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173 Cards in this Set
- Front
- Back
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astrocytes
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physical support, repair K+ metabolism, removal of excess neurotransmitter, maintenance of BBB, reactive gliosis in response to injury.
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What is the astrocyte marker?
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GFAB
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origin of astrocytes?
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neuroectoderm
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microglia
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CNS phagocytes, not readily discernible in nissl stains. Have small irregular nuclei and relatively little cytoplasm
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HIV-infected miroglia fuse to form what?
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multinucleated giant cells in the CNS
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origin of microglia
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monocytes
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origin of oligodendrocyets?
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neuroectoderm
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How do oligodendrocytes appear in a nissl stain?
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small nuclei with dark chromatin and little cytoplasm
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predominant type of glial cell in the CNS white matter?
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oligodendrocytes
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What do oligodendrocytes look like on H and E?
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fried egg
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schwann cell
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each schwann cell myelinates only 1 PNS axon. Also promotes axonal regeneration.
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where are schwann cells derived from?
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neural crest
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What cells are destroyed in Guillain Barre vs MS?
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schwann cells for Guillian Barre and oligodendrocytes for MS
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Free nerve endings
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C-slow, unmeyelinated fibers, AD- Fast, myelinated fibers
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Free nerve endings location and senses?
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L- All skin, epidermis, some viscera
S-Pain and temperature |
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MIessner's corpuscles location and senses?
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L-Glabrous (hairless) skin
S-position sense, dynamic fine touch (eg manipulation) adapt quickly |
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MIessner's corpuscles
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large myelinated fibers
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Pacinian corpuscles
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large myelinated fibers
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Pacinian corpuscles location and senses?
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L-deep skin layers, ligaments and joints
S-Vibration, pressure |
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Merkel's disks
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large, myelinated fibers
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Merkel's disks location and senses?
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L-hair follicles
S-position sense, static touch (e.g. shapes, edges, textures), adapt slowly |
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Where is the inflammatory inflitrate in guillian barre?
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endoneurium
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postrema
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vomiting after chemo, response to emetics
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OVLT
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senses change in osmolarity
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What does the hypothalamus control?
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TAN HATS
-Thirst and water balance -Adenohydrophysis -Neurophyphysis -Hunger -Autonomic regulation -Temperature regulation -Sexual urges |
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lateral area of hypothalamus?
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hunger, descriction = anorexia, failure to thrive (infants). Inhibted by leptin
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Ventromedial area
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satiety. Destruction (e.g. craniopharymgioma) = hyperphagia. Stimulated by leptin
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Anterior hypothalamus
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cooling parasympathetic (A/C)
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posterior hypothalamus
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heating sympathetic
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septal nucleus
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sexual urges
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Suprachiasmatic nucleus
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circadian rhythm (you need to get sleep to be charismatic)
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Lateral geniculate in the thalamus
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visual. projects via optic radiations to occipital cortex (Lateral for light)
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Medial geniculate nucleus in thalamus?
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auditory (medial for music)
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Ventral posterior nucleus lateral part in thalamus?
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body sensation (proprioception, pressure, pain, touch, vibration via dorsal columns, spinothalamic tract)
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Ventral posterior nucleus medial part in thalamus?
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facial sensation (put your Makeup on your face)
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Ventral anterior/lateral nuclei in thalamus?
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motor
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blood supply of the thalamus?
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posterior communicating, posterior cerbral, and ICA (anterior choroidal arteries.
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Limbic system
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cingulate gryus, hippocampus, fornix, and mammillary bodies. Responsible for Feeding, Fleeing, Fighting, Feeling and sex
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cortical input that the cerebellum receives?
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contralateral input via middle cerebellar peduncle and ipsilateral proprioceptive info via inferior cerebellar peduncle.
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input nerves vs output nerves to cerebellum?
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input= climbing and mossy fibers
output = purkinje fibers |
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Deep nuclei (L to M) of cerebellum
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Dentate, Emboliform, Globose, Fastigial (Don't eat greasy foods)
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lateral cerebellum?
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voluntary movement of extremities
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Medial cerebellum
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balance, truncal coordination, ataxia, propensity to fall toward ipsilateral side
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Neurologic symptoms in wilson's dz?
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-involvement of the lentiform nucleus (globus pallidus and putament)
-wing-beating tremor -psychosis -cirrhosis |
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internal capsule damage
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-occurs when perforating arteries are obstructed (lacunar infacts)
-results in pure motor or pure sensory deficits, dysarthia-clumsy hand syndrome |
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What are lewy bodies composed of?
