what is this section from

spinal cord

are neurons or glial cells more common in the CNS

nerons

what are the glial cells associated with the CNS

astrocyte
microglial cell
oligodendrocyte
ependymal cell

what do ependymal cells line

all ventricles and choroid plexus

what are the most common glial cells

astrocyte

what are the haloed cells in the CNS

oligodendrocytes

what are the cells that populate this screen

oligodendrocytes

why would there be clear spaces around these oligodendrocytes

just like fat (myelin) washes out from Schwann glial cells

hat cells are lining this space in this frame

ependymal cells

what cells do ependymal cells look like

ciliated columnar cells

what is the only glial cell that looks epithelial

ependymal cells (simple columnar like in glands)

what is the configureation of the choroid plexus

papillary in configuration

what is the role of the choroid plexus

pump out CSF

what is this

choroid plexus

what type of cells is this a cluster of

microglia (MP of CNS)

what are the cellular reactions of neurons

acute: red neuron=karyolysis
subacute, chronic, cell loss, gliosis
axonal
inclusions

what are the cellular reactions of glia

gliosis
(swelling, fibers, inclusions)

what all go hand in hand with gliosis in terms of nonspecific reaction to injury

GLIOSIS
EDEMA
DEMYELINIZATION

nonspecific reactions to almost any type of injury

what kind of neuronal injury took place here

acute neuronal injury (red nucleus)

look for gliosis, neuronal loss in this picture

what types of cerebral edema can take place

vasogenic
cytotoxic

what is the normal weight of the CNS

1200-1300 gms

what happens in vasogenic cerebral edema

BBB is disturbed; intravascular to intercellular

what type of cerebral edema is cytotoxic

intracellular

where can cerebral edema go

subfalcine (supratentorial)
cingulate (tentorial)
cerebellar tonsillar (subtentorial or infratentorial)

what is the fourth obvious sign of cerebral edema

flattening of gyri and small sulci

why do flattened gyri signify edema

compression against calvarium

what was likely going on here

hemorrhage and edema

what does notching of the cingulate gyrus indicate

cerebral edema

what does cerebellar tonsil herniation indicate

cerebral edema

what are the symptoms of cerebral edema

headache
hallucinations
coma

death

what can cause hydrocephalus

impaired resorption
increased production (rare)
obstruction

what is communicating vs noncommunicating hydrocephalus

entire head vs part of the head

what types of pressures will someone have in hydrocephalus

high pressure and normal pressure

what is the key factor in whether hydrocephalus will result in any cranial enlargment

fontanelle closure

which fontanelle stays open for a while

anterior

what can hydrocephalus on the CT look like

dilated ventricles

what is going on here

hydrocephalus

what is this aqueductal stenosis causing

hydrocephalus on MRI

what space would be more dilated: space after aqueductal stenosis or before it

before

what type of imaging is this and what is being shown

MRI: water dense in MRI
arrow poniting to periventricular damage, which is more likely with high pressure hydrocephalus

would dilated ventricles at autopsy signal hydrocephalus

YEP

where are some places where the CNS is malformed

neural tube
forebrain
posterior fossa (infratentorial)
syringomyelia/hydromyelia

what are some neural tube malformations

anencephaly
encephalocele
spinal bifida

what are some forebrain malformations

polymicrogyria
holoprosencephaly
agaensis of CC

what are some posterior fossa malformations

arnold chiari (infratentorial herniation)
dancy walker (cerebellar cyst)

what is this

anencephaly

what antigen is found when spina bifidas are present

AFP

what type of cancer also has a penchant for AFP presence in the bloodstream

hepatoma

where is spina bifida usually

bottom of the zipper

what is polymicrogyria

small gyri

what is holoprosencephaly

failure of the prosencephalon to develop and separate

what is the prosencephalon

anterior/superior portion of the neural tube

what is wrong with this baby

holoprosencephaly

what is the limiting factor of the falx

corpus callosum

what is wrong with this brain

absent corpus callosum

what is the range of symptoms with an absent corpus callosum

mild or partial cases are asymptomatic, severe cases result in severe retardation or fatality

