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Pathology_4 01: Neuro

Pathology_4 01: Neuro

by rhymenoceros, Jul. 2009

Subjects: 01 neuro pathology-4

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	___ is the commonest cause of dementia	AD
	AD causes ___% of dementia	50-75
	5 kinds of AD	sporadic late onset familial early onset familial late onset down syndrome associated other-degeneration associated
	familial __ onset AD is rare	early
	AD presents first with ___, then progresses to ___ lobe dysfunction with ___ (2)	memory problems parietal dysphasia dyspraxia
	late stage AD causes ___ (2)	immobility muteness
	regions of brain spared by AD	occipital lobe motor cortex
	cortex in AD is generally ___	thin
	AD pattern of atrophy is ___	nonspecific
	5 histopath findings in AD	amyloid plaques neurofibrillary tangles amyloid angiopathy granulovacuolar degeneration hirano bodies
	amyloid plaques are aka ___ (2) plaques. they are composed of ___. they are intra/extracellular	neuritic senile Abeta peptide extracellular
	2 kinds of amyloid plaques	diffuse mature
	mature plaques contain ___ (2), but diffuse plaques only contain ___	Abeta dystrophic neurites Abeta
	neurofibrillary tangles are composed of ___, which is a ___. they are intra/extracellular	hyperphosphorylated tau microtubule-associated protein intracellular
	NFTs are commonly found in ___ neurons	cortical
	NFTs are visible in H&E stain as ___ in cytoplasm	extra basophilia
	plaques and NFTs are best seen with ___ stain	Bielschowsky
	Abeta is derived from ___	APP
	When APP is cleaved by ___, Abeta is not formed. When it is cleaved by ___ (2), it is.	alpha secretase beta secretase gamma secretase
	beta secretase cleaves APP at ___	N terminal
	pathogenic Abeta has ___ AAs. normals have a longer/shorter Abeta in their CSF.	42 or 43 shorter
	tau in NFTs is hyperphosphorylated because	tau phosphatase isn't working
	degree of dementia correlates better with # of ___ than with # of ___.	NFTs plaques
	APP gene is on chromosome ___	21
	T/F: mutant APP can cause increased Abeta production	true
	early onset familial AD is caused by mutation of ___ (2), which are components of ___.	presenilin 1 presenilin 2 gamma secretase
	presenilin 1 is on chromosome ___	14
	allele ___ of ApoE protein increases risk of AD and reduces ___.	epsilon4 age of onset
	all of the changes in AD are present in normals but ___	to a lesser degree
	DLB is ___.	dementia with Lewy bodies
	in DLB Lewy bodies are present in ___ (2). they are intra/extracellular	cortex substantia nigra intracellular
	Lewy bodies can be stained for ___ (2)	ubiquitin alpha-synuclein
	60-80% of DLB has ___ (2)	amyloid plaques NFTs
	with H&E Lewy bodies appear as ___	hyaline ovals
	anatomical change in Pick disease	fronto-temporal lobar atrophy
	pick cells contain ___, which contain ___.	pick bodies tau
	2 viruses implicated in MS	HHV6 measles
	MS autoimmunity is triggered when ___ cells release ___ to activate ___, which ___.	CD4 T cells IFNg MQs eat myelin
	4 kinds of MS	classic acute neuromyelitis optica concentric sclerosis
	T/F: MS plaques can occur in grey matter	true
	___ is a stain for myelin	gluxol fast blue
	active MS plaques have infiltration by ___ (2). ___ are preserved and ___ are depleted.	lymphocytes MQs axons oligodendrocytes
	myelin inside MQs can be stained with ___, which stains ___.	sudan red fat
	inactive MS plaques have reduced ___ (2) and increased ___.	oligodendrocytes axons astrocytes
	degenerating axons are ___er	thick
	shadow plaques are intermediate regions where partial ___ or ___ has occured	remyelination demyelination
	MS plaques can simulate ___, esp ___	tumor astrocytoma
	___ is the 3rd leading cause of death in US. the 2 main kinds are ___ (2).	cerebrovascular disease ischemic hemorrhagic
	2 kinds of ischemic event	thrombosis embolism
	2 kinds of hemorrhagic event	hypertensive hemorrhage aneurysm rupture
	global cerebral ischemia is usually from	shock
	8 brain regions in decreasing order of sensitivity to hypoxia	hippocampus cerebral neocortex cerebellum thalamus basal ganglia brain stem HTh SC
	___ region aka ___ is most sensitive area of hippocampus	CA1 sommer sector
	neurons in layers ___ (2) are most sensitive parts of cortex	3 5
	in cerebellum, ___ cells are most sensitive	Purkinje
	brains of ventilated brain-dead pts undergo a ___ process which causes ___.	autolytic respirator brain
	early changes in global ischemia occur over ___. ____s are characteristic	12-24 h red neuron
	subacute changes in global ischemia occur over ___, and include ___ (3)	24h--2 weeks necrosis MQ influx vascular proliferation
