Pathology: Cns

Front 1

Forms the falx cerebri and the tentorium

cerebelli

Back 1

Dura mater

Front 2

Delicate, weblike membrane beneath dura mater

Back 2

Arachnoid

Front 3

Tightly adherent to the brain

Back 3

Pia mater

Front 4

Nerve cells =

Back 4

Neurons

Front 5

Support cells =

Back 5

Macroglia

Front 6

Astrocytes, oligodendrocyte, and ependymal cells are types of....

Back 6

Macroglia

Front 7

Main support cells in the brain

Back 7

Astrocytes

Front 8

Produce myelin

Back 8

Oligodendrocytes

Front 9

Line the ventricles

Form Choroid plexus

Secretes Cerebrospinal fluid

Back 9

Ependymal cells

Front 10

Antigen-presenting cells

Back 10

Microglia

Front 11

Monocytes/macrophages of the brain

(phagocytosis)

Back 11

Microglia

Front 12

Intracranial pressure can be caused by.....

Back 12

1. Cerebral edema

2. Hydrocephalus

3. Intracranial hemorrhage

4. Tumors/neoplasms

Front 13

Clinical signs and symptoms:

1. severe headaches

2. vomiting

3. Reduced level of consciousness or coma

4. HTN and slow pulse (Cushing's reflex)

Back 13

Intracranial pressure

Front 14

Cheyne-Stokes respirations

Dilated non-responsive pupils

Spasticity

Death

Back 14

Brainstem compression (elevated ICP)

Front 15

Progressively deeper breathing, then apnea, then repeats

Back 15

Cheyne-Stokes respirations

Front 16

Increased fluid/water content in the brain

Back 16

Cerebral edema

Front 17

Causes:

1. Ischemia

2. Trauma

3. Inflammation

4. metabolic disturbances

5. high altitude

Back 17

Cerebral edema

Front 18

Types of Cerebral edema

Back 18

1. Vasogenic

2. Cytotoxic

Front 19

Integrity of the blood-brain barrier is disrupted

Back 19

Vasogenic (cerebral edema)

Front 20

Intracellular fluid increase from injury or toxins

Back 20

Cytotoxic (cerebral edema)

Front 21

Excessive CSF within the ventricles of the brain

Back 21

Hydrocephalus

Front 22

Most causes of hydrocephalus are a result of.....

Back 22

1. Decreased reabsorption of CSF

2. Increased production of CSF

Front 23

Hydrocephalus could be caused by.....

Back 23

Obstruction

Front 24

Result of Hydrocephalus in children

Back 24

Enlargement of the head

Front 25

Result of Hydrocephalus in adults

Back 25

Enlargement of ventricles and increased

intracranial pressure

Front 26

Dilation of the ventricles w/ increase in CSF

secondary to brain atrophy

Back 26

Hydrocephalus ex vacuo

Front 27

Herniation can occur as a result of....

Back 27

Increase in intracranial pressure

Front 28

Herniation is less common in....

Back 28

young children

Front 29

Types of Herniation

Back 29

1. Subfalcine

2. Transtentorial

3. Tonsillar (life threatening)

Front 30

Three main mechanisms for Cerebrovascular

disease in the brain:

Back 30

1. Thrombotic occlusion

2. Embolic occlusion

3. Vascular rupture

Front 31

All three mechanisms of Cerebrovasculardisease in the brain can clinically present as....

Back 31

"Stroke"

Front 32

High altitude

Impaired oxygen-carrying capacity

Inhibition of oxygen use (eg. cyanide poisoning)

Back 32

Functional hypoxia

Front 33

Tissue hypoperfusion

Caused by hypotension and vascular occlusion

Back 33

Ischemia

Front 34

Sever systemic hypotension

Maybe just confusion, with recovery

Sever: neurons die --> (vegetative state)

Back 34

Global Cerebral Ischemia

Front 35

Cerebral artery occlusion initially leads to.....

Back 35

Focal Cerebral Ischemia

Front 36

Collateral flow (circle of Willis) can limit damage

Back 36

Focal Cerebral Ischemia

Front 37

What's more common: embolic infarcts or thrombolic infarcts?

Back 37

Embolic infarcts

Front 38

Typically in presence of atherosclerotic plaques and stenosis.

