Neuro 5,6, 9: Intro To Cns And Cerebrovascular Diseases, Csf, Bbb, And Cerebral Edema

Front 1

Name 2 regions in the CNS with neuromelanin.

Back 1

Substantia nigra

Locus Ceruleus

Front 2

How is central chromatolysis different from acute neuronal injury in terms:

1. cause
2. reversibility
3. histology

Back 2

Central chromatolysis:
due to axonal injury
reversible
enlarged cell body with nissl substances peripherally; eccentric nucleus and large nucleolus

Acute neuronal injury
due to ischemia, hypoglycemia, infection, or toxin
Irreversible
forms red neurons (shrinkage and eosinophila of cell body, pyknotic nucleus, disappearance of nuclelous and nissl substance)

Front 3

Name 2 intraneuronal inclusions with tau protein. 1 with alpha-synuclein.

What are common diseases associated with each inclusion

Back 3

inclusions with tau protien
1. Neurofibillary tangles - seen in aging, AD, PD, progerssive supranuclear palsy, Down Syndrome, dementia
2. Pick body - Pick disease or FTD

inclusion with alpha-synuclein
1. Lewy body - seen in PD, LBD (lewy body dementia)

Front 4

GFAP stains?

Back 4

astrocytes

Front 5

Name 5 functions of astrocytes.

Back 5

1. Metabolic buffer or detoxifier
2. nutrient supplier
3. electrical insuator for neuron
4. BBB
5. repair and scar formation

Front 6

Define gliosis

Back 6

hypertrophy and hyperplasia of astrocytes in response to injury

Front 7

What are Alzheimer type II cells?

Describe its histology

Back 7

hypertrophy of protoplasmic astrocytes

large nucleus and chromatin clearing.

Front 8

What are rosenthal fibers?

Describe their histology

Back 8

degenerated astrocytes.

appear as thick, elonaged eosinophilic strcuctures

Front 9

What are corpora amylacea?

How are they different from Lafora bodies?

Back 9

Corpora amylacea are lamellated basophilic bodies containing glycogen and protein.
due to aging

Lafora bodies are basophilic intracytoplasmic bodies in neurons. PAS postive and seen in myoclonic epilepsy pts.

Front 10

What are rod cells?

Microglial nodules?

Back 10

Rod cells are reactive microglia due to neurosyphilis

Microglial nodules are reactive microglia that are clustered. This is due to viral infections

Front 11

the lines are pointing at pathologic neurons.

the Left neurons are called? due to?

The right neuron is due to?

Back 11

Left - Red neuron due to acute neuronal injury

Right - due to axonal injury; called central chromatolysis

Front 12

These are pathologic neurons with intraneuronal bodies.

What bodies are present in the Left neuron? right?

Back 12

Left - neurofibrillary tangle

Right - Lewy body

Front 13

The above pictures show gliosis.

What type of gliosis is shown in each picture?

Back 13

Left - fibrillary gliosis

Right - gemistocystic gliosis

Front 14

The arrows are pointing at special types of astrocytes.

Name them.

What is the common cause of the astrocytes on the Left pic?

Back 14

Left - Alzheimer's type II cells due to hyperammonia

right - rosenthal fibers (degenerated astrocytes

Front 15

This is a slide of brain.

Name the objects indicated by the arrows.

Back 15

corpora amylacea

Front 16

the arrows are pointing at what type of glial cells?

Which histological feature signifies the identity of this cell?

Back 16

Oligodendrocytes

Halo cytoplasm around the nucleus

Front 17

This is a slide of CNS.

What type of cells are the arrows pointing at?

What 2 pathophysiology can develop such cells?

Back 17

Foamy macrophages.

due to infarct or demyelination

Front 18

The arrow is indicating what kind of nodule?

common cause?

Back 18

microglial nodue due to viral infection

Front 19

Name 3 areas in the cerebrum that ar emost susceptible to generalized (global) hypoxia.

Back 19

1. Sommer sector of hippocampus
2. Watershed area of infarction (b/t areas of ACA and MCA)
3. layers III and V of cortex

Front 20

How can you differentiate b/t acute and subacute phases of cerebral infraction histologically?

Back 20

acute - Red neurons, neutrophils

subacute - foamy macrophages, reactive gliosis, vascular proliferation, liquefactive necrosis, and early cavitation.

Front 21

What type of plaques cause "pale" infarct? "red" infact?

Back 21

Pale infarcts are commonly due to atherosclerotic plauqes.

Red infarcts are commoly due to embolism.

Front 22

What regions of the brain are affected by lacunar infarct?

Which arteries are occluded?

Back 22

Deep regions of the brain (basal ganglia and thalamus)

Occlusion of small penetrating arteries.

Front 23

What is the most common type of aneurysm that leads to intraparenchymal hemorrhage in basal ganglia?

What is the cause of aneurysm development?

Back 23

Charcot-bouchard microaneurysm due to hypertension.