what is syrinx

dilation of the central canal of the spinal cord

what is being pointed out

syrinx

what are some perinatal brain injuries

intraparenchymal hemorrhage
intraventricular hemorrhage
periventricular leukomalacia
cerebral palsy refers to nonprogressive diffuse cerebral pathology apparent at childbirth

can intracerebral hemorrhage extend intraparenchymally and vice versa

yep

what types of things can CNS trauma cause

skull fractures
parenchymal injuries
traumatic vascular injury
sequelae
spinal cord trauma

what are the brain traumas

contusion (bruise)
laceration (tear)
coup/contre coup
concussion

is a concussion clinical or pathological

clinical

what is the hallmark of contusion

hemorrhage

what are the types of skull fractures

hairline
depressed/displaced

what are skull fractures associated with

epidural hematoma

if there is contact but no skull fracture what is next on the list of thoughts

subdural hematoma

what do subarachnoid hematomas result from

some sort of arterial leak, no trauma

how does an intraparenchymal hemorrhage go

any way

how does an intraventricular hematoma transpire

no trauma, rare in adults, common in premies

what does the most superficial layer of the dura blend with

periosteum

what can subdural hematomas be related to

congenital aneurysms

where does a subarachnoid hemorrhage occur

big intracranial arteries

what 2 things commonly cause subarachnoid hemorrhage

hemorrhagic CVAs due to arterial wall rupture

ruptured aneursym

could HTN be a risk factor for subarachnoid hemorhage

yep

could intraparenchymal hemorrhage extend/dissect both ways if it is big enough

yes ventricular and subarachnoid

which way is this intraparenchymal hemorrhage dissecting

intraventricularly

could an intraventricular hemorrhage diseaect intraparenchymally

yes

what are the 3 main CNS trauma sequelae

hydrocephalus
dementia (punch drunk syndrome)
diffuse axonal injury

what is the most common CNS trauma sequelae

hydrocephalus

what is the more often sequelae of CNS trauma and what is it from

hydrocephalus from impaired reabsorption (hemorrhage that affected reabosrption parasagittally

is dementia a specific syndrome

no

what is difffuse axonal injury from

repeated trauma damaging white matter

what does spinal cord trauma parallel

brain patterns of injury (cellularly)

what is spinal cord trauma secondary to

spinal column displacement

what does the level of injury of the spinal cord mirror

motor loss (death, quadriplegia, paraplegia

know this fucking chart

what are the cereebrovascular diseases usualyl called

stroke

what are the types of stroke

ischemic and hemorrhagic

what is another name for ischemic stroke

thrombotic

what is decreased in ischemic stroke

blood and O2

what happens in acute ischemic stroke

edema to neuronal microvacuolization to pyknosis to karyorrhexis to neutrophils

what happens in chronic ischemic stroke

MP to gliosis

what is hemorrhagic stroke due to usually

rupture of artery/aneurysm

what does the middle cerebral artery supply

lateral brain

what does the posterior cerebral artery supply

medial, some posterior and anterior

what does the anterior cerebral artery supply

medial, some posteiror and anterior

what has happened here

thrombotic MCA

what has happened here

hemorrhagic ACA

what is the only exception in the brain to normal progression of inflammatory response

usually no fibrosis in the brain, gliosis

where would the CNS be sensitive to HTN

intracerebral area
basal ganglia region (lenticulostriate arteries of internal capsule and putamen)

what type of stroks would be more likely in a hypertensive issue

hemorrhagic

can edema be felt better than seen on gross brain

yep

what type of infarct is this

lacunar infarct

are lacunar infarcts asymptomatic? why?

