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Clincial Neuro
Intro to Neuropathology
101
Biology
Graduate
01/02/2008

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Cards

Term
What are the 3 unqiue perfusion characteristics of the CNS
Definition

1. CSF

2. No lymphatics

3. Blood brain barrier

Term
Are neurons capable of regeneration?
Definition
Yes, but for the most part they are not
Term
What kind of matter are neurons?
Definition
Grey
Term
What are neuron cell bodies called in the CNS? How about the PNS?
Definition

1. Nuclei

2. Ganglia

Term
What is an Axonal reactoin?
Definition
The response of a neuronal cell body after the axon has been cut, it's regeneitve w/ increased protein synthesis
Term
What are the characteristics of Axonal reaction?
Definition

1. Enlargement of the cell body

2. Periperhal displacement of the nucleus

3. Peripheral displacement of Nissl substance

4. Pink cytoplasm (eosinophilia)

Term
If you see an cell body w/ Central chromatolysis What has happened?
Definition
The axon was cut and seperated from the cell body
Term
Axonal reaction would eventually lead to _____
Definition
Axonal sproutting
Term
How would an axon look like in Axonal degeneration
Definition

1. Swollen organelles

2. Breakdown of the axon

3. Breakdown of myelin membranes

Term
Wallerian degeneration is _________ but in the PNS
Definition
Axonal degeneration
Term
Acute neuronal injury refers to what?
Definition
Changes seen 6-12 hrs after injury
Term
If you see shrinkage of the cell body, eosinophila of the cytoplasm & condensation of the nucleus, what's going on?
Definition
Acute neuronal injury
Term
Acute neuronal injury is also call ____
Definition
red neurons
Term
If you see Acute Neuronal injury you're likely to see?
Definition
Accompanied by swelling of neuronal process
Term
Where are you more likely to see neuronal degeneration
Definition
Slowly progressing neurologic diseases
Term
What has atrophied in Alzheimers? in parkinsons? And in huntingtons
Definition

1. Cerebral

2. Substantia nigra

3. Caudate nucleus

Term
Glia cells are devired from _____ & Schwann cells from ____
Definition

1. Neural tube

2. Neural crest

Term
Glia includes ____, _____ & _____
Definition

1. Astrocytes

2. Oligodendrocytes

3. Ependymal glia

Term
What kind of appearance to do oligodendrites have?
Definition
fried egg appearance
Term
Astrocytes are found in what kind of matter
Definition
Grey & white
Term
What's the function of the astrocytes
Definition
Help form the blood brain barrier via it's foot processes
Term
What is the main cell responding to irreversible brain injury
Definition
Astrocytes
Term

Name the responses of astrocytes to brain injury

Hint 7

Definition

1. Swelling

2. Proliferation (form glial scar)

3. Synthesis of GFAP (related to actin)

4. Formation of intracytoplasmic Rosenthal fibers

5. Formation of extracytoplasmic corpora amylacea

6. Formation of intracytoplasmic argyrophilic fibrils

7. Formation of Alzheimer type II

Term
The term gliosis & astrocytosis refer to
Definition
glial scarring process
Term
What causes accumulation of pink cytoplasm in brain injury
Definition
GFAP
Term
Alexander disease is due to a
Definition
mutation in GFAP
Term
Oligodendrites are found in the CNS ____ matter where they are made and their function is to maintain the _______ ______
Definition

1. White

2. Myelin sheath

Term
What is the function of Ependymal cells
Definition
They're tight functions that prevent CSF from crossing into adjacent brain tissue
Term
What is a microglia
Definition
Macrophage
Term
What does the Choroid plexus produce? How does it do it?
Definition

1. CSF

2. Filters the blood & alters the protein, gluose composition of the filtrate

Term
What is the origin of the Choriod plexus
Definition
Ectodermal epithelium that invades the ventriicles of the neural tube and form the papillary tissue in the lateral, third & fourth ventricle
Term
What forms the dura mater, leptomengines & virchow-robin space
Definition
Fibroblast
Term
Name the 3 types of Brain edema
Definition

1. Vasogenic

2. cytotoxic (cellular)

