Pathoma - 17 (CNS Part 2)

arold001's version from 2015-12-30 21:31

Section 1

Question Answer
What artery is affected in epidural hematoma?Middle meningeal artery
Whats the cause of subdural hematoma?tearing of BRIDGING VEINS that lie btw dura and arachnoid
whats a complication of both epidural hematoma and subdural hematoma?herniation
whats displaced in a tonsillar herniation?displacement of cerebellar tonsils into the FORAMEN MAGNNUM
whats being compressed in a (cerebellar) tonsillar herniationcompression of the brainstem leads to cardiopulmonary arrest
whats dispalced in an uncal herniationdisplacement of TEMPORAL LOBE UNCUS under TENTORIUM CEREBELLI
name 3 things being compressed in uncal herniation?compression of CN III
compression of PCA
rupture of paramedian artery leading to Durets (brainstem) hemorrhage
what are leukodystrophies?mutations in enzymes needed for the PRODUCTION or MAINTENANCE of myelin
what enzyme is defected in metachromatic leukodystrophy?deficiency of arylsulfatase --> now myelin cant be degraded and accumulates in lysosomes of oligodendrocytes
whats impaired in Adrenoleukodystrophy?impaired addition of Coenzyme A to long chain fatty acids --> accumulation of fatty acids damages adrenal glands and white matter of the brain
what HLA is associated with Multiple Sclerosis?HLA - DR2
pt with MS has an MRI scan...shows classic PLAQUES...what is that?plaques = area of white matter demyelination
gross exam of the brain shows grey-appearing plaques in white matterMS
whats the 2 treatment drugs for MS?IFN-beta and Natalizumab (mab against alpha4-integrin)

Section 2

Question Answer
what virus is associated with subacute sclerosing panencephalitis?measles virus
what does "pan" in panencephalitis mean?pan = both grey and white matter
whats the difference btw SSPE vs. PML?SSPE: slowwwwww. PML: RAPID!
JC virus infection of oligodendrocytesPML = rapid vision loss, weakness, dementia

Section 3

Question Answer
what does degeneration of the cortex lead to?dementia
what does degeneration of the brainstem and basal ganglia lead to?movement disorders
whats the most common cause of death in Alzheimers disease?infection
what increases the risk of sporadic AD? decreases the risk?Increases risk: e4 allele of apolipoprotein E.
Decreases risk: e2 allele
what mutation is associated with FAMILIAL early onset Alzheimers Disease?mutations in presenilin 1 and 2
what chromosome is APP on?chromosome 21 (shows that AD is associated with down syndrome)
what are the 2 cases in which we see early AD?familial mutation in presenilin 1 and down syndrome
what angiopathy is associated with AD and why?amyloid can deposit around blood vessels which weakens the vessel wall, increasing risk of hemorrhage --> cerebral amyloid angippathy
whats NT change is seen in AD?decrease ACh in nucleus basalis of meynert
whats the 2nd most common cause of dementia?vascular dementia
degenerative disease of frontal and temporal cortexpicks disease
ROUND aggregates of tau proteinpicks bodies in neurons
whats loss in parkinsons disease?loss of dopaminergic neurons in substantia nigra of basal ganglia
MPTP exposure leads to what disease?MPTP --> MPP = parkinsons disease
histology shows loss of pigmented neurons in substantia nigra and round eosinophilic inclusions of alpha-synuclein in neuronsParkinsons disease
what is a lewy body made out of?alpha-synuclein
when does dementia appear in parkinsons disease?LATE!!!!
whats the difference btw parkinsons disease and Lewy body dementia?Parkinsons disease: LATE onset dementia. Lewy body dementia = EARLY onset dementia
dementia, visual hallucinations, parkinsonian featureslewy body dementia
degeneration of GABAnergic neurons in the caudate nucleus of basal gangliahuntington disease
when does expansion of CAG repeats in huntingtons disease occur?expansion of repeats during SPERMATOGENESIS leads to anticipation
explain how you get chorea in huntingtons diseaseloss of GABAnergic neurons of caudate nucleus --> loss of inhibitory hold on cortex --> random firing of system --> random purposeless movement of muscles --> CHOREA

Section 4

Question Answer
increased CSF resulting in dilated ventricles --> stretching of corona radiata nerve fibers --> dementianormal pressure hydrocephalus
whats the triad of normal pressure hydrocephalus?urinary incontinence, gait instability, dementia
wet, wobbly, wackynormal pressure hydrocephalus
what procedure provides immediate relief for normal pressure hydrocephalus?LP!
whats the treatment of normal pressure hydrocephalus?ventriculo-peritoneal shunting = shunt CSF from ventricles to peritoneum
rapid dementia +ataxia + startle myoclonusCJD
what are seen on EEG of pts with CJD?Spike-wave complexes are seen on EEG

Section 5

Question Answer
Name the top 4 organs taht like to metastasize to the brain?lung, breast, kidney, skin
What cells form the BBB?astrocytes
Involuntary contraction of muscle with little stimulistartle myoclonus
name the 3 most common brain tumors in kidspilocytic astrocytoma
malignant high grade tumor of astrocytesGBM
which adult brain tumor likes to cross the corpus callosumGBM
benign tumor of arachnoid cellsmeningioma
what brain tumor expresses ESTROGEN receptors?meningioma
whats the tumor marker of schwanoma?S100+
imaging shows a calcifed tumor in the WHITE MATTER (where oligodendrocytes are), involving the FRONTAL lobeoligodendroglioma
caclified tumor in the white matter of the frontal lobeoligodendroglioma
rosenthal fiberspilocytic astrocytoma
what receptors does meningioma express?estrogen receptors
brain tumor shows small round blue cellsmedulloblastoma
homer-wright rosettesmedulloblastoma
malignant tumor derived from the granular cells of cerebellummedulloblastoma
where are pilocytic astrocytomas located?CEREBELLUM (this is different since most childhood tumors are BELOW the tentorium)
perivascular pseudorosettesependymoma
childhood brain tumor that arises in the 4th ventricle with hydrocephalusependymoma
Bitemporal hemianopsia in children? adults?child: craniopharyngioma
adults: prolactinoma
childhood tumor that arises from epithelial remnants of Rathkes pouchcraniopharyngioma

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