Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
93 Cards in this Set
- Front
- Back
|
What CNS lesion has a "popcorn" appearance on MRI FLAIR?
|
Cavernous hemangioma
|
|
|
What is a way to tell the difference between cavernous hemangioma and arteriovenous malformation by histology?
|
Cavernous hemangioma has no intervening brain parenchyma between vessels while AVM has intervening brain parenchyma.
|
|
|
Most common locations for berry aneurysms?
|
Anterior communicating > posterior communicating > middle cerebral
|
|
|
What is the first 3 most common causes of death?
|
1. Heart disease
2. Cancer 3. Stroke |
|
|
What percentage of strokes are occlusive vs. hemorrhagic? Which is more lethal?
|
Occlusive = 80%
Hemorrhagic = 20% Hemorrhagic is more lethal |
|
|
Which cells are most sensitive to hypoxia? (4)
|
1. Hippocampal pyramidal cells of C1
2. Pyramidal neocortical neurons (layers 3, 5, 6) 3. Purkinje cells 4. Striatal neurons |
|
|
What regions of the brain are most sensitive to hypoxia? (5)
|
Most to least sensitive to hypoxia:
1. Cerebral cortex 2. Corpus striatum 3. Thalamus 4. Brainstem 5. Spinal cord |
|
|
What are the locations for lacunar infarct? (4)
|
Basal ganglia
Thalamus Gray-white matter junction Brainstem |
|
|
Timeline of a cerebral infarct:
Eosinophilic neurons, shrunken nuclei, neuronal dropout. |
6-12 hours
|
|
|
Timeline of a cerebral infarct:
Neutrophils, vacuolation of white matter. |
1-2 days
|
|
|
Timeline of a cerebral infarct:
Beginning of macrophage infiltrate. |
3-5 days
|
|
|
Timeline of a cerebral infarct:
Maximum macrophage infiltrate gliosis. |
1-3 weeks
|
|
|
Timeline of a cerebral infarct:
Dissolution of tissue, cavitation (macrophages may persist) |
weeks to years
|
|
|
This hemorrhage is due to tear of the meningeal arteries, most often due to trauma.
|
Epidural
|
|
|
This hemorrhage is due to tear of the bridging veins, most often due to trauma.
|
Subdural
|
|
|
This hemorrhage is due to bursting of aneurysm or AVM.
|
Subarachnoid
|
|
|
This hemorrhage is due to hypertension or amyloid angiopathy.
|
Intraparenchymal
|
|
|
This hemorrhage occurs in permature babies secondary to perinatal hypoxic injury involves bleeding of the germinal matrix.
|
Intraventricular
|
|
|
What type of amyloid is found in Alzheimer's disease?
|
beta-amyloid
|
|
|
Familial forms of Alzheimer's disease has to do with mutations of what gene on what chromosome?
|
Amyloid precursor protein (APP) gene on chromosome 21
|
|
|
Meningitis in what population?
Haemophilus influenza |
Haemophilus influenza: all ages
|
|
|
Meningitis in what population?
Streptococcus pneumoniae |
Streptococcus pneumoniae: adults
|
|
|
Meningitis in what population?
Neisseria meningitidis |
Neisseria meningitidis: children/young adults
|
|
|
Meningitis in what population?
Group B streptococci |
Group B streptococci: neonates
|
|
|
Meningitis in what population?
Escherichia coli |
Escherichia coli: neonates
|
|
|
Meningitis in what population?
Listeria monocytogenes |
Listeria monocytogenes: neonates, adults
|
|
|
What is the most common pediatric brain tumor? Where is the most common location of this tumor?
|
Pilocytic astrocytoma, most commonly in the cerebellum
|
|
|
What grade are pleomorphic xanthoastrocytoma?
|
WHO Grade 2
|
|
|
What syndrome is associated with subependymal giant cell astrocytoma?
|
Tuberous sclerosis
|
|
|
Most common locations for ependymoma?
|
Cerebellum = 4th ventricle or vermis
|
|
|
What WHO Grade are ependymoma and myxopapillary ependymoma?
|
Ependymoma = WHO Grade 2
Myxopapillary ependymom = WHO Grade 1 NOTE: Anaplastic ependymom is WHO Grade 3 and there is no WHO Grade 4. |
|
|
What is the location for myxopapillary ependymoma?
|
lower spinal cord
|
|
|
What is the location for subependymoma?
|
Anywhere in the intraventricular system and spinal cord
|
|
|
This lesion most commonly involves the temporal lobe and is associated with seizures. It is circumscribed and shows both glial and ganglionic elements.