3. Interstitial

Term
What's the most common cause of brain edema
Definition
Vasogenic edema
Term
The BBB is made up of what?
Definition
Endothelium + Basement membrane + astrocytic foot processes
Term
This is caused by the breakdown the BBB
Definition
Vasogenic edema
Term
Vasogenic edema may be ____ or ____
Definition

1. focal

2. diffuse

Term
What kind of edema involves swelling of the neurons, glia & endothelial cells due to an influx of extracellular water
Definition
Cytotoxic
Term
Cytotoxic edema occurs in _____
Definition
hypoxia & ischema
Term
Give the mechanism of cytotoxic edema
Definition
Low ATP leads to lack of ATPase pump activity and sodium acculmuates inside the cell followed by water
Term
How do you correct cytotoxic edema
Definition
Reoxygenate
Term
Why don't you want to give lots of water to a dehydrated person with high sodium?
Definition
It can lead to cytotoxic edema
Term
Cytotoxic edema can coexist w/ ______ _____
Definition
Vasogenic edema
Term
Define Interstital edema?
Definition
CSF escaping the ventricle through the ependymal lining increasing intracranial pressure
Term
What is herniation
Definition
The brain moves due to volume increase
Term
Name the two ways you can get Herniation from
Definition

1. edema

2. Any tissue added to the cranial space

Term
What are the 4 characteristic sides of herination
Definition

1. Subfalcine

2. Transtentorial

3. Tonsillar

4. Transcalvarial herniation

Term
If the cingulate gyrus is pushed underneath the falx you get
Definition
Subfalcine herination
Term
Which arteries does an subfalcine herniation more likely to compress causing an infarct
Definition
Anterior cerebral arteries
Term
Transtentorial herniation occurs when the temporal lobe is pushed through the _______ & compresses the ______
Definition

1. Tentorium

2. Midbrain

Term

Name the complications of a Transtentorial herniation

Hint 5

Definition

1. Crushing of the ipsi or contralateral cerebral peduncle against bone causing weakness of one side of the body

2. Alters consciousness

3. Crushes the posterior cerebral artery, may cause infarct in the midbrain

4. Crushes the CN III causing ipsilateral or contralateral blown pupil

5. Midbrain/pons compression w/ injury to the branches of the basilar artery causing midline hemorrhages

Term
When pressure causes the medial portions of the cerebellar hemispheres to compress the medulla, what kind of herniation is this?
Definition
Tonsillar
Term
Define Hydrocephalus
Definition
Increased volume of CSF leads to enlargement of the ventricles
Term
How much CSF is in a normal adult? How often is it completely renewed?
Definition
140-150 ml and renews every 6-8 hrs
Term
What are the 5 causes of Hydrocephalus
Definition

