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112 Cards in this Set

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How many milliliters of CSF are produced per day?
500 ml
How much CSF is within the ventricles?
25 ml
Name two degenerative diseases that primarily involve the basal ganglia and mesencephalon?
Parkinson's Disease
Huntington Disease
Where is the obstruction located in noncommunicating hydrocephalus?
Within the ventricular system
Where is the obstruction located in communicating hydrocephalus?
Within the subarachnoid space or arachnoid villi
What is the gross pathology of Parkinson's disease?
Depigmentation of substantia nigra
What is the histopathology of Parkinson's disease? (4)
1. Degeneration of neurons in substantia nigra and locus ceruleus
2. Lewy bodies (idiopathic PD)
3. Neurofibrillary tangles (postencephalitic PD)
4. Degeneration of dopaminergic striatonigral pathway
What is the usual cause of cellular brain edema?
Ischemia
Where is vasogenic brain edema located? (gray or white matter)
White matter
Where is cellular (cytotoxic) brain edema located? (gray or white matter)
Both, but gray is more significant
Periventricular edema is indicative of what condition?
Hydrocephalus
What is the gross pathology of Huntington Disease?
Atrophy of caudate nucleus and putamen
What is the histopathology of Huntington disease? (4)
1. Loss of major projection neurons in striatum
2. Intranuclear inclusions in neurons
3. Loss of neurons in globus pallidus
4. Mild to moderate cerebral cortical atrophy
What is the histopathology of ALS? (5)
1. Loss of large motor neurons with gliosis
2. Degeneration of cortico-spinal (pyramidal) tracts
3. Bunina bodies and other ubiquitin positive cytoplasmic inclusions in some motor neurons
4. Degeneration of anterior spinal roots
5. Neurogenic atrophy of skeletal muscles
What is the gross pathology of Alzheimer's disease?
Diffuse cerebral cortical atrophy
Hydrocephalus ex vacuo
What is the gross pathology of dementia with Lewy bodies? (3)
1. Some degree of diffuse cerebral atrophy is likely to be present
2. Variable pallor of the substantia nigra is likely to be present
3. Locus ceruleus is usually depigmented
What is the cause of hydrocephalus in TB meningitis?
Meningial fibrosis
What type of meningitis has characteristic dilatation of the Virchow-Robin (perivascular) spaces in the basal ganglia?
Cryptococcal leptomeningitis
What is the histopathology of dementia with Lewy bodies?
1. Lewy bodies of both classical and cortical types
2. Alzheimer-type pathology (senile plaques & neurofibrillary tangles)
What type of pathogen is the most common cause of encephalitis?
Viruses
What is the pathology of viral encephalitis? (4)
1. Necrosis with hemorrhage
2. Perivascular chronic inflammation
3. Microglial nodules
4. Sometimes viral inclusions
Where does herpes encephalitis typically localize?
Temporal and frontal lobes
Where does the polio virus localize in the CNS?
Anterior horn cells
What is the most common cause of coma in the absence of an intracranial hematoma?
Diffuse axonal injury
What immunohistochemical stain can serve as a sensitive marker to diffuse axonal injury?
APP
What type of hematoma is found in shaken baby syndrome?
Subdural
(often bilateral)
What is typically the source of bleeding in a subdural hematoma?
Bridging veins
What is typically the source of bleeding in an epidural hematoma?
Meningeal artery (usually middle)
What are the typical shapes of subdural and epidural hematomas?
Epidural = convex or lens
Subdural = crescent
In which lobes do brain contusions most commonly occur?
Temporal and frontal
Where are focal hemorrhages found in the gross pathology of diffuse axonal injury?
Parasagittal white matter
Corpus callosum
Dorsolateral quadrants of rostral brainstem
Where do pilocytic astrocytomas commonly occur?
Cerebellum
Hypothalamus
Optic nerve
What age group are pilocytic astrocytomas most common in?