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alpha-synuclein-intracellular inclusion
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Exposure to MPT can cause what dz?
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parkinsons
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What dz does a contralateral subthalamic nucleus lesion (lacunar stroke) cause?
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Hemiballism
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Hemiballism
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sudden flailing of 1 arm or/and leg. Loss of inhibition of thalamus through globus pallidus
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In Huntington's dz what changes to you see on CT?
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caudate nucleus (loss of GABA); enlarged lateral ventricles, atrphy of putamen, atrohy of globus pallidus, atrophy of frontal lobe and defined sulci
"The HUNTER got A TROPHY bc he CAUght a GLOBal PArrot out FRONT. He then got a big head (enlarged ventricles) and defined his sulci" |
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Huntingtons dz chromosme?
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Chromosome 4 CAG repeat (Caudate loss, Ach and GABA)
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Huntingtons dz: what causes the neuronal death?
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NMDA-R
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Symptoms of huntington's dz?
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Chorea, depression, aggresion, progessive dementia, grimace invuluntarily,
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Pathophys of huntington's dz?
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decrease in GABA, ACh and substance P in striatum.
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dystonia
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sustained, involuntary muscle contraction (writers cramp)
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myoclonus
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sudden breif muscle contraction. (jerks, hiccups)
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Frontal lobe lesion
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Disinhibition and deficits in concentration, orientation, and judgemnet; may have reemergence of primitive reflexes
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Right parietal lobe lesion
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-Spatial neglect syndrome (agnosia of the C/L side of the world)
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lesion of Reticular activating system (midbrain)
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Reduced levels of arousal and wakefulness (eg coma)
Reticular = Reduces arousal |
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Mamillary body lesion
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Wernicke-Korsakoff syndrome
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basal ganglia lesion
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tumor at rest, chorea or athetosis
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Cerebellar hemisphere lesion
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Intention temor, limb ataxia; damage to the cerebellum results in ipsilateral deficits; fall toward side of lesion (cerebellum --> SCP --> c/l cortex--> corticospinal decussation = ipsilateral) (cerebellar hemispheres are laterally located and affect lateral limbs
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Cerbellar vermis lesion
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Truncal ataxia, dysathia. (vermis is centrally located and affects central body)
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subthalamic nucleus lesion
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contralateral hemiballismus
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hippocampus lesion
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-antrograde amnesia, inability to make new memories
-a Hippopotamus eats everything in sight meaning it takes everything in, takes memories it. If you damage it you can no longer form memories |
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Paramedian pontine reticular formation (PPRF) lesion
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eyes look away from side of lesion
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frontal eye feilds lesion
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eyes look toways lesion
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Central pontine myelinolysis
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Acute paralysis, dysarthria (slow slurred difficult speech), dysphagia, diplopia, loss of conciousness. Commonly caused by very rapid correction of hyponatremia
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Recurrent laryngeal nerve injury
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Loss of all laryngeal m. except cricothyroid. hoarseness
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Brocas aphasia
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Blood supply= L. MCA
-inferior frontal gyrus |
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Wernickes
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blood supply= L. MCA
superior temporal gyrus |
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global aphasia
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nonfluent aphasia with impaired comprehension. Both Brocas and Wernikes are affected
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Conduction aphasia
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Poor repetition but fluent speech, intact comprehension. Arcuate fasciculus--connects Broca's Wernike's areas
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Anterior spinal artery deficit?
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C/L hemiparesis (lower extremities), medial lemniscus (decreased C/L proprioception_, ipsilateral paralysis of hypoglossal nerve
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PICA (lateral medullary syndrome, aka Wallenberg's)
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CN 5, 8, 9, 10 and 11. C/L loss of pain and temp, ipsilateral dysphagia, hoarsness, decreased gag reflex, vertigo, diplopia, nystagmus, vomiting, ipsilateral Horner's. ispsi facial pain and temp, ipsi ataxia
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AICA (lateral inferior pontine syndrome)
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Ipsi facial paralysis, ipsi cochlear nucleus, vestibular (nystagmus), ipsi facial pain and temp, ipsi dystaxia
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Posterior cerbral artery deficit
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C/L homonymous hemianopia with macular sparing, supplies occipital cortex
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middle cerbral artery deficit
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C/L face and arm paralysis and sensory loss, aphasia (dominant sphere) left sides neglect
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anterior cerebral artery deficit
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supplies medial surface of the brain, leg-foot area of motor and sensory cortices, Lower extremities, urinary incontinance and primitive reflexes.