yes because of very small pinpoint size

what type of hemorrhage is this

slit hemorrhage

what usually ruptures in a subarachnoid hemorrhage

large intracerebral arteries which are the primary branches of the circle of willis

what are some causes of subarachnoid hemorrhage

congenital (berry aneurysm)
atherosclerotic (direct wall rupture)

what is young woman dropping dead instantly for not reason

berry aneurysm

are berry aneurysms or atherosclerotic aneurysms more common

athero by a LOT

where are the most common places for berry aneurysms

what are the types of hypertensive encephalopathy

acute
chronic

what are the symptoms of acute hypertensive encephalopathy

headaches
confusion
anxiety
convulsions

what are the symptoms of chronic hypertensive encephalopathy

dementia
gait disturbances
basal ganglia symptoms

what are some basal ganglia symptoms of hypertensive encephalopathy

tremors
athetosis
chorea
ballism
dystonia

what are some various CNS infections

acute meningitis
acute focal suppurative infections
chronic bacterial
viral fungal

what are the main infections of the CNS

meningitis
encephalitis
meningoencephilits

what causes meningitis (generally)

bacterial

what causes encephalitis (generally)

viral

what are the specific causes of meningitis

e. coli, strep b
HIB
n. meningitis
s. pneumo

what is sign of meningitis infection

PMNs in CSF, increased protein, reduced glucose

what particular viruses cause encephalitis

arboviruses
HSV
CMV
VZV
polio
rabies
HIV

what will be present in the virchow robbins spaces in encephalitis

lymphs and MPs

what is the big CNS invader when someone has HIV

toxoplasma

how will leptomeninges look for in CNS infection

cloudiness

what are some acute focal suppurative CNS infections

cerebral abscesses
subdural empyema
extradural abscess

where can cerebral abscesses take effect

local (mastoiditis, sinusitis)
hematogenous (tooth extraction, sepsis)
staph, strep
fibrous capsule

what do subdural empyemas take placce in

sinusitis

where do extradural abscesses take place i n

osteomyelitis

what is shown here

abscesses with satellits

RIM SIGN

what is the difference between capsules or pseudocapsules

true capsules are lined with epithelium

whats all over this abscess

neutrophils

what is being pointed out here

subdural empyema

why are many epidural abscesses in the spinal cord secondary to surgery

bone trauma

what are the chronic bacterial meningoencephalitises

TB, brain and meninges
syphilis: gummas in brain
lyme disaes: neuro borrielosis

what is a gumma

large granuloma from syphillis

can large granulomas look like tumors?

yep: tuberculoma

what is going on here

NeuroBorreliosis: encephalitis BACTERIAL THIS TIM

why would encephlo-meningitis be a better term than meningo-encephalitis

viruses usually involve CNS parenchyma rather than meninges

what is th hallmark of viral encephalitis

perivascular lymphocytic cuffing

wahts going on here

viral encephaitis

what is bitemporal encephalitis until proven otherwise

HSV

what is going on here

bitemporal encephalitis

what is labeled by the arrow

eosinophilic negri body of rabies

what is this shit

CMV basophilic inclusins

what if you see perivascular giant cells in white matter

HIV ENCEPHALITIS

what is the cause of PML (progressive multifocal leukoencephalopathy)

JC polyoma virus

what does PML primarily affect

oligodendrocytes

what is the main feature of PML

demyelination

what is demyelination associated with

gliosis and edema

what is this on the MRI

demyelinization

what is gliosis associated with

demyelinazation and edema

what is edema associated with

demyelininzation and gliosis

what is shown here

gliosis

what is this

myelin/fat stain of PML: large area in middle with no myelin

what is subacute sclerosing panencephalitis associated with

measles virus

what happened here

subacute sclerosing panencephalitis

what are the fungal meningo-encephalities

cryptococcus
candida
aspergillus
mucor

what type of stain is this

India ink

what are these microabscesses caused by

cryptococus

what simple fungal stain could you use for abnormal areas in the brain

PAS

what are the "other" things that can infect the CNS

malaria
toxoplasmosis
amebiasis
trypanosomes
rickettsiae
echinococcus

what are the prion diseases

creutzfeldt-jakob diseasee
gerstmann-straussler-schneinker syndrome
fatal familial insomnia
kuru
scrapie
mink transmissible encephalopathy
chronic wasting disease
BSE