Back 38

Focal Cerebral Ischemia

Front 39

Treated w/ thrombolytics

Back 39

Non-hemorrhagic infarcts

Front 40

Re-perfussion of ischemic tissue

Leads to multiple small hemorrhages

Back 40

Hemorrhagic infarcts

Front 41

Occurs when blood supply to the brain is interrupted (occlusion or hemorrhage)

Back 41

Cerebrovascular Accident ("stroke", CVA)

Front 42

Signs and symptoms:

1. Severe headache

2. Dizziness

3. Slurred speech

4. Weakness/numbness (unilateral)

5. Visual disturbances

Back 42

Cerebrovascular Accident ("stroke", CVA)

Front 43

Most common cause of stroke

Back 43

Infarct

Front 44

Most Infarcts are due to....

Back 44

Cerebral atherosclerosis

Front 45

Increased risk:

1. Diabetes

2. Smokers

3. Hypertension

Back 45

Infarct

Front 46

TIAs (Transient Ischemic Attacks) are important predictors of......

Back 46

Infarcts

Front 47

Most common cause of Intracranial

hemorrhage

Back 47

Hypertension

Front 48

Other causes:

1. coagulation disorder

2. neoplasms

3. open heart surgery

4. Berry aneurysm

Back 48

Intracranial hemorrhage

Front 49

Increased intracranial pressure, neck rigidity, brainstem compression

Back 49

Intracranial hemorrhage

Front 50

Most frequent cause of Subarachnoid hemorrhage is.....

Back 50

Saccular (Berry) aneurysm

Front 51

Straining at stool or orgasm

Back 51

Subarachnoid hemorrhage

Front 52

Excruciating headache

Back 52

Subarachnoid hemorrhage

Front 53

Up to 1/2 die from this hemorrhage

Back 53

Subarachnoid hemorrhage

Front 54

Males

Ages 10-30

Seizures, intracerebral hemorrhage, or

subarachnoid hemorrhage

Back 54

Arteriovenous malformation

Front 55

Lacunes

Acute hypersensitive encephalopathy

(diastolic >130mmHg)

Back 55

Hypertensive cerebrovascular disease

Front 56

Inflammatory process

Opportunistic infection in immunosuppressed patients

Back 56

Vasculitis

Front 57

Clinically silent trauma

Back 57

Frontal lobe

Front 58

Severely disabling trauma

Back 58

Spinal cord

Front 59

Fatal trauma

Back 59

Brain stem

Front 60

Coup (site of impact) or countrecoup (opposite side)

Back 60

Traumatic parenchymal injury

Front 61

Coup and countercoup are both....

Back 61

Contusions

Front 62

Crest of sulci are most susceptible in.....

Back 62

Traumatic parenchymal injury

Front 63

Reversible altered consciousness from head

injury, in the absence of contusion.

Back 63

Concussion

Front 64

Loss of consciousness

Temporary respiratory arrest

Loss of reflexes

Back 64

Concussion

Front 65

Neurologic recovery usually complete

Amnesia of event persists

Back 65

Concussion

Front 66

Pathogenesis of Concussion is....

Back 66

Unknown

Front 67

Middle meningeal artery

Back 67

Epidural hematoma

Front 68

Tearing of bridging veins b/w the hemispheres

Back 68

Subdural hematoma

Front 69

Subdural hematoma are more common in....

Back 69

elderly (stretching of veins from brain shrinkage)

Front 70

Abscesses

Back 70

Epidural infections

Front 71

Empyemas

(sinusitis or osteomyelitis)

Back 71

Subdural infestions

Front 72

Brain access

TB

Toxoplasmosis

Encephalitis

Spongiform encephalopathies

Back 72

Parenchymal infections

Front 73

Inflammation of the leptomeninges and

subarachnoid space

Back 73

Leptomeningitis (Meningitis)

Front 74

Meningitis is most commonly due to....