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Anterior Communicateding artery
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most common site of circle of willis aneurysm; lesions may cause visual defects
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postior communicating artery deficit
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common area of aneurysm; causes CN III palsy
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Lateral striate deficit
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supply interal capsule, caudate, putamen, globus pallidus. Infarct of the posterior limb of the internal capsule causes motor hemiparesis
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Watershed zone deficit
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-Between anterior cerebral/middle cerebral, posterior cerbral/middle cerbral arteries.
-hypotension = upper leg/upper arm weakness, defects in higher order visual processing |
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Basilar artery deficit
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infarct causes locked in syndrome (CN III is typically intact)
"theres a bumble bee on your nose and now you're cross-eyed" |
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In general stroke of anterior circle
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General sensory and motor dysfunction, aphasia
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In general stroke of posterior circle
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-Cranial nerve deficits (vertigo, visual deficits), coma, cerebellar deficits (ataxia)
-Dominant hemisphere (ataxia, nondominant (neglect) |
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MC site for berry aneurysm?
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anterior communicating artery
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berry aneurysms are a/w what dzs?
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adult polycystic kidney dz, Ehlers-Danlos syndrome, Marfan's
"Ehler-Danlos, the Marshan, liked BERRies and had many kidneys" |
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Charcot bouchard microaneurysms?
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a/w chronic HTN, affect small vessels (basal ganglia, thalamus)
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blood or yellow spinal tap means which type of hemorrhage?
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Subarachnoid hemorrhage
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parenchymal hematoma
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-caused by HTN, amyloid angiopathy. Lobar strokes all over brain, DM, and tumor. Typically occurs in basal ganglia and internal capsule
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Diagnosis of stroke?
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-CT w/o contrast. Distinguishes hemorrhagic from non-hemorrhagic stroke
-MRI can identify posterior fossa infacts |
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2-3 days after a subarachnoid hemorrhage what are you at risk for?
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vasospasm due to blood breakdown products which irritate vessels (treat with calcium channel blockers)
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mc overall type of stoke?
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ischemic type due to thrombis
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TIA
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less than 24 hrs. Visual loss, parasthesias, hemiparesis, loss of speech. Usually caused by microembolism of plaque material
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Strokes in MCA
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c/l hemiparesis and sensory loss in face and UE. (head and eyes deviate towards lesion)
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Stroke in ACA
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c/l hemiparesis and sensory loss in LE
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liquifactive necrosis
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hypoxic injury to cells. 1)Thrombosis causes ischemic changes in neurons.
2)Release of lysomal enzymes from neurons result in degradation of tissue leaving a cavity 3) astrocyte proliferation |
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Cerebral amyloid angiopathy
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recurrent lobar hemorrhages. B-amyloid is deposited into the arterial wall = rupture. Reccurant hemorhagic stroke (less severe)
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what type of stroke causes red neurons?
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-Atherosclerosis
thrombi lead to ischemic strole with necrosis which leads to red neurons |
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From cystic cavity with reactive gliosis
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Atherosclerosis
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etiologies of ischemic stroke
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atrial fibrillation, carotid dissection, patent foramen ovale, endocarditis.
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Lacunar strokes
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block small vessels, are secondary to HTN. Treatment: tPA within 3 hrs
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What does an old infarct in the brain look like
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cystic cavity by a dense wall. Wall of cyst is formed by astrocyte process
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embolic/hemorrhagic stroke
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hemorrhagic infaction extending into periphery pf cerebral cortex
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gross and microscopic findings of Atherosclerotic stoke?
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wedge shaped area of pale infarction. Develops at periphery of the cerebral cortex
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most vulnerable areas to ischemic stroke
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hippocampus, neocortex, cerebellum, watershed areas.
