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53 Cards in this Set

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List the anatomic & physiologic features that are uniques to the CNS?
1. Rigid skull & spinal column = volume of which is fixed after early childhood
2. Autoregulation of Blood flow = cerebral blood flow is regulated to a large extent independently from systemic blood circulation
3. No lymphatic system
4. CSF system
5. Limited immune surveillance = immunologically secluded from the rest of the body
6. Unique response to injury
7. Vulnerability of lack of perfusion
8. Lack of regeneration
Define Vasogenic Edema
accumulation of fluid between the neurons & glia & most prominently in the Virchow-Robin spaces around the blood vessels

Develops as a consequence of BBB dysfunction = fluid escapes from the vascular space into the interstitial space of the parenchyma across the cytoplasm of Endothelial cells
Define Cytotoxic Edema
Fluid accumulates inside cells

Most frequently caused by ischemia &/or hypoxia = lead to hydropic swelling of neurons & glial cells
Define Interstitial Edema
Result of increased bulk of CSF thru the Ependymal lining = dysfunction of the brain-CSF barrier

Typically a complication of Hydrocephalus
What intracranial pressure is associated with edema?
> 200 mm water
What pathologies are seen in Cerebral Edema?
1. Soft brain
2. Flat gyri
3. Narrow slit-like sulci
4. compressed Ventricles
5. possible Herniation
What is a Subfalcine Herniation? What is an alternate name? What artery may be compressed?
Results from a unilateral hemispheric mass lesion that expands the volume of one hemisphere, dislocates the midline structures & forces the ipsilateral Cingulate gyrus to be compressed underneat the FALX CEREBRI

Alternate = Cingulate Herniation

Anterior Cerebral Artery
What is a Transtentorial Herniation? What is an alternate name? What can be compressed & how is it manifested?
Caused by expansion of one or both Supratentorial tissue compartments. Uncus gyri hippocampi is displaced & herniated underneath the free edge of the Tentorium

Alternate = Uncinate Hernia

3rd Cranial nerve = dilation of the Ipsilateral Pupil + abnormal eye movement on the same side
What is a Tonsilar Herniation? What may it cause?
Life-threatening condition b/c the herniated cerebellar tonsils that are forced into the Foramen Magnum compress vital Respiratory & Cardiac centers within the Medulla Oblongata
Duret Hemorrhage
-common with a Trantentorial Herniation
-midbrain with blood
What is seen here?
Midbrain herniation + Oculomotor nerve palsy (eye down & out) + Mydriasis...what herniation?
Transtentorial Herniation
Increase in the CSF volume that causes enlargement of the Ventricles
Hydrocephalus
What makes the CSF?
Choroid Plexus
How is Hydrocephalus manifested in Newborns before the closure of Sutures?
Ventricles dilate & enlarge the head circumference
What is "Hydrocephalus Ex Vacuo?
Dilated appearance of the ventricles when the brain mass is decreased

Ex. Alzheimer's disease
Hydrocephalus
What are these pictures showing?
Describe the flow of CSF
1. Choroid Plexus
2. Lateral Ventricles
3. Interventricular Foramen (Foramen of Monroe)
4. Third Ventricle
5. Cerebral Aqueduct (Aqueduct of Sylvius)
6. Fourth Ventricle
7. Foramen of Magendie & Luschka
8. Subarachnoid Space over brain & Spinal Cord
9. Reabsorption into Venous Sinus blood via Arachnoid Granulations
What things cause Focal Lesions?
Tumor
Infarct
Abscess
What things typically cause Multifocal lesions? (3)
1. Metastases

2. Small infarcts

3. Abscesses
System Degeneration
-typically slowly progressive
-Ex: Motor Neuron Disease (ALS)
What generally is this showing?
Diffuse Disorder
-Neuronal = Lysosomal storage disease
-White Matter = Leukodystrophy
What generally is this showing? What could be possible causes?
List the types of Glia found in the CNS
1. Astrocytes
2. Oligodendrocytes
3. Ependymal cells
4. Microglia
Material consisting of granular Endoplasmic Reticulum & Ribosomes & occuring in nerve cell bodies & dendrites
Nissl Substance
any of the long, thin, microscopic fibrils that run through the body of a neuron and extend into the axon and dendrites
Neurofibrils
cytoplasmic Nissl Substance within neuron
What does this picture exemplify?
Cerebellar cortex showing large Purkinje cells and smaller dark granule cell neurons (at lower right).
What cells are seen in this picture?
What are 2 unique principles of Neurons?
1. Selective vulnerability = very sensitive to Ischemia

2. Post-mitotic cells = no regeneration
What pathology is seen during Acute Injury of neurons? What most commonly causes it?
Pynknotic nuclei & an acidophilic cytoplasm = Red neuron

Ischemia, Anoxia, Hypoglycemia
What things occur in the process of "Axonal Reaction"?
1. Perikaryon swells
2. Chromatolysis = degranulation of Nissl Substance (RER) -> loss of basophilia
What is Wallerian Degeneration?
degeneration of nerve fibers Distal to the injury
What is Transsynaptic Degeneration?
Atrophy of nerve cells due to loss of input
Neuromelanin

Lipofuscin = 'wear & tear' pigment
What is the white arrow pointing at? What is seen within the cytoplasm of some cells?
Neurofibrillary Tangle in Hippocampal CA1 neuron
What is seen here?
Lewy bodies = Parkinson Disease
What are the arrows pointing at?
Which Glia are derived from the Neuroectoderm?

Which Glia is derived from the Mesoderm?
Astrocytes
Oligodendrocytes
Ependymal cells

Microglia
Glial that are in close contact with neurons & have small oval nuclei with star-like processes
Astrocytes
Glia that have cytoplasmic extensions that attach to blood vessels, forming part of the BBB
Astrocytes
Glia that contain "Glial Fibrillary Acidic Protein" (GFAP)
Astrocytes
What is another term for Gliosis?
Astrocytosis
Reactive Gliosis (Astrocytosis)
-pink-staining cells
What is seen here?
Reactive Astrocytosis
What is seen here?
Gemistocytes
-a form of Astrocytosis
What is seen here?
Metabolic Astrocyte
-clear nuclei in Cerebral Cortex
-stimulated to proliferate when there is some sort of metabolic disease occurring
What is the arrow pointing at?
Rosenthal Fiber
-usually seen in chronic disease
-often seen around old sites of injury
What is the arrow pointing at?
Corpora Amylacea = inclusions within Astrocytes
-seen in aging
-gliosis
What are seen here?
What are the properties of Oligodendrocytes?
1. few processes
2. small dark round nuclei
3. make, maintain myelin
-1 Oligo: wraps up to 50 axons
4. Injury: myelin loss or abnormal myelin
5. Tumors: Oligodendrogliomas
Oligodendrocyte in normal White Matter
What is the arrow pointing at?
Columnar ciliated cells lining the Ventricular System
Ependymal cells
Normal Ependymal cells with cilia
What is seen here?
Patchy Ependymal loss - when they are injured, they don't come back
What important property of Ependymal cells is exemplified here?
Choroid Plexus

Secrete CSF
What cells are seen here? What is their functinon?
Phagocytic cells of mesenchymal origin of the CNS
Microglia
Microglial Nodule
-elongated rods, club-shaped
What is seen here?