	repair phase of global ischemia occurs at ___ and includes ___ (2)	2 weeks removal of necrotic tissue reactive gliosis
	in red neurons ___ is missing	distinction between nucleus and cytoplasm
	border zone aka ___ infarctions occur at ___ regions of arterial supply. a high risk area is ___. these infarcts are caused by ___.	watershed most distal between ACA and MCA hypotensive episodes
	2 causes of focal ischemia	thrombosis embolism
	thrombosis is usually caused by ___, which is most prominent at ___ (2).	atherosclerosis carotid bifurcation MCA
	3 non-atherosclerotic causes of thrombosis	1' angiitis of CNS cerebral AD arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) cerebral amyloid angiopathy
	CADASIL is caused by mutation in ___	Notch3
	most common source of embolism to brain is ___	mural thrombus
	3 causes of mural thrombi	MI valvular disease AF
	less commonly emboli to brain can come from	atherosclerotic plaques in carotids
	red infarcts are caused by ___, pale infarcts by ___.	emboli thrombi
	hemorrhage from embolism is caused by ___	reperfusion
	3 phases of GROSS infarct pathology	softening/discoloration edema/marked discoloration liquefactive necrosis
	softening and discoloration happen at ___	12--36 h
	edema and marked discoloration happen at ___	2--3 days
	4 phases of MICRO infarct pathology	red neuron formation neutrophilic infiltration MQs and microglia astrocytic proliferation
	red neuron formation happens at ___	1--4 days
	neutrophilic infiltration happens at ___	up to 48 h
	MQ and microglial dominance happens at ___	48h--2 or 3 weeks
	in an early infarction the white matter appears ___ (2)	edematous expanded
	intracerebral spontaneous hemorrhage happens around age ___ and is most commonly caused by ___. it is also caused by ___, such as ___.	60 HTN coagulation disorders ITP
	hypertensive hemorrhage usually happens in ___ (3)	putamen pons thalamus
	tissue surrounding cavity after a hemorrhage is often colored by ___	hemosiderin
	most common cause of subarachnoid hemorrhage is ___	ruptured berry aneurysm
	berry aneurysms are present in ___% of people, mostly in the ___ circulation	2 anterior
	berry aneurysms are associated with ___ (4)	ADPKD Ehlers-Danlos IV neurofibromatosis I Marfan's
	berry aneurysm rupture is more common in men/women in __th decade	women 5
	in SAH blood is present between brain and ___	leptomeningus
	aneurysms lack ___	elastic fibers
	most meningitis is inflammation of pachy/leptomeninges	lepto
	3 kinds of meningitis	acute aseptic chronic
	2 main causes of acute bacterial meningitis in neonates	E. coli group B strep
	main species of group B strep	S. agalactiae
	2 main causes of acute bacterial meningitis in elderly	S. pneumoniae Listeria
	main cause of acute bacterial meningitis in young adults	N. meningitidis
	___ (2) can cause acute bacterial meningitis in immunocompromised	Klebsiella anaerobes
	H. influenzae causes a ___ exudate, pneumococci a ___ one	basal convexital
	organization of purulent infiltrate can cause ___	obstruction of CSF flow
	2 main bacteria causing brain abcess	Strep Staph
	3 modes of spread of brain abcess	implantation local spread hematogenous
	2 sources of abcess via local spread	sinusitis mastoiditis
	3 most common locations for brain abcess	frontal lobe parietal lobe cerebellum
	4 layers of brain abcess from inside to out	purulent exudate membrana pyogenica with granulation tissue scar reactive gliosis
	tuberculous meningoencephalitis causes a ___ exudate on ___ of brain with ___ granules on ___	gelatinous base white leptomeninges
	vascular changes in tuberculous meningoencephalitis this may cause ___	obliterative endarteritis brain infarct
	if tuberculous meningoencephalitis is long-standing, ___ can develop, causing ___	fibrous arachnoiditis hydrocephalus
	3 histopath findings in viral CNS infection	viral inclusion bodies neuronophagia microglial nodules
	neuronophagia means	microglia ate neurons
	___ causes the most common form of acute necrotizing encephalitis. this mostly damages ___	HSV1 MTL inferior brain
	HSV1 causes ___ inclusion bodies	cowdry type A
	CMV causes ___ (3) in fetuses	periventricular necrosis periventricular calcification microcephaly
	CMV causes ___ (2) in immunosuppressed. these are ___ infections	necrotizing hemorrhagic ventriculoencephalitis choroid plexitis subacute
	when CMV involves SC and roots it causes ___	radiculoneuritis
	HIV subacute encephalitis presents with ___	AIDS dementia complex
	4 histopath findings in HIV subacute encephalitis	microglial nodules giant cells necrosis reactive gliosis
