23yo. fever, severe headache, generalized convulsion and stiffness of neck

flex knee when flex neck

resistence to completely extend knee

brain has white to yellowish discoloration

purulent meningitis.

acute subarachnoid suppuration: severe headache, generalized convulsion, change of consciousness

CSF: high WBC, high protein, low sugar

60 y.o. died 20 hr after acute MI, when suffer severe hypotension.

edematous  w/ flattened gyri and compressed sulci.

what cell of what area are more involved?

what is order of cell affected by ischemia: astrocyte/oligodendrocyte/neuron

what part are more voluerable, sulci vs. gyri

what is more harmful: infarct or metabolite of infarct

watershed infarct.

purkinje cell of cerebellum

pyramidal cell of hippocampus, Sommer's sector

neuron > oligodendrocyte > astrocyte

depths of sulci more volnerable than crest of gyri.

metabolite of infarct

7 types of infarct, and color

occluded emboli that breaks -> necrosis, and reperfuses -> hemorrhage

in situ thrombotic occlusion

thrombosis with bilateral hemorrhagic infarct

multiple infarct from sudden severe hypotension,

slow and prolonged ischemia with inner cavitation and glitter cell, and complete infarct, preservation of molecular layer,

hypotension induced incomplete infarct: neuronal and oligo death but preservation of reactive astrocyte

multiple small infarcts of basal ganglion and basis pontis

hemorrhagic infarct: dark

anemic infarct: brown

venous infarct: superior sagittal sinus

watershed infarct.

laminar necrosis

ischemic/anoxic encephalopathy

lacunes.

7 y.o automobile accident, massive blood loss and hypotension lasting 10-15 min, patient survive about 6 weeks.

Sommer's sector show absence of neuron and but reactive astrocyte

2 areas its most common

ischemic/anoxic encephalopathy

CA1 sommer's sector of hippocampus

border zone of ACA/MCA

hypotension of relatively slow onset but long duration.

persistence of molecular layer

pyramidal layer affected > granular layer

cavitation with large cells of foamy cytoplasm in the cavity

surrounding molecular layer has reactive astrocyte

Old cavity laminar infarct.

gitter cell: large cells of foamy cytoplasm in the cavity

multiple cavitary infarct from hypertension

in basal ganglion and basis pontis

occlusion of lenticular striate artery

65 y.o. woman memory began to deteriorate, unable to perform routine function, profoundly demented and incontinent.

brain weight 950 gm / 1200. symmetrical generalized cortical atrophy affecting the frontal lobe with widened sulci and narrowed gyri

congophilic angiopathy

at cerebral cortex see amyloid core with degenerating neuritic terminals and reactive astrocyte

amyloid plaques

neuritic plaques

neurofibrillary tangles

large pyramidal neuron with cytoplasmic vacuoles containing black dots

hydrocephalus ex vacuo

Alzheimer's

granuolo-vacuolar degeneration: large pyramidal neuron with cytoplasmic vacuoles containing black dots

hydrocephalus ex vacuo due to brain atrophy.

mucicarmine staine

round, red structures

Cryptococcal mucoid capsule

only yeast present in tissue

PMN inflammatory infiltrate in V-R space

no reactive astrocyte at parynchyma

hyperplasia and proliferation of microglial cell

destruction of neuron by phagocytic process

viral encephalitis

perivascular cuffing: PMN inflammatory infiltrate in V-R space

microglial nodule: hyperplasia and proliferation of microglial cell

neuronophagia: destruction of neuron by phagocytic process

DDX:

laminar necrosis

contusion

molecular layer preserved

depth of sulci

molecular layer fucked

crest of gyri

clotted blood beneath dura

torn bridging vein

encapsulated

most common saccular aneurysm of brain

where is 30%

where is another 30%

where is 10%

what part of tissue is ruptured that cause hemorrhage

Berry aneurysm

ACA

ICA/ACA junction

PCA

muscular layer

3 area for hypertensive hemorrhage

rupture of occipital lobe

basal ganglion

pons

internal capsule

cerebral Ab amyloid angiopathy

PMN infiltrate

muscle fibers has basophilic cytoplasm and center and round nuclei

pale, amorphic fibers

polymyositis

need 3 sx:

infiltrate

regenerating fibers: muscle fibers has basophilic cytoplasm and center and round nuclei

degenerated fibers: pale, amorphic fibers

globoid body 

desmyelinating disease

fucked beta-galactosidase

accumulate galactocerebroside

depigmentation of substantia nigra

eosinophilic, intracytoplasmic spherical/vermiform inclusion in pigmented neuron

PD

lewy body:

eosinophilic, intracytoplasmic spherical/vermiform inclusion in pigmented neuron

ALS

fucked motor section

severe atrophy of frontal and temporal lobe

walnut type

posterior 2/3 of superioro temporal gyrus spared

argyrophilic cytoplasmic inclusions

Pick's Dz

Pick body: argyrophilic cytoplasmic inclusions