Front 24

What disorder is commonly associated with intraparnchymal lobar hemorrhage in the brain?

Back 24

Amyloid angiopathy due to deposition of beta-amyloids

Front 25

What aneurysm is associated with lipohyalinosis of arterioles?

What does this cause? common site?

Back 25

Charcot-Bouchard aneurysm

Causes IP hemorrhage usually in the basal ganglia

Front 26

What type of aneurysm is most commoly associated with subarachnoid hemorrhage?

Where is the usual location? Which vessels (2 most common)?

Back 26

Saccular or berry aneurysm

bifurcation
Anterior comm artery (40%) and MCA (34%)

Front 27

Fusiform aneurysm is common which arteries?

What is the cause?

Back 27

Vertebral and basilar arteries

Atherosclerosis of the vessel AKA atherosclerotic aneurysm.

Front 28

What is the pathophysiology of mycotic aneurysm?

What is the complication of this aneurysm?

Back 28

Infected emboli (bacterial or fungal) usually from cardiac source get in the vessels causing inflammatory rnx in the wall resulting in weakening and formation of aneurysm.


Rupture and cause intraparenchymal hemorrhage

Front 29

Name 4 types of vascular malformation.

Back 29

arteriovenous malformation
Cavernous angioma
venous angioma
capillary telangiectasia

Front 30

What is AVM?

Back 30

Arteriovenous malformation - clusters of arteries and veins

Front 31

What kind of infarct causes necrosis in the above brain? How do you know?

Back 31

Lacunar infarcts (pale)

There are cavitations in the thalamus and basal ganglia

Front 32

Where is the hemorrhage?

What is the cause?

What type of aneurysm is most commonly formed in the above brain?

Back 32

Intraparenchymal hemorrhage in the basal ganglia.

Rupture of Charcot-Bouchard aneurysm due to HTN

Front 33

This is a slide of Charcot-Bouchard aneurysm. What is the arrow indicating?

Back 33

Lipohyalinosis

Front 34

The above picture is a section of artery in the cerebrum.

1. what kind of stain? What view?
2. What is this disorder called?
3. What type of hemorrhage can this result in?

Back 34

1. Congo red stain in apple-green birefringence view
2. Amyloid angiopathy
3. Intraparenchymal lobar hemorrhage

Front 35

Describe the CSF flow from the lateral ventricles to sinuses.

Be sure to describe the connection b/t 4th ventricle and cisterns

Back 35

CSF produced from choroid plexus of all ventricles.

Lateral ventricle --> foramen of Monro --> third ventricle --> aqueduct of Sylvius --> 4th ventricle --> Foramina of Magendie (to cisterna magna cistern) and formina of Luschka (to pontine cistern) --> subarachnoid space --> arachnoid villi --> sinuses

Front 36

This is a sagittal MRI scan of the brain.

Identify the spaces indicated form A to E.

Back 36

A. Interpeduncular cistern
B. chiasmatic cistern
C. Pontine cistern
D. Superior or Quadrigeminal cistern
E. Cisterna Magna

Front 37

What is the total volume of CSF?
What is the normal CSF pressure?

Back 37

140 ml

100-200 mmH20 or 15mmHg

Front 38

Differentiate communicating form non-communicating hydrocephalus.

Back 38

Communicating hydrocephalus - hydrocephalus caused by a blockage after the 4th ventricle outlet formane or at arachnoid granulation

Non-communicating - obstruction prior to or at exit of the 4th ventricle outlet foramen.

Front 39

There is an obstruction at the foramen of Magendie. What kind of hydrocephalus is this?

Back 39

non-communicating hydrocephalus

Front 40

What is the normal cerebral perfusion pressure (CPP)?

How do you calculate this?

Back 40

normal CCP = 50 mmHg

CCP = MAP - ICP = 70 - 20 (mmHg)

Front 41

What are 2 common treatments for hydrocephalus?

Back 41

ventricular shunt and third ventriculostomy

Front 42

What are 3 components of blood-brain barrier?

Back 42

1. tight juctions of the capillary endothelium
2. basement membrane
3. astrocytic endfeet

Front 43

What are 3 components of the blood-CSF barrier?

Back 43

1. fenestrated capillary endothelium
2. basement membrane
3. tight junctions of the choroid plexus endothelium.

Front 44

List 3 types of cerebral edema. For each edema, describe where the edema is and indicate whether the BBB is intact or not.

Back 44

1. Cytotoxic edema - intracellular edema with intact BBB

2. Vasogenic edema - extracellular edema with disrupted BBB

3. Interstitial edema - edema of the ventricles and there is an increased ICP that causes CSF to leak into the parenchyma of the brain

Front 45

Describe the Monro-Kellie doctrine.

Back 45

There is a limited space in the head and if there is an increase in ICP something has to give to compensate for it.

Volume of skull = brain + SAS + vessels + ventricles