what are some common features of prion diseases

infectious agents with no DNA
lead to dementia
prion protein accumulation
spongiform changes in neurons and glia
transmissble, fatal no treatment

why are prion diseases called spongiform

due to spaces between the cells caused by conformational changes

what is prion replication due to

protein undergoes conformational change to induce neighboring proteins to become like it

are prion proteins normally found in humans

yes

what chromosome are prion proteins on

20

what is this a dead giveaway of

spongiform (prion disease)

is CJD epidemic

no

what happens in CJD

rapidly progressive dementia
cerebelar ataxia

what is affected in CJD

grey matter

what are some of the demyelinating disaess

MS
MS variants: Acute disseminated encephalomyelitis, acute necrotizing hemorrhagic encephalomyelitis

if not for edema associated with demyelination, would the plaques be seen on MRI

no

what is the cause of MS

nobody knows

does MS affect females or males more

females

when does MS usually take course

30-40

what is MS a disease against

white matter: plaquing of the nerves

what is increased in the CSF with MS

CSF gamma globulin/oligoclonal bands

what does MS often present with

visual probelms

what is happeneing here

demyelination: MS

what is stained blue here

myelinated white matter

grossly, what would plaques look like in contrast to better myelinated areas

less white

what would plaques look like microscopicallly

demyelination, edema, gliosis, preseravtion of nerve fibers, inflammtory cells

what are some degenerative disaeses of the CNS

cortex
basal ganglia and brain stem
spinocerebellar
motor neurons

what are CNS degenerative disaess of the cortex

dementias

what are CNS degenerative diseass of the BG and brainstem

parkinsonian diseass

what are CNS degenerative diseass of the spinocerebellar tract

ataxias

what are CNS degenerative diseass of the motor neurons

muscle atrophy

what are some cortical degenerative diseas

alzheimer's diseas
frontotemporal dimentia
pick disease
progressive supranuclear palsy
corticobasal degen
vascular dimentias

what is the most common CNS cortical degenerative diseass

alzheimer's

what are most of the dementias

tauopathies

what happens to the cortex (grey matter) in alzhemiers

atropphy

what is present in alzheimers

neuritic plaques
neurofibrillary tangles
amyloids

are neuritic plaques just like MS's plaques

NO

are the sulci or gyri prominent in cortical atrophy

cortical loss

what is being shown here

plaques and tangles and beta amyloid of alzhemier's sieas

what is aneuritic plaque

cluster of nerve fibers surrounding a substance that ends up being beta amyloid

what is a tangle

phosphorylated MTs around indivdiual neurons

what is this

neuritic plaque

what type of stain can be used to find beta amyloid

immunohistochemical stain

what is ponted out in red and yelow here

red: plaques
yellow: tangles

what stains are used here

congo red on left
congo red with polarized light on right

is there alpha amyloid

yes with Igproliferative disaess like myelomas

what is being ponited out here

neurons with tangles displacing nucleus

what is a tangle

hyperphosphorylation of a neuron microtubule, causing it to precipitate

what are the "other" cortical dementias

tau gene proteins/tauopathies

frontotmeporal
pick disaese (lobar atrophy)
progressive supranuclear palsy
corticobasal degeneration
vascular dementia

what are most cortical dementias known as

tauopathies

what is vascular dementia associated with

multiple infarcts: lacunar, cortical, embolic

what is the second commonest form of dimentia after alzheimer

vascular dimentia

what is this and how do we know

MID because MS is purely white matter loss

what are the CNS degenerative diseases in the basal ganglia and brainstem

parkinsonism
parkinson diseas
multiple system atrophy
huntington disaes

is parkinsonism a clinical syndrome or a diseas

clinical syndrome

what are the featurs of parkinson syndrome

diminished facial expression
stooped posture
slowness of voluntary movement
festinating gait (short, fast)
rigidity
pillrolling tremor

