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Ch 28 CNS (to p1290)
Terms in this set (80)
"red neurons" that suffered hypoxia/ischemia are indicative of what type of neuronal injury ?
Neruonal death caused by degeneration, apoptosis, and reactive gliosis is indiciative of what type of injury ?
Subacute and Chronic
You notice the neruons on the micrograph exhibit Nissl Substance, rounded cell bodies and large nucleoli. What is going on ?
Axonal Reaction ( regeneration attempt)
What do the nerual inclusions lipofuscin, storage material and "inclusion bodies indicate.
WHat cells are responible for repair and scar formation as well as important elements of the blood-brain barrier
Describe Astrocytes exhibiting Rosenthal Fibers, Corpora Amylacea,Alzheimer Type II.
-elongated , eosinophillic (long-standing gliosis, pilocytic astrocytomas
-Lamellated polyglucosan bodies (degenerative change
-enlarged nucleus with intranuclear glycogen and pale chromatin (hyperammonia)
Name the 3 types of Cerebral Edema
What is the main difference between Non-communicating and communicating hydrocephalus
NCH --> enlargement of only a portiong of ventricular system
CH--> enlargement of entire ventricular system
The anterior cerebral artery is being compressed what type of herniation is the cause ?
If too many cells leave the proliferating poulation of cells in the brain then ______ results.
If too FEW cells exit the proliferating cell population then _____ results.
An acute neuronal injury under an H&E stain shows?
Shrinkage of cell body
Pyknosis of nucleus
Loss of Nissl substance
the irreversible condensation of chromatin in the nucleus of a cell undergoing necrosis or apoptosis
RER found in cell body and dendrites, but not axon of neurons.
Reactive glia are the best marker for what kind of neural injury?
subacute and chronic
What virus can affect ependymal cells?
Two conditions associated with injury to oligodendroglia?
Acquired demyeinating disorders (M.S.)
Microglial response to injury...(4)
2) Develop elongated nuclei (rod cells of neurosyphilis)
3) Form aggregates about small foci of tissue necrosis (microglial nodules)
4) Congregating around cell bodies of dying neurons (neuronophagia)
Axonal reaction to neuronal injury.
1) increase protein synthesis
2) Axonal sprouting
3) Displacement of nucleus
4) Enlargement of nucleous
5) Dispersion of Nissl substance (central chromatolysis)
Seriously damaged motor axon regeneration is seen best in the...
anterior horn cells of the SC
Cytoxic = intracellular edema (hydrocephalus)
Vasgoenic = extracellular edema
Macroscopic characteristics of cerebral edema include:
1) Focal or diffuse swelling of brain tissue
2) Flattened Gyri
3) Narrowed sulci
4) Sectioned tissue may appear excessively moist (occasionally faintly yellow)
Microscopic characteristics of cerebral edema include:
1) enlarged perivascular and perineuronal spaces
2) Vacuoles in white mater
3) *Occasionally protein-rich fluid in small extracellular lakes
4) *Astrocytosis in chronic phases
Ultrastructual (see on EM) characteristics of cerebral edema include:
1) Swollen astrocytic foot processes
2) Enlarged space splitting of myelin lamellae
Brain herinations are due to the displacement of
cerebral tissue through natural (dural) or surgical openings due to increased volume of tissue (hematomas, tumors and edema)
An accumulation of pigment derived from lipid breakdown is associated with....
a lipofuscin is ass/ w/ neuronal inclusions
What are the inclusions associated with 1) Herpetic infection and 2) Rabies
1) Cowdry bodies
2) Negri bodies
Inclusions in both the nucleus and cytoplasm can be caused by what virus?
Pt has Alzheimer Disease, where you expect to find neuronal inclusions?
intracytoplasmically (neurofibrilary tangles)
Pt has vacuolization of the perikaryon and neuronal cell processes, what disease do you suspect?
histopathic indicator of CNS injury
Astrocyte undergoing both hypertrophy and hyperplasia
abnormal increase in number of cells
What does glial swelling indicate?
Acute insult- failure of cell's pump systems to maintain osmotic pressure
Occurs in hypoxia/hypoglycemia/toxic injuries
Bergmann gliosis (define, what kind of injury)
specific rxn of astrocytes btw molecular and granule cell layers of cerebellum
Thick, elongated, brightly eosinophilic, irregular contour explain
These cells occur within astrocytic processes and contain two heat shock proteins as well as ubiquitin. Name the cell and the heath shock proteins.
αβ-crystallin and hsp27
Rosenthal fiber contain αβ-crystallin and hsp27, what else contains these two heat shock proteins?
corpora amylacea or polyglucosan bodies
aka polyglucosan bodies
Indicate degenerative changes in astrocytes
Made of heat shock proteins and ubiquitin
Pt has glial cytoplasmic inclusions, these characterize...
several CNS degenerative diseases (Multiple system Atrophy)
Composed of α-synuclein
Pt with chronic hyperammonemia due to chornic liver disease (Wilson disease) or defects of the uear cycle will have...
1) Alzheimer type II astrocyte
NOT RELATED TO ALZHEIMER DISEASE
2) Large nucleus (2-3x size)
3) Pale staining central chromatin
4) intra nuclear glycogen droplets
5) Prominent nuc. mem and nucleolus
Differences btw Vasogenic and Cytotoxic edema...
1) Vasogenic- disruption of intracellular spaces (localized or generalized)
2) Cytotoxic- increased intracellular fluids secondary to membrane injury
Similarities btw vasogenic and cytotoxic edema...
1) Brain appears softer than normal and "over fills" cranial vault
2) Flattened gyri
3) Narrowed sulci
4) Compressed ventricles
What is considered to be raised intracranial pressure?