Back 74

infection

Front 75

Pia mater and arachnoid space

Back 75

Leptomeninges

Front 76

3 main types of meningitis:

Back 76

1. Acute purulent (bacterial)

2. Acute lymphocytic (viral)

3. Chronic

Front 77

Usually secondary to spread of a nasopharyngeal infection

Back 77

Acute purulent (bacterial) meningitis

Front 78

CSF: neutrophils

Back 78

Acute purulent (bacterial) meningitis

Front 79

May be associated with encephalitis

Back 79

Acute lymphocytic (viral) meningitis

Front 80

CSF: Lymphocytes

Back 80

Acute lymphocytic (viral) meningitis

Front 81

Usually from bacteria and fungi

Back 81

Chronic meningitis

Front 82

Common agents:

Mycobacterium tuberculosis

Cryptococcus neoformans

Brucella species

Treponema pallidum

Back 82

Chronic meningitis

Front 83

CSF: monocytes, lymphocytes

Back 83

Chronic meningitis

Front 84

Inflammation of the brain

Back 84

Encephalitis

Front 85

Most often viral

Back 85

Encephalitis

Front 86

Most cases are associated with meningitis

Back 86

Encephalitis

Front 87

Most common cause of epidemic encephalitis in Americas

Back 87

Arboviruses

Front 88

Most common cause of sporadic viral

encephalitis in US

Back 88

HSV-1

Front 89

AIDS dementia

Back 89

HIV

Front 90

Types:

1. Sporadic

2. Familial

3. Iatrogenic

4. Variant

Back 90

Prion diseases

Front 91

Characterized by vacuolation of neurons

Back 91

Spongiform encephalopathies

Front 92

Spongiform encephalopathies are caused by

Back 92

Abnormal prion proteins

Front 93

Most common Spongiform encephalopathies

Back 93

Creutzfeldt-Jakob disease

Front 94

variant CJD

Back 94

Mad cow disease

Front 95

Amyloid plaque

Back 95

vCJD

Front 96

85% sporadic

Rapidly-progressive dementia

Back 96

CJD

Front 97

Behavioral disorders

Progressed more slowly

Bovin spongiform encephalopathy

Back 97

vCJD

Front 98

Most common demyelinating disease

Back 98

Multiple sclerosis

Front 99

Autoimmune, with contributing factors

Back 99

Multiple sclerosis

Front 100

Clinical:

1. Visual disturbances

2. paresthesia

3. spasticity

4. speech disturbances

5. gait abnormalities

6. emotional and cognitive changes

Back 100

Multiple sclerosis

Front 101

Atypical facial pain

Back 101

Multiple sclerosis

Front 102

Areas of demyelination

Back 102

Plaques

Front 103

Areas of remyelination

Back 103

Shadow plaques

Front 104

Most common cause of dementia

Back 104

Alzheimer disease

Front 105

Most cases of Alzheimer disease are....

Back 105

Sporadic

Front 106

Defect in processing of amyloid precursor

protein

Back 106

Alzheimer disease

Front 107

Beta-amyloid core and peripheral abnormal tau protein

Back 107

Senile plaques

Front 108

Coarse filaments in the cytoplasm of neurons (tau protein)

Back 108

Neurofibrillary tangles

Front 109

Generalized brain atrophy and dilation of ventricles

Back 109

Alzheimer disease

Front 110

Defect in dopaminergic pathways

Back 110

Parkinson disease

Front 111

"Pill rolling"

Expressionless face

Stooped posture

Back 111

Parkinson disease

Front 112

Loss of melanin-containing neurons in the

substantia nigra

Back 112

Parkinson disease

Front 113

Lewy bodies

Back 113

Parkinson disease

Front 114

Laminated, eosinophilic intracytoplasmic inclusions representing abnormal aggregates of protein (alpha-synuclein)

Back 114

Lewy bodies

Front 115

Disease of extrapyramidal motor system

Back 115

Huntington disease/Chorea

Front 116

Huntington disease/Chorea genetic transmission is....

Back 116

Autosomal dominant

Front 117

Trinucleotide repeat (CAG)

Back 117

Huntington disease/Chorea

Front 118

Paternal transmission associated w/ early onset

Back 118

Huntington disease/Chorea

Front 119

Piano playing finger motion

Facial twitching/grimacing

Back 119

Huntington disease/Chorea

Front 120

Neuropsychiatric disturbances:

Derision

Behavioral changes

Cognitive impairment

Seizures

Dementia

Back 120

Huntington disease/Chorea

Front 121

Degenerative disease of upper motor neurons

Back 121

Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig)

Front 122

Cause of Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig) is.....

Back 122

Unknown

Front 123

Babinski's reflex

Back 123

Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig)

Front 124

1.Astrocytomas

2. Oligodendrogliomas

3. Ependymomas

Back 124

Gliomas

Front 125

Medulloblastoma

Back 125

Primitive neuroectodermal tumors