Young (1-3 decades)
What is the histological pattern of pilocytic astrocytoma? (3)
Biphasic growth pattern
Solid & microcystic
Degenerative astrocytic changes
What is the radiological finding of diffuse astrocytoma?
T2 hyperintensity on non-contrast MRI
What is the histological pattern of diffuse astrocytoma?
Diffuse infiltration by cytologically atypical cells
What is the histological feature that distinguishes anaplastic astrocytoma from diffuse astrocytoma?
Mitotic activity
What is the radiological finding typical of a glioblastoma?
(Ring) enhancement on post-contrast T1 weighted MRI
What are histological findings that distinguish glioblastoma from other gliomas?
Microvascual proliferation (with leaky blook vessels)
Necrosis (pseupalisading)
What type of brain tumor is frequently calcified?
Oligodendroglioma
What are the genetic features that are typical of oligodendrogliomas and how does their presence affect the tumor's prognosis?
LOH 1p and 19q
Presence of both is favorable and indicates likely response to chemotherapy
What are the six most common locations for meningiomas?
Parasagittal/flacine
Convexity
Sphenoid wing
Suprasellar
Olfactory groove
Posterior fossa
What is the frequency of metastatic brain tumors as compared to primary tumors?
10x more frequent
What are the most common sites for ependymomas?
Cerebellum and Spinal Cord
What grade is the majority of ependymomas?
Grade II
What is the most common familial cancer syndrome and what are the associated cancers of the syndrome?
NF1
Neurofibromas and optic nerve gliomas (pilocytic)
Meningiomas and Scwannomas are associated with which familial cancer syndrome?
NF2
What are the two types of peripheral nerve tumors?
Neurofibroma
Schwannoma
Iris hamartomas are typically found in what type of CNS tumor syndrome?
NF1
A biphasic neoplasm and verocay bodies are found in the histology of what cancer?
Schwannoma
What is the most common type of embryonal brain tumor?
Medulloblastoma
What two things can cause the symptoms associated with pituitary adenoma?
Hormone production
Mass effects
What are the four most frequent primary sites of intraparenchymal metastatic tumors?
Lung
Breast
Skin
Kidney
What is the most common primary brain tumor?
Meningioma
What percentage of strokes are ischemic?
80%
Which is more vulnerable to ischemia: neurons or glial cells; white matter or gray matter?
Neurons, Gray matter
Neurons of which four parts of the brain are most vulnerable to ischemia?
1. Cerebral cortex
2. Hippocampus
3. Deep cerebral nuclei
4. Purkinje cells of cerebellum
What will eventually form in an area of pan-necrosis?
A cavity
In ischemic strokes, what is focal ischemia due to?
Occlusion of a blood vessel
In ischemic strokes, what is global ishemia due to? (3)
1. Cardiac arrest
2. Systemic hypotension
3. Increased intracranial pressure
During what time period following a stroke is the mass effect primarily present?
The first week
Where do lacunar infarcts occur? (3)
1. Cerebral white matter and internal capsule
2. Deep cerebral gray mater (basal ganglia, thalamus)
3. Pons
What is the most common cause of intracerebral hemorrhage?
Hypertension
What are three brain related diseases associated with small-vessel arteriosclerosis?
1. Intracerebral hemorrhage
2. Lacunar infarct
3. Binswanger's disease
None
What is the most common cause of subarachnoid hemorhage?
Ruptured berry aneurysms
85% of berry aneurysms are found in what part of the cerebral circulation?
Anterior (ICA) circulation
What is the most common location for berry aneurysms (40%)?
Junction of the anterior cerebral artery and the anterior communicating artery
What portion of patients that suffer from aneurysmal subarachnoid hemorrhage die from the event?
33%
What is seen microscopically on the first day of a stroke?
1. Coagulative necrosis of neurons (red neurons)
2. Tissue edema
3. Influx of neutrophils
What is seen microscopically on the second day of a stroke?