Increased CSF pressure about 200μm of water in recumbent posture
General cause of raised intracranial pressure?
1) diffuse or generlized brain edema
2) focal tumor
3) abscess hemorrhage
Displacement of a portion of brain against the rigid dura folds is a....
Pt has an aymmetric expansion that displaces the cingulate gyrus under the falx cerebri, what is this and what is associated with it?
Subfalcine (cingulate) herination
ass/ w/ compression of branches of anterior cerebral artery
The medial aspect of the temporal lobe is compressed against the free margin of the tentorium cerebelli. What type of herination?
Transtentorial (unicate/mesial temporal) herination
Complications associated with a transtentorial herination include:
1) Compression of CN III
2) Compression of Post. Cerebral Arteries
3) Hemorrage lesion in midbrain + pons (secondary brainstem/Duret hemorrages)
3) *if Large: Compress contralateral cerebral peduncle (Kernohan's notch)
Tonsillar herination (define, causes)
Cerebellar tonsils through the foramen magnum
*causes brainstem compression
Pt has excessive CSF within the ventricular system, this is known as...
What are the two flavors of hydrocepholous?
Non-Communicating- Local expansion, pressure does not impact other ventricles
Communicating- Generalized pressure increase + enlargement of entire ventricular system
Neural tube defect
failure of a portion of NT to close/reopening of region
*can involve neural tissue/meninges/and bone or soft tissue
Malformation at anterior end of neural tube that is more common in females and though to develop ~28 days of gestation.
*absence of brain and calvarium
diverticulum of malformed CNS tissue extending through a defect in the cranium
Most common neural tube defect, usually of the caudal tube.
Spina Bifida (spinal dysraphism)
extension of CNS tissue through vertebral column
*meningocele if only meninges herniate
Polymicrogyria (define, 3 characteristics, cause)
Loss of normal external contours of cerebral convolutions
-neocortex has 4 layers (instead of 6)
-Caused by tissue injury at time of neuronal migration
What is more common, mega or microcephaly? Causes?
1) Chromosomal abnormality
2) Fetal EtOH syndrome
3) HIV-1 in utero infection
Extreme micro encepahlization with no gyri
Spectrum of malformations
1) incomplete sep. of cerebral hem
2) *Sometimes facial manifestations (cyclopia/arrhinencephaly)
3) ass/ w/ trisomy 13 (rarely trisomy 18)
4) Some increase in diabetic mothers
What malformations is associated with trisomy 13 and related to the exprsesion of Sonic Hedgehog?
An abscence of the callosal fibers along with a bat-wing deformity are a major structural abnormality of what syndrome?
Aicardi due to agensis of corpus collosum
Compare Pt of with surgical or congenital absence of callosal fibers.
Surgical- stereotypical defect
Congenital- NOT stereotypical defects
Arnold-Chiari Type I vs. II
I- low lying cerebral tonsils, may cause CSF bloackade leading to medullar compression (Rx: Surgery)
II- Small posterior fossa, misshapen midline cerebellum and downward extension of vermis (herinated)
Arnold-Chiari Type II is usually accompanied by?
hydrocephalus and lumbar myelomeningocele
Arnold-Chiari Type II may include:
1) Medullary malformation
2) Tectal malformation
3) Aqueduct stenosis
4) Cerebral heterotopias (displaced gray mater)
5) dygronyelia (increased fluid in central canal)
Differences Syringomyelia and Hydromyelia
Syring- fluid-filled cleftlife cavity within cord (syrinx)
Hydro- discontinuous multisegmental or confluent expansion of ependymal-lined central canal of cord
Similarities of Syringomyelia and Hydromyelia
1) 1ssociated with destruction of adjacent structures
2) Surrounded by dense network of reactive gliosis
bleeding into the substance of the brain tissue
*premature infants at risk (thalamus/caudate junction)
Cerebral palsy (define, incudes, linked to)
broad clinical term referring to nonprogressive neurologica motor deficits
Inlcudes: spasticity, dystonia, ataxia, athetosis, paresis
*linked to insults before/during/after birth
Infarct in the supratemtorial preiventricular white mater (more often in premature babies)
A premature baby is born, he has chalky yellow plaque with discrete regions of white mater necrosis and mineralization...WHAT'S GOING ON?
Lesions of both white and gray mater is _____ encephalopathy.
Injury to the depths of the sulci. Causes a thinning and gliotic gyri (ulgyria)
loss of gray mater in the deep nuclei of the cerebrum followed by irregular myelination
*looks like a marble
Pt is unaware of her location and name, she just suffered a blow to the head while attempting to juggle wine bottles. What are some immediate effects of this injury?
Loss of consciousness
Temporary respiratory arrest
Loss of reflexes
Coup vs. Countrecoup
Coup- Cerebral injury at the point of contact
Countrecoup- cereral injury at the brain diametrically opposite point of contact
Diffuse axonal injury
Damage to Node of Ranvier of axon with subsequent alternations in axoplasmic flow
Bleeding into the potential space btw dura and skull, appears as a smooth almond shaped mass. What's is going on? What was damaged, how does it develop (Sx)?
Epidural hematoma (middle meningeal artery)
Subdural hematoma...tell me all about it.
Innersurface of dura/outer arachnoid layer (bridging veins)
Trauma rips vessels draining from brain into sinus where they penetrate dura (dural-arachnoid margin)
*infants + eldery are particularly susceptible (extra space in da skull)
Post-traumatic dementia (define, effects).
Follows repeated head traumas
Similar to dementia pugilisteica
Thinning of corpus callosum
Diffuse axonal injury
Diffuse αβ-positive plaques
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