|
Ganglioglioma
|
|
|
This lesion is cortically based with radiology showing bone erosion. This tumor is composed of well-differentiated neuroepithelial cells arranged along vascular structures and "floating" neurons. The histological architecture is typically nodular within cortical or subcortical regions. It is associated with seizures wand often coexists with cortical dysplasia.
|
Dysembryoplastic neuroepithelial tumor
|
|
|
Location for medulloblastoma.
|
Cerebellum/posterior fossa, vermis
|
|
|
Most common genetic abnormality in medulloblastoma? The presence of what gene amplification carries a poor prognosis?
|
Most common abnormality: isochromosome 17q
Poor prognosis: myc amplificaiton |
|
|
Which subtypes of meningioma are WHO Grade 2? What defines an atypical meningioma?
|
Subtypes:
Clear cell Chordoid Atypical Def Atypical: > 4 mites/10 HPF Brain parenchymal invasion 3 or more of the following: - small cell morphology - sheeting - high N/C ratio - geographic necrosis - prominent nucleoli |
|
|
Which subtypes of meningioma are WHO Grade 3? What defines anaplastic meningioma?
|
Subtypes:
Rhabdoid Papillary Anaplastic Def Anaplastic: - >20 mites/10 HPF - appearance of high grade sarcoma |
|
|
Hemangiopericytoma IHC:
CD34 BCL-2 EMA S100 GFA CD99 |
Hemangiopericytoma IHC:
CD34 + BCL-2 + EMA - S100 - GFA - CD99 + |
|
|
Location of Rathke cleft cyst?
|
Intrasellar
|
|
|
Location of epidermoid cyst?
|
Base of skull or cerebellar
|
|
|
Location of dermoid cyst?
|
Midline
|
|
|
Metastatic tumors to brain from most common to least common?
|
1. Pulmonary
2. Breast 3. Melanoma 4. Unknown 5. GI 6. GU |
|
|
Metastatic tumors to spinal cord from most to least common?
|
1. Breast
2. Pulmonary 3. Prostate 4. Lymphoma |
|
|
Which CNS tumor is associated with VHL?
|
Hemangioblastoma
|
|
|
Which CNS tumors are associated with Turcot syndrome? What are other features of Turcot syndrome?
|
Turcot Syndrome:
- colonic polyps and/or carcinoma - cranofacial exostosis - Medulloblastoma (APC 5q21-22) - Glioblastoma (MLH1 3p21; PMS2 7q) |
|
|
What CNS tumors are associated with NF2?
|
Meningioma, acoustic neuroma (Schwannomas), ependymomas, astrocytomas
|
|
|
What CNS tumor is associated with Gorlin syndrome?
|
Medulloblastoma
Gorlin Syndrome = Nevoid basal cell carcinoma syndrome: - BCCs - OKC - Medulloblastoma - Germline mutation of hte PTCH gene 9q22.3 |
|
|
What gene is mutated in NF1 and NF2.
|
NF1: neurofibromin 17q11.2
NF2: merlin 22q12 |
|
|
What is the mechanism of central pontine myelinolysis?
|
Rapid correction of serum hyponatremia
|
|
|
What is a cephalocele? Meningocele? Encephalocele?
|
Cephalocele: Defect in the dura and cranium with herniation.
Meningocele: type of cephalocele with herniation of meninges only Encephalocele: type of cephalocele with herniation of brain and meninges |
|
|
In the setting of anencephaly, AFP is ____ and there is ____hydramnios.
|
In the setting of anencephaly, AFP is HIGH and there is POLYhydramnios.
|
|
|
What is holoprosencephaly?
|
Failure to separate into hemispheres
|
|
|
What is the Dandy Walker malformation?
|
Defective development of the roof of the fourth ventricle.
|
|
|
What is schizencephaly?
|
Gray matter extension from the ventricle to the cortex with direct communication of the ependymal surface with cortical leptomeninges.
|
|
|
What is lissencephaly?
|
Smooth brain
NOTE: Acquired from CMV invection or inherited |
|
|
What is the defective protein in Canavan's disease? What gene? DX?
|
Canavan's Disease:
Protein: aspartoacylase deficiency Gene: ASPA 17pter-p13 DX: hihg N-acetyl aspartic acid in urine |
|
|
What is the defective protein in Krabbe's disease? What gene? DX?
|
Krabbe's disease:
Protein: galactocerebrosidase (GALC) deficiency Gene: GALC 14q31 DX: Deficient enzyme in WBC or skin fibroblasts |
|
|
What is porencephaly?
|
Big cyst in the brain lined by gliotic what matter due to neonatal infarct or trauma.