Macrophages and maximal edema
What is seen microscopically on the third day of a stroke?
Proliferation of astrocytes
Which is the more common type of hemorrhagic storke?
Intraparenchymal hemorrhage
What are four consequences of an intercerebral hemorrhage?
1. Local brain destruction
2. Mass effect
3. Extension into ventricles (hydrocephelus)
4. Seizures
What is the leading cause of morbidity and mortality in aneurysmal subarachnoid hemorrhage?
Arterial vasospasm
What is the predominant clinical symptom of degenerative diseases primarily involving the cerebral cortex?
Dementia
Are metabolic and nutritional diseases among the major causes of dementia?
Yes
What is a common cause of intracerebral hemorrhage in elderly individuals and Alzheimer disease patients?
Amyloid angiopathy
What are the neurofibrillary tangles of Alzheimer's disease composed of?
Intraneuronal tau protein aggregates
What is seen in this image?
β-amyloid deposit of Alzheimer's disease
What is seen in this image
Senile plaque
What is seen in this image?
Neurofibrillary tangles
What is seen in this image?
Cortical Lewy bodies
What is the pathology of prion disease? (5)
1. Cerebral and/or cerebellar atrophy in some cases
2. PrP amyoid plaque (deposit)
3. Spongy vacuolation of neuropil
4. Neuronal loss
5. Glial hypertrophy and proliferation (gliosis)
What disease process is seen in this image?
Prion disease
(spongy changes)
What disease is see in these images?
Variant CJD
What is the predominant clinical symptom of degenerative diseases primarily involving the basal ganglia and mesencephalon?
Movement disorders
What is the predominant clinical symptom of degenerative diseases primarily involving the basal ganglia and mesencephalon?
Movement disorders
What is the disease process seen in this image?
Lewy bodies in Parkinson's disease
What disease process is seen in the spinal cord of the patient on the right?
(left image is normal)
ALS
What is seen in this image?
Epidural hematoma
What traumatic brain injury is seen in this image?
Subdural hematoma
What is an early clinical sign of uncal herniation?
Ipsilateral pupil dilation
What are early clinical signs of central diencephalic herniation (transtentorial) herniation?
Drowsiness and small pupils
What are the four primary symptoms of hydrocephalus?
Headache
Nausea
Vomiting
Papilledema
What are five common causes of hydrocephalus?
1. Aqueductal stenosis
2. Chiari II malformation
3. Dandy-Walker malformation
4. Post-inflammatory hydrocephalus or post-hemorrhagic hydrocephalus
5. Tumors
This image of the basal ganglia is characteristic of what infectious disease of the brain?
Cryptococcal leptomeningitis
(characteristic dilatation of the Virchow-Robin (perivascular) spaces in the basal ganglia)
What areas of the brain does HSV-1 infection preferentially involve?
Temporal lobes
Inferior frontal lobes
What parts of the nervous system does poliovirus preferentially infect?
Motor neurons of spinal cord
Brain stem
What cell type does JC virus preferentially infect?
Oligodendrocytes
What areas of the brain does rabies virus typically infect?
Hippocampus
Cerebellum
What part of the nervous system does varicella-zoster virus typically infect?
Dorsal root ganglia
The temporal lobe localization and hemorrhagic necrosis seen in this image is typical of what type of encephalitis?
Herpes encephalitis
What consequence of the mass effect is seen in this image?
Uncal herniation
The biphasic growth pattern seen in this image is typical of what brain tumor?
Pilocytic astrocytoma
What glioma is seen in this image?
Anaplastic astrocytoma
Which type of glioma is seen in this image?
Glioblastoma
What type of glioma is seen in this image?
Oligodendroglioma
What type of brain tumor is seen in this image?
Ependymoma
(rosettes)
What type of tumor is seen in this image?
Parafalcine meningioma
What type of brain tumor is seen in these images?
Schwannoma
The image above would be expected on what day of a stroke?
The first
This image would be expected on what day following a stroke?
Third