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timeline of irreversible neuronal injury
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-red neurons (12-48 hrs)
-necrosis and neutrophils (24-72 hrs) -macrophage (3-5 days) -reactive gliosis + vascular proliferation (1-2 wks) -glial scar (>2 wks) |
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CSF
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made by the choroid plexus; it is reabsorbed by venous sinus arachnoid granulations
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normal pressure hyrdocephalus
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-(wet wobbly wacky)
-does not result in increase in subarachnois space volume. Expansion of ventricles distrorts fibers of corona radiata -dementia, ataxia and urinary incontinance (reversible) |
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communicating hydrocephalus
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decrease CSF absorption by arachnoid villi, which can lead to increased intracranial pressure, papilledema, and herniation
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Hydrocephalus ex vacuo
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appearance of increased CSF in atrphy (alzheimer's ds, advanced HIV, Pick's dz) Intracranial pressure is normal; triad is not seen
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Where is a lumbar puncture usually performed?
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L3-L4 or L4-L5
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syringomyelia
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damages anterior white commissure of spinothalamic tract (2nd order neurons) resulting in b/l loss of pain and temp sensation (usually C8-T1); seen with Arnold-Chiari II
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tabes dorsalis (neurosyphilis)
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degeneration of dorsal roots and dorsal columns; impaired proprioception, locomotor ataxia. Charcot's joints, shooting (lightening pain). Absence of DTRs, (+) romberg and sensory ataxia at night
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demyelination of dorsal columns, lateral corticospinal tracts and spinocerebellar tracts are caused by what?
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Vitamin B12 neuropathy, vitamin E deficiency and friedreich's ataxia
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what part of the spinal cord is affected in poliomyelitis and werdnig-hofmann dz?
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lower motor nueron lesions only, due to destruction of anterior horns; flaccid paralysis
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Spinal cord lesion is ALS (lou gehrig's dz)
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both LMN and UMN signs; no sensory, cognitive or oculomotor deficits. Preservation of bowel and bladder function.
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What is ALS (lou gehrig's dz) caused by?
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defect in superoxide dismutase 1 (SOD1), betal nut ingestion.
"Al's betal was super but defective" |
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MC sign of ALS?
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fasciculations, m. weakness (begins w/ atrophy of intrinsic m in hands)
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TX of ALS?
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Riluzole
"AL realized that his betal was super but defective" |
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genetics of Friedreich's ataxia?
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AR, GAA repeat, Frataxin gene
"He's stumbling around saying ARRR and GAAAa" |
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Frataxin deficiency specifically leads to what?
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impairment in mitochondria homeostasis so cells are more prone to apoptosis
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signs and symptoms of Friedreich's ataxia?
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staggering gait, frequent falling, nystagmus, dysarthia, pes cavus , hammer toes, hypertrophic cardiomyopathy (cause of death). Presents in childhood with kyphoscoliosis
"frat bother with a large heart, staggering and falling, sick (nystagmus), can't speak (dysarthia), he decides its a good idea to hammer the high arch (pes cavus), falls and becomes kyphoid" |
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facial cn
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facial movement, taste from antior 2/3 of tongue, lacrimation, salivation (submandibular and sublingual glands), eyelid closing (orbicularais oculi), stapedius muscle in ear
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Glossopharyngeal cn
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taste from posterior 1/3 of tongue, swallowing, salvation (parotid gland), monitoring carotid body and sinus chemo- and baroreceptors and stylopharyngeus (elevated pharynx, larynx)
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Vagus cn
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taste from epiglottic region, swallowing, palate elevation, midline uvula, talking, coughing, thoracoabdominal viscera, monitoring aoritc arch chemo-and baroreceptors
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parinaud syndrome
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paralysis of conjugate vertical gaze due to lesion in superior colliculi (e.g. pinealoma)
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What proteins/chomosomes are affected in early onset alzheimer's dz
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-APP (chromosome 21)
-Presenilin-1 (chromosome 14) -Presenilin-2 (chromosome 1 "When you're young you want PRESENts. When you're 1 yrs old you get 14 but when you're two you only get 1 :(" "When you're 21 you can drink APPletinits" |
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What proteins/chomosomes are affected in late onset alzheimer's dz
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-ApoE4 (chromosome 19) binds to tau protein in neurons = tangles
-ApoE2 (chromosome 19) is protective "APOstles are old, you learn about them when you are 19. If you show up to class at 4 your life is in tangles. If you show up for class at 2 you're protected from getting a bad grade" |
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What does AB stain as in alzheimer's dz?
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-stains (+) with congo red and has apple green birefringence w/ poloarization
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Glycogen synthase Kinase (GSK)
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-Increased in alzheimers.