1. Non-obstructive "communicating"

2. Obstructive "non-communicating"

3. Hydrocephalus

4. Normal pressure

5. Choroid plexus neoplasms secreting CSF (RARE)

Term
Meningitis can lead to diminished arachnoid granulation transfer to the venous circulation impairing CSF, this can lead to
Definition
Non-obstructive hydrocephalus
Term
If there is impaired CSF flow w/in the subarachnoid space this can lead to
Definition
Non-obstructive hydrocephalus
Term
When does Osbructive hydrocephalus occur?
Definition
Due to a mass occluding the flow of CSF w/in the ventricular system
Term
Enlargement of the ventricles due to loss of the tissue around them is
Definition
hydrocephalus
Term
Give examples of Hydrocephalus
Definition
Old infarct, alzheimers
Term
Normal pressure hydrocephalus may occur because grandula leptomeningeal fibrosis is equilibrated by decreased _____
Definition
CSF
Term
What is the 3rd leading cause of death in the U.S
Definition
Cerebrovascular disease
Term
6-12 hrs after irreversible injury what appears?
Definition
Red neurons
Term
24-48 hrs after irreversible injury who does the area look like?
Definition
Soft and edematous
Term
48-2 weeks after irreversible injury what is seen?
Definition
necrosis, macrophages & reactive gliosis
Term
Grossly who does an irreversible injury look like 24-2 weeks
Definition
soft and friable
Term
2 weeks to years later how does an area look like if it had irreversible injury
Definition
shrunken, collapse area or a cyst lined by gliosis and white matter replaced by a yellow glial scar
Term
What kind of scar does not play a role in infarct but could be seen in trauma
Definition
collagen
Term
Anemic or bland infarcts are found where
Definition
carotid system or vertebral system
Term
what are the sources of emboli
Definition
Carotid, aortic atherosclerosis, cardiac mural thrombi
Term
Cardiorespiratory arrest or hypotension can cause what kind of infarcts
Definition
Global
Term
How do global infarcts present?
Definition
Encephalopathy w/out any local neurologic signs, may be brain dead, no coronal activity w/ flat EEG, brainstem damage
Term
if the infarct is distributed throughout the entire hemisphere, what is the cause of it?
Definition
a thombus plugging the blocked carotid artery due to antherosclerosis
Term
A MCA distributed infarct is almost always due to
Definition
an emboli to the MCA branch point at the circle of willis from a cardiac mural thrombus or carotid bifurcation (rare)
Term
Non-traumatic brain hemorrhages can be divided into
Definition
intraparenchymal & subarachnoid types
Term
What's an intraparenchymal hemorrhage
Definition
Blood collects and compresses or destroys the brain and eventually leaves a cyst
Term
In the USA intraparenchymal hemorrhages are associated w/
Definition
hypertension
Term
What's an Charcot-Bouchard aneurysm
Definition
the arteriole dilates and thins and this may rupture and hemorrhage
Term
What's a lacunar infarct
Definition
small infarcts in the tissue immediately surround the arteriole
Term
What's the most common cause of Non-traumatic subarachnoid hemorrhage
Definition
Berry aneurysm
Term
The common sites of berry aneurysms is
Definition
branch points of the circle of willis
Term
An adult w/ polycystic disease is at increase risk for
Definition
berry aneurysms
Term
Berry aneurysm rupture are common in what decade and in what gender?
Definition
5th decade in women
Term
If a patient complains of a worst headache ever he most likely has...
Definition
Berry aneurysm
Term
What are complications of surviving a berry anuerysm
Definition
Rebleeding, vasospasm of nearby artereies & scarring of the leptomeninges leading to hydrocephalus
Term
What are the 4 categories of Traumatic injuries
Definition
1. Skull fractures
2. Parenchymal injuries
3. Traumatic vascular injury
4. Spinal cord injuries
Term
A skull fracture injury may be
Definition
open, closed or penetrating
Term
name the 4 Parenchymal injuries
Definition
1. Concussion
2. Contusions
3. Laceration
4. White matter injury
Term
If you have neurological syndromes, loss of consciousness, respiratory arrest and are flexia, what happened?
Definition
Concussion
Term
What's a contusion?
Definition
Brusing of the gyri at the site of injury or opposite site
Term
Mechanical forces can contribute to what kind of parenchymal injury
Definition
White matter injury
Term
White matter injuries happen in 50% of coma patients due to
Definition
Axonal swelling & hemorrhages in the corpus callosum and brain stem
Term
Name the 3 types of Traumatic vascular injuries
Definition
1. Epidural hematoma
2. Subdural hematoma
3. Traumatic intraparenchymal & subarachnoid hemorrhage
Term
Where does the blood accumulate in a epidural hematoma
Definition
Between the dura and calvarial surface
Term
Which hematoma would result from a tear of the middle meningeal artery
Definition
Epidural
Term
Where is the blood coming from in a subdural hematoma? Where is it collecting?
Definition
A leaky briding vein and it collects between the dura and outer layer of the archnoid
Term
Most of the injuries associated w/ Spinal cord are due to
Definition
Displacement of the spinal column
Term
A subarachnoid hemorrhage can be due to?
Hint 3
Definition
Trauma, coagulopathy & berry aneurysm
Term
A subdural space can occur in ___ head injuries causes tears of ________ _____
Definition
any & bridging veins
Term
What's the major cause of coma in accidents w/out contusional injuries
Definition
White matter injuries
Term
If the temporal bone is associated w/ trauma, what happened
Definition
Tear of the dural artery w/ rapidly explanding epidural hematoma and increased ICP
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