what is the clinical finding of parkinsonism

substantia nigra pathologic state

what are some other substantia nigra diseass

parkinson diseas
multiple system atrophy
postencephalic parkinsonism
progressive supranuclear palsy, cortical basilar degeneration

what is the key idea in parkinsonsim

not enough dopamine

where is there pallor in parkinson's disease

substantia nigra and locus ceruleus

LEWY BODIES ALSO present

what are lewy bodies

alpha-synuclien protein

what happened here

parkinson's diseas as seen in SN

what happened here

parkinsons diseas as seen in LC

which patient has parkinson's

right becuase of decreased dopamine

what is this and what is it from (disease)

lewy body

parkinson's

along iwth the parkinson symptoms, what does parkinsons disaese involve

progressive symptoms
hallucinations
dementia
symptomatic response to Ldopa

what happens in multiple system atrophy

wide spectrum of diseasses

glial cytoplasmic inclusions in oligodendrocytes (alpha synuclein)

what are the clinical symptoms of multiple system atrophy

parkinsonism
autonomic dysfunction

what is this

alpha synuclein stains

what type of disease is Huntingon's

genetic

what happens in Huntingon's

progressive motor loss and dementia

chorea and jerky movements

fatal

atrophy of basal ganglia (corpus striatum

ventricular enlargment

what types of disesases are spinocerebellar degenerations

ataxias

what are some spinocerebellar degenerations

spinocerebellar ataxias
Friedrich ataxia
ataxia telangiectasia

what are some motor neuron diseass

ALS
bulbospinal atrophy (kennedy syndrome)
spinal muscular atrophy

what is the etiology of ALS

unknown

what is ALS

progressive muscle atrophy due to motor neuron loss

what does ALS progress from

hand weaknes to diaphragm

where does ALS take place

anteiror horn cells reduece and gliotic

demyelination in corticospinal tracts

what is this a pic of

ALS

what are the categories of genetic metabolic diseass

neuronal storage diseases

leukodystrophies

mitochondrial encephalitis

what trait do the neuronal storage diseases have

classical autosomal recessive enzyme deficiencies

whta do the leukodystrophies present

abnormal myelin synthesis

what happens with mitochondrial encephalopathies

mitochondrial gene mutations

what are the major leukodystrophies

Krabbe
metachromatic
adreno
pelizaeus-merzbacher
canavan

what are leukodystorphies

a group of disorders characterized by progressive degeneration of the myelinated white matter of the brain

what are leukodystrophies caused by

imperfect growth/development of myelin due to genetic defects in the enzymes required for proper myelin production and maintenance

what are the acquired toxic/metabolic CNS diseases

vitamin B1 def (Wernicke-Korsakoff)
vitamin B12 def (vibratory sense)
diabetes (increase/decreased glucose)
hepatic failure (NH4)
CO (cortex, hippocampus, purkinje cells)
CH3-OH (retinal ganglion cells)
CH3-CH2-OH (acute/chronic, direct/nutritional)
radiation (brain most resistant to radiation therapy)
chemo (methtrexate+radiation)

what is the showing of wernicke korsakoff syndrome

hemorrhagic mamillary bodies

what column will demyelinate in B12 deficiency

posterior column (subacute combined degeneration)

what is earliest clinical symptom of Wernicke Korsakoff

loss of vibratory sense

what are some CNS tumors

gliomas of astrocytes, oligodendrogliomas, ependymomas

neuroblastomas

medulloblastomas

meningiomas

lymphomas

metastatic

what do ependymal cells look like

glandular

what do oligodendrocytes have around them

halos

what do meningiomas have the constistency of

super ball

are primary lymphomas of the brain rare? when are they common

yes
AIDS most common

if there is just one lesion in the brain, what is the probablity it is primary

50/50

if there is a nonprimary tumor in the brain, where did it pprobably come from

lung

what are the symptoms of CNS tumors

headache
vomiting
mental changes
motor problems
seizures
increased IC pressure
any localizting CNS abnormality