-phosphorylates AB and signals nueronal apoptosis -also increases hyperphosphorylization of tau protein which causes neurofibulary tangles -Is increased bc there is a dysfunction in Wnt which usually inactivates GSK "G, you do not WaNT Alzheimer's" |
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What do you see on a CT scan of an alzheimers pt?
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cerebral atrophy with dilation of ventricles
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senile neuroptic plaques in alzheimers?
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core AB surrounded by neuronal cell processes w/ tau protein
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amyloid angiopathy in alzheimers?
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risk for cerebral hemorrhage causes weakening of vessels
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Pick's disease
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-dementia, aphasia, parkinsonian aspects; change in personality. Spares Parietal lobe and Posterior 2/3 of superior temporal gyrus
-Frontotemporal atrophy -Pick bodies (intracellular, aggregated tau protein) |
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histological/gross findings in pick's dz?
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-pick bodies (intracellular aggregated tau protein)
-frontotemporal atrophy |
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Lewy body dementia
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-parkinsonism with dementia and hallucinations
-alpha-synuclein defect |
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Creutzfeldt-jacob dz
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-rapidly pregressive (weeks to months) dementia with myoclonus
-spongiform transformation of gray matter -prions (alpha helix --> beta sheet) "oh MY your brain looks like a SPONGE" |
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progressive multifocal leukoencaphalopathy
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demyelination of CNS due to destruction of oligodendrocytes. A/w JC virus (polymovirus) and seen in 2-4% of AIDS pts (reactivation of latent viral infection) Rapidly progressive. Usually fatal
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Acute disseminated (postinfectious) encephalomyelitis
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multifocal periventricular inflammation and demyelinaton after infection (chickenpox, measles) or certain vaccinations (rabies, smallpox)
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Metachromatic leukodystophy
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AR lysosomal stage dz, most commonly due to arylsulfatase A deficiency. Build-up of sulfatides leased to impairment of myelin sheath
"ARY SULked all the time. He was so metachromatic and dramatic" |
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Charcot-Marie-tooth disease
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-also known as hereditary motor and sensory neuropathy.
-group of progressive hereditary nerve disorder related to the defective production of proteins involved in the structure and function of peripheral nerves or the myelin sheath -legs have inverted bottle appearance (atrophy of lower legs) "If you don't have a TOOTH, then you can't chew PROTEINS to make peripheral nerves or myelin sheath" |
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sturge-weber syndrome
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congenital disorder with port-wine stains (aka nevus flammeus)
-typically in V1 opthalmic distribution; ipsilateral leptomeningeal angiomas, -pheochromacytomas. -Can cause glaucoma, seizures, hemiparesis and mental retardation -occurs sporatically "Sturge-Weber got sporatically wacked in the eye. This caused him to have, glaucoma etc. and a huge port-wine colored bruise on his face" |
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tuberous sclerosis
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-hemartomas in CNS, skin, organs,
-cardiac rhabdomyomas, renal angiomyolipomas, -subendymal giant cell astrocytoma, -mitral regurgitation, seizures, -"ash leaf spots" (hypopigmented skin lesions)" -sabecous adenoma, shagreen patch. "The GIANT TUBE in the green SHAGgy PATCH was surrounded by LEAVEs which turned to ASH in the winter, it had HEARTS carved into it (cardiac rhabdomyomas) and dogs PEED on it (renal angiomyolipomas). At the top of the tube was a light that would flicker (seizures)" |
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major complication of tuberous sclerosis?
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seizures, mental retardation
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neurofibromatosis 1 (von racklinghausen's dz)
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Cafe-au-lait spots, lisch nodules (pigmented iris hamartomas), neurofibromas in skin, optic gliomas, pheochromocytomas.
-AD, mutated NF-1 gene on chromsome 17 "Lischa, a 17 yo old girl was the FIRST one to buy a LAte. She had pretty EYES and was very hyper (pheochromocytomas)" |
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neurofibromatosis 2
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-NF-2 tumor supressor gene. Codes the protein merlin
-chromosome 22 -b/l acoustic neuromas "When Merlin turned 22 he went deaf" |
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meniere's dz
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tinnitus, vertigo, and snsorineal hearing loss. Tinnitus = ringing in the affected ear, often accompanied by feeling of fullness.
