradykinesia and rigidity and dementia |
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Amyotrophic Lateral Sclerosis |
Progressive disorder in which there is loss of upper motor neuons in the cerebral cortex and lower motor neurons in spinal cord and brainstem |
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Amyotrophic Lateral Sclerosis |
Anterior roots of the spinal cord are thin, due to loss of lower motor neuron fibers |
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Amyotrophic Lateral Sclerosis |
Precentral motor gyrus in the cortex may be atrophic |
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Amyotrophic Lateral Sclerosis |
Asymmetric weakness of habds, manifested as dropping of objects and difficulty in performing fine motor tasks, and cramping and spasticity of arms and legs |
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Wernicke Encephalopathy |
Thiamine deficiency characterized by acute appearance of combination of psychotic symptoms and opthalmoplegia |
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Wernicke encephalopathy |
Foci of hemorrhage and necrosis in mamiary bodies and walls of third and fourth vernticles |
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Korsakoff syndrome |
Disturbances of short term memory and confabulation |
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Infiltrating Astrocytoma |
80% of adult primary brain tumora in adults |
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Infiltrating Astrocytoma |
Usually found in cerebral hemisphere, most often in fourth through sixth decades |
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Infiltrating Astrocytoma |
Seizures, headaches, and focal neurologic deficits |
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Anaplastic Astrocytoma |
More densely cellular and have a greater nuclear pleomorphism, mitotic figures |
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Gemistocytic Astrocytoma |
Brightly eosinophilic cell body fron which emanate abundant, stout processes |
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Glioblastoma |
Similar to anaplastic astrocytoma with additional features of necrosis and vascular endothelial cell proliferation |
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Pilocytic Astrocytoma |
Located in cerebellum but may also appear in the floor and walls of the third ventricle, the optic nerves, and occasionally the cerebral hemisphere |
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Oligodendroglioma |
Infiltrating gliomas comprised of cells thwy resemble oligodendrocytes |
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Oligodendroglioma |
Well circumscribed, gelatinous, gray masses, often with cysts, focal hemorrhage, and calcification |
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Oligodendroglioma |
Tumors are composed of sherts of regular cells with spherical nuclei containing finely granular chromatin surrounded by clear halo of vacuolated cytoplasm |
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Ependymoma |
Most often arise next to the ependyma-lined ventricular system |
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Ependymoma |
Gland-like round or elongated structures (rosettes, canal) that resemble the embryonic ependymal canal |
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Ependymoma |
Perivascular pseudorosettes |
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Medulloblastoma |
In children, located in midline of cerebellum but lateral locations in adults |
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Medulloblastoma |
Tumor may express neuronal granules, from Homer-Wright rosettes |
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Medulloblastoma |
Roof of the 4th ventricle |
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Atypical Teratoid/Rhabdoid |
Highly malignsnt tumor of young children in posterior fossa ans supratentorial compartments |
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Rhabdoid Tumor |
Divergent differentiation with epithelial, mesenchymal, neuronal, and glial components and often inckudes rhabdoid cells |
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Rhabdoid Tumor |
Rhabdomyosarcoma |
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Meningioma |
Benign tumor of adults usually attached to the dura that arise from meningothelial cells of arachnoid |
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Syncytial |
Whorled clusters of cells that sit in tight groups without visible cell mebranes |
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Fibroblastic |
Elongated cells and abundant collagen deposition |
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Transitional |
Share features of syncytial and fibroblastic types |
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Psammomatous |
With psammoma bodies |
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Secretory |
PAS-positive intracytoplasmic droplets and intracellular lumens |
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Atypical Meningiomas |
Highest rate of recurrence and more aggressive local growth and may require radiation therapyf |
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Anaplastic meningioma |
Highly aggressive tumor with the appearance of high grade sarcoma, but retaining some histologic evidence of meningothelial origin |
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Papillary Meningioma |
Pleimorphic cells arranged around fibrovascular cores |
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Rhabdoid meningioma |
Sheets of tumor cells with hyaline eosinophilic cytoplasm containing intermediate filaments |
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Schwannoma |
Alternating Antoni A(cellular) and Antoni B (loose) |
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Schwannoma |
Verocay bodies (acellular) |
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Neurofibroma |
Malignant schwannoma |
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Cowden Syndrome |
Dysplastic gangliogliocytoma of cerebellum |
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Cowden Syndrome |
Mutations in PTEN resulting PI3K/AKT signaling pathway activity |
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Li-Fraumeni syndrome |
Medulloblastoma caused mutation in TP53 |
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Turcot Syndrome |
Medulloblastoma or glioblastoma caused by mutation in APC or mismatch repair genes |
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Gorlin syndrome |
Medulloblastoma caused by mutations in PTCH gene resulting up regulation of sonic hedgehog signaling pathways |
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Neurofibromatosis I |
Neurofibromas of peripheral nerve, gliomad of optic nerve, pigmented nodules of iris and cutaneous hyper-pigmented macules |
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Neurofibromatosis II |
Bilateral schwannomas of the vestibulocochlear nerves and multiple meningiomas |
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Tuberous Sclerosis Complex |
Autosomal dominant syndrome, hamartomas within CNS take the form of cortical tubers and subepebdymal nodules |
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Tuberous Sclerosis Complex |
Cysts may be found at various sites, including liver, kidneys, and pancreas |
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Von Hippel Lindau Disease |
Autosomal dominant disease develop hemangioblastomas of CNS and cysts involving pancreas, lover, and kidneys and develop renal cell carcinoma and pheochromocytoma |