|
|
|
Pick's disease affects what part of the brain? When familial, what gene is involved?
|
Picks: frontal and temporal lobes
Gene: tau protein (17q) |
|
|
Huntingtons disease:
Pattern of inheritance Age of onset Gross findings Gene |
Huntingtons disease:
Pattern of inheritance: AD Age of onset: 4th decade Gross findings: basal ganglia (caudate, putamen) and coritcal atrophy Gene: HD gene 4p with CAG expansion |
|
|
Parkinson disease is associated with what neurotransmitter at what pathway? Gross finding?
|
Parkinson:
NT: dopamine Pathway: Nigrostriatal dopamine pathway Gross: depigmentation of substantia nigra and locus ceruleus |
|
|
Niemann-Pick disease is due to deficiency of what enzyme?
|
Sphingomyelinase
|
|
|
What type of fracture?
Raccoon eyes |
Raccoon eyes: Anterior fossa
|
|
|
What type of fracture?
CSF rhinorrhea |
CSF rhinorrhea: Anterior fossa
|
|
|
What type of fracture?
Battle sign (blood over mastoid) |
Battle sign (blood over mastoid): middle fossa
NOTE: also often involves CN 3, 4, and 6 |
|
|
What type of fracture?
Results from fall from height |
Fall from height: ring fracture
|
|
|
This infection can be associated with acute hemorrhagic encephalitis involving one or both temporal lobes.
|
HSV
|
|
|
Negri bodies in Purkinje cells and hippocampal neurons may be seen in this infection.
|
Rabies
|
|
|
This virus which causes progressive multifocal leukoencephalopathy mostly in AIDS patients attacks what cells?
|
JC virus attacks oligodendroglia causing demyelination.
|
|
|
This infection causes basilar meningitis or intraparenchymal granulomas.
|
Histoplasma
|
|
|
Changes seen in this disease include spongy change, vascular hyperplasia and hemorrhage in the mammillary bodies, dorsal thalamus, hypothalamus and periaqueductal gray matter.
|
Wernicke's encephalopathy
|
|
|
IHC of JC virus?
|
SV40 T antigen (will cross-react with papovavirus) highlight viral inclusions in oligodendorcyte nuclei.
|
|
|
Common mutations:
Medulloblastoma |
1. Isochromosome 17q (most common)
2. PTCH (pathced gene) 9q22.3 found in Gorlin syndrome 3. MYC amplification (poor prognosis) |
|
|
Common mutations:
Glioblastoma |
EGFR amplification
|
|
|
Major protein in Lewy bodies?
|
alpha-synuclein
|
|
|
Organism that causes neurocysticercosis?
|
Taenia solium
NOTE: Neurocysticercosis comes from ingestion of eggs which become larvae in the gut, penetrate walls and go disperse through the body. Ingestion of cysts result in tapeworm in gut but no disseminated disease. |
|
|
Duret hemorrhages are what?
|
Duret hemorrhages: hemorrhage in pons due to uncal herniation
|
|
|
What axons are lost in tertiary syphilis?
|
Dorsal columns
|
|
|
In Alzheimer disease, nueorfibrillary tangles are made of what protein? What about plaques?
|
Tangles: tau
Plaques: beta-amyloid |
|
|
These enlarged astrocytes with lucent nuclei can be seen in association with many liver diseases including posthepatic and alcoholic cirrhosis, Rey's syndrome, and urea cycle enzyme deficiencies. These cells are never associated with Alzheimer disease.
|
Alzheimer type 2 astrocytes
|
|
|
What brain abnormality is seen in Wilson's disease?
|
Degeneration of basal ganglia
|
|
|
What brian abnormality is seen in Huntington's disease?
|
Loss of neurons in the striatum = caudate and putamen.
|
|
|
What CNS abnormality is seen in B12 deificiency?
|
Myelinopathy of the spinal cord
|
|
|
What histology is seen in toxoplasmosis?
|
Tissue cysts containing tachyzoites
|
|
|
What cells are involved?
CMV infection |
Ependymal cells
|
|
|
What cells are involved?
HIV |
cerebral microglial/monocyte/macrophage
|
|
|
What cells are involved?
JC |
Oligodendorytes, some astrocytes
|
|
|
What cells are involved?
HSV1 |
Cortical neurons
|
|
|
What cells are involved?
Rabies |
Neurons of hippocampus pyramidal cells, cerebral cortex, and Purkinje cells
|
|
|
What blood test finding for adrenoleukodystrophy?
|
increased long chain fatty acid levels
NOTE: can be found in tissue or serum |
|
|
What blood test finding for metachromatic leukodystrophy?
|
low sulfatase levels
|