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Glioblastoma multiforme (grade IV astrocytoma)
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MC primary brain tumor
-prognosis grave -cerebral hemisphere -can cross corpus callosum (butterfly glioma) -stain for GFAP "on the show GLI, girls where BUTTERFLies in their hair and think they are Ghetto-FABulous. They have GRAVE/dramatic problems. They pseudopalsate/"dance" around and sing so loud you wish they would all just hemorrhage and necrose" |
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Glioblastoma multiforme (grade IV astrocytoma) histo/gross
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pseudopalisading pleomorphic tumor cells - border central areas of necrosis and hemorrhage
-microvascular proliferation |
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Meningioma
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-adult
-mc benign brain tumor -occurs in convexities of the hemisphere and parasagittal region -arises from arachnoid cells external to the brain. Resectable |
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Meningioma histo
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-adult
-spindle cells concentrically arranged in a whorled pattern; psammoma bodies (laminated calcifications) "Adult MEN like it when girls whorl around their psammoma bodies. They also like spiders (arises from arachnoid cells)" |
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Schwannoma
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3rd most common primary brain tumor
-adult -often locaized to CN 8 -resectable -usually found at cerebellopontine angle -S-100 positive "He was 100 years old, couldn't hear and liked watching the SCWANNs" |
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oligodendroglioma
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-adult
-rare, slow growing, most often in frontal lobes (calcifications). Chicken-wire capilary pattern -fried egg cells "Olga the adult chicken had large eggs so she always had to be the front chicken" |
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pituitary adenoma
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-adult
-MC = prolactinoma -Rathke's pouch |
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Pilocytic (low grade astrocytoma)
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-children
-Usually well circumscribed -posterior fossa or supratentorial -GFAP (+) -Benign, good prognosis "Rose, a benign child, would thaw the snow by PIIng in a corkscrew motion. She would make a well-circumscribe shape and she though she was ghetto-fab" |
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Pilocytic (low grade astrocytoma) histo
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rosenthal fibers (eosionphilic corkscrew fibers. Cystic + solid (gross)
"Rose, a benign child, would thaw the snow by PIIng in a corkscrew motion. She would make a well-circumscribe shape and she though she was ghetto-fab" |
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medullo-blastoma
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children
-malignant cerebellar tumor. -form of primitive neuroectoderm tumor (PNET) -can compress the 4th ventricle "Homer Wright was always MEDDLING. He liked ROSE but he was a highly malignant child. He would draw BLUE CIRCLES on her, hack into the NET and pretend like he was her brother in 4th grade" |
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medullo-blastoma histo
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-Rosettes or perivascular pseudoreosette pattern of cells
-solid (gross), small blue cells (histology). Radiosensitive "Homer Wright was always MEDDLING. He liked ROSE but he was a highly malignant child. He would draw BLUE CIRCLES on her, hack into the NET and pretend like he was her brother in 4th grade" |
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Ependymal cell tumors
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children
-4th ventricle can cause hydrocephalus -poor prognosis |
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Ependymal cell tumors histo
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-perivascular pseudorosettes
-GFAB -rod-shaped blepharoplasts (basal ciliary bodies) found near nucleus |
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hemangioblastoma
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-children
-most often cerebellar; a/w von Hippel-lindau syndrome when found with retinal angiomas. Can produce EPO--> secondary polycythemia |
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hemangioblastoma histo
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foamy cells and high vascularity
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Craniopharygioma
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-childhood
-benign childhood tumor, confused with pitutary adenoma (can also cause bitemporal hemianopia) most common childhood supratentorial tumor |
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Craniopharygioma histo
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-Derived from remnants of rathke's pouch
-calcifications is common (tooth enamel-like) |
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Arnold Chiari
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Caudal extension of medulla and cerebellar vermis through foramen magnum
2. Noncommunicaiing hydrocephalus 3. Platybasia (flattening of base of skull) 4. A/w Meningomyelocele, Syringomyelia 5. Treatment = Decompression surgery |
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Dandy walker
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Partial or complete absence of the cerebellar vermis
2. Cystic dilation of fourth ventricle 3. Non communicating hydrocephalus 4. Treatment • Shunt to treat hydrocephalus |
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location of synthesis of NE?
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locus ceruleus
"NEel before locus ceruleus" |
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location of synthesis of Dopamine?
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Ventral tegmentum and SNc
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location of synthesis of 5-HT
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ralphe nucleus
"Ralph was a really happy guy" |
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location of synthesis of ACh?
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Basal nucleus of meynert
"Mey I? ACHOO" |
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Location of synthesis of GABA?
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Nucleus accumbens
"succumb to the gabby woman" |