	blood vessels in HIV subacute encephalitis have	prominent endothelial cells foamy MQs
	HIV subacute encephalitis changes occur in ___ (3)	white matter diencephalon brain stem
	progressive multifocal leukoencephalopathy is caused by ___, which infects ___ and causes ___.	JC polyomavirus oligodendrocytes demyelination
	PML occurs in ___ pts	immunosuppressed
	PML causes ___ demyelination in ___ (3)	irregular cerebrum brainstem cerebellum
	oligodendrocytes in PML lesion have ___ (2) nuclei with ___	glassy large viral inclusions
	___ astrocytes may be present in PML and not in MS	giant
	4 kinds of brain tumors	glioma meningioma neuronal tumors poorly differentiated
	3 kinds of glioma	astrocytoma oligodendroglioma ependymoma
	3 kinds of astrocytoma	well-differentiated anaplastic glioblastoma
	top 4 intracranial tumors overall	glioblastoma/anaplastic astrocytoma meningioma other well-diff astrocytoma
	top 4 intracranial tumors, age over 15	glioblastoma/anaplastic astrocytoma meningioma/nerve sheath other well-diff astrocytoma
	top 3 intracranial tumors, age <15	well-diff astrocytoma primitive neuroectodermal tumor (PNET) other
	___s are 80% of adult 1' brain tumors. they occur most commonly in ___.	astrocytoma cerebral hemispheres
	astrocytomas stain for ___. their malignant potential can be measured with ___ staining, which labels ___.	glial fibrillary acidic protein (GFAP) Ki67 dividing cells
	tumors which take up radiocontrast are more/less malignant	more
	4 grades of astrocytoma	pilocytic fibrillary diffuse anaplastic glioblastoma
	pilocytic astrocytomas occur most commonly in ___. they are benign/malignant and have ___ fibers.	cerebellum benign Rosenthal
	fibrillary astrocytoma has high/low Ki67 index cellularity is high/low and atypia is high/low.	low high low
	gemistocytic astrocytomas are grade ___ or ___. their cells are large/small and more ___philic	2 3 large eosino
	glioblastoma has the features of ___ plus ___ (2)	anaplastic astrocytoma necrosis endothelial/vascular proliferation
	necrosis in glioblastoma is surrounded by ___	pseudopalisading cells
	endothelial proliferation in glioblastoma is caused by ___ produced by tumor	VEGF
	pseudopalisading is caused by release of ___ by ___	growth factors dying cells
	2 early mutations in astrocytoma transformation 2 early metabolic changes in astrocytoma	17p- p53 PDGFR overexpression p14 downregulation
	1' glioblastoma happens without ___	preexisting low grade astrocytoma
	EGFR overexpression is important in ___ glioblastoma, p53 mutation in ___.	1' 2'
	oligodendrogliomas occur at age ___ and are located mostly in ___	30--50 cerebral hemispheres
	4 histopath findings in oligodendroglioma	small round nucleus perinuclear halo anastomosing capillaries calcification
	oligodendroglioma has ___ GFAP stain and high/low Ki67 index	negative low
	genetic markers for oligodendrogliomas. ___s with this mutation are sensitive to ___.	LOH on 1 and 19 anaplastic oligodendroglioma special chemo
	ependymomas in children occur near ___, in adults in ___.	4th ventricle SC
	ependymoma cells form ___ or perivascular ___.	rosettes pseudorosettes
	ependymoma has ___ GFAP and ___ cytokeratin	positive positive
	___ (2) ependymomas have better prognosis. prognosis is better/worse in adults than children.	spinal supratentorial better
	medulloblastoma is more common in children/adults. it occurs in ___ of cerebellum.	children vermis
	medulloblastoma stains positive for ___ (3).	neuron specific enolase synaptophysin Ki67
	___ rosettes may be present in medulloblastoma. GFAP is usually ___.	Homer-Wright negative
	___ is only 1% of intracranial tumors but is the most common in immunosuppressed	1' CNS lymphoma
	___ is present in neoplastic ly cells in 1' CNS ly.	EBV genome
	prognosis in 1' CNS ly is good/bad	bad
	___ spread is common in 1' CNS ly	periventricular
	1' CNS ly is usually ___ ly	DLBCLy
	1' CNS ly can be detected with ___ stain	CD20
	meningiomas arise from ___ cells and are attached to ___	arachnoid dura
	the ___ variant of meningioma is flat and causes ___	en plaque hyperostotic rxn
	meningiomas are more common in men/women	women
	multiple meningiomas are suggestive of ___	neurofibromatosis type 2
	most meningiomas are benign/malignant, but tend to ___	benign recur
	grade of meningioma is determined by ___ (2)	# of mitoses brain invasion
	3 kinds of grade 2 meningiomas	atypical chordoid clear cell
	___ (3) meningiomas are grade 3, highly agressive	rhabdoid anaplastic papillary
	___ meningioma has psammoma bodies	psammomatous

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