do CNS tumors present abruptly

no very subtle, only appear after tumor is sizeable

what is the routine workup of CNS tumors

history
physcial
neurologic exam
LP (cytology)
CT
MRI
brain angiography
biopsy

what are the questions to be asked of a CNS tuomor

benign or malignant
primary or met
location
age
x ray density and MRI signals
calcifications
vascularity
necrosis
liquefaction
edema
compression of neighbors

how old are people that normally get CNS tumors

younger

what do certain CNS tumors have an abundant amount of

Ca

what do you do an angiogram for in CNS tumors

vascularity determinatino (how much this thing has grown)

gliosis vs. glioma, how to tell

age
white vs grey matter
gross texture
vascularity
mitoses
N/C, pleomorhpism, hyperchromasia
calcifications
cysts
satellitosis
delineation

what is a good indication of malignancy

vascularity and necrosis in high amounts usually indicate malignancy

gliiosis or glioma

could be either one

what is this

glioma, intermediate grade

what is this

glioma high grade

what is needed for the diagnosis of a high grade glioma

necrosis

what are the higher grade gliomas called

gliobastome multiforme

what is often seen in GBM

perivascular growth pattern

what is this

GBM

palisading and necrosis

what is the sign of rapid growth in a tumor

central necrosis

why would there be central necrosis in a tumor

outgrows blood supply and liquiefies centrally, like abscess

what is this

central necrosis

what kinds of glial cells are these

oligodendrocytes

what is this

oligodendroglioma

where do oligodendroglomas frequently occur

frontal or temporal lobes

what are oligodendroglioma classifications

low or high grade

who are oligodendrogliomas commmon in

men and women 20-40, but also children

are oligodendrogliomas more common in men or wome

men

how many of brain tumors are oligodendrogliomas

2%

what chromosome losses are associated with oligodendrogliomas

1p or 19q

what is this

ependymomas

would a choroid plexus tumor be a type of ependymoma

yep

would an ependymoma result in an overproduction of CSF

yep

are ependymomas diffuse in the brain

no, localized

where do ependymomas develop from

cells that line the hollow cavities at bottom of brian and canal containing the spinal cord

do ependymomas grow slow or fast

either

where are ependymomas located

ventricles

where do ependymomas extend

spinal cord

what can ependymomas do

block ventricles causing hydrocephalus

what does occurrence peak in ependymomas

5 and 34

how many brain cancer are ependymomas

2%

what do ependymomas look most like

adenocarcinoma

what type of cancer is this

neuroblastoma (rosettes)

what is any midline cerebellum tumor in a child until proven otherwise

medulloblastoma

are medulloblastomas PNET tumors

yes

what is this

medulloblastoma

where do meningiomas occur

where dura is

are meningiomas vascular

yes

are meningtiomas benign

yes but can be invasive

what do meningiomas invade

areas adjacent to dura, parasagittal, falx, tentorium, venous sinuses

what are meningiomas like

well defined like a superball

what are often meningiomas have

psammoma bodies

what is part of this meningioma denser than

bone

what is this

meningioma

other than meningiomas what are psammoma bodies diagnostic of

papillary carcinomas

what CNS diseases are common in AIDS

toxoplasmosis
lymphomas
encephalitis

what is this

toxoplasmoma

what are the metastatic CNS tumors that go to the brain

lung
breast
melanoma
kidney
GI

is a solitary brain mass more likely to be metastatic or primary

same odds

what are the paraneoplastic syndromes

small cell, lung
lymphomas
breast cancer

purkinje cell degen
encephalitis, limbic system
sensory neurodegen (DRG)
eye movement disorders

what are the familial CNS tumor syndromes

NF1 (neurofibromas and gliomas)
NF2 (schwannomas and meningiomas)

tuberous sclerosis (CNS and somatic hamartomas)
Von hippel lindau (CNS hemangioblastomas, chiefly cerebellar)