Basic neuropathology

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Author:
lazzsant
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126942
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Basic neuropathology
Updated:
2012-01-12 18:31:03
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Martinez
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Neuropathology
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  1. Tissue stains
    • 1) H&E = pink w/ blue dots
    • 2) Cresyl violet- nissl substance
    • - Luxol fast blue - glia
    • 3) Bielschowkys silver- fiber neurons
    • 4) GFAP- immunohistochemistry (glia tumors)
  2. Chromatolysis
    • Neuronal reaction
    • acute axon injury -> perikaryon -> swelling & peripheral displacement of nucleus & nissl substance
    • Regeneration of the axon

    Caused by: acute infection, toxic, vascular, or metabolic changes
  3. Red neuron
    Neuronal reaction after acute injury that leads to necrosis or apoptosis.

    • shrinkage, pyknosis of nucleus(dense chromatin), triangular, cytotoxic edema, eosinophilia, loss of nissl bodies
    • H & E stain 12 -24 hours after irreversible hypoxic insult.
    • WHERE: hippocampus, neocortex, purkinje cells
  4. Chronic ischemia
    • Neuronal reaction
    • cork screw axons with microglia infiltration
  5. Nonperfused brain
    • acidophilic neurons, vascular proliferation
    • neurophagy via scavenger cells -> microglia scar & iron deposition
  6. neuronal atrophy
    • Neuronal reaction
    • end stage
    • accumulation of lipfuscin, distortion, dead neuron
    • If seen histologically = prolonged death
  7. numeric atrophy
    >30% depopulation in a given section
  8. Trans-synaptic degeneration
    • neuronal reaction (neuronal atrophy)
    • dendrite degeneration -> loss of afferent connection
    • WHERE: lat geniculate bodies (optic nerve damage)
    • - mammillary bodies (degen of fornix)
    • - neurons of gracile & cuneate (degen of post spinal cord)
  9. Microscopically: binuclear nueron
    - fenestrated neuron
  10. Neuronal hypertrophy
    • Neuronal reaction (trans-synaptic finding)
    • binuclear
    • neurofibrillary degeneration
    • fenestrated neuron
  11. Ferrugination
    • Iron deposit
    • SEEN IN:
    • Chronic trauma(boxers)
    • Old infarcts
    • Stage III syphilis
  12. Viral inclusions
    • CMV inclusion
    • Herpes cowdry bodies
    • oligodendrocytes with viral intranuclear inclusions
    • intracytoplasmic negri (rabies)
  13. Alzheimers
    Pakinsons
    Creutzfeldt-Jakob disease
    • Intracyoplasmc inclusions and highly resistant to degradation.
    • Alzheimers- neurofibrillary tangles
    • Parkinsons - Lewy bodies
    • Creutzfeldt-Jakob disease- vacuolization of perikaryon & neuronal cell processes in the neuropil
  14. Tay sachs diease
    • Neurolipid accumulation
    • Ganglioside
  15. Niemann Pick
    • Neurolipid accumulation
    • sphingomyelin
  16. Gaucher
    • Neurolipid accumulation
    • Glucocerbroside
  17. Gliosis
    local proliferation of astrocytes which leads to hypertrophy and hyperplasia
  18. Protoplasmic astrocytes vs fibrous astrocytes
    • Protoplasmic = intial repair
    • fibrous = later repair
  19. Anisomorphic vs Isomorphic
    • Anisomorphic = cortical scars
    • Isomorphic = white matter
  20. Reactive gliosis vs astrocytic gliosis
    • Reactive gliosis:
    • Hypertrophy of cytoplasmic processes
    • inc production of GFAP
  21. Astrocytic gliosis:
    hypertrophy and hyperplasia of astrocytes
  22. Gemistocytic gliosis
    Bright pink, somewhat irregular swath around an eccentric nucleus, from which emerge numerous stout, ramifying processes.
  23. Found near tumors or areas of necrosis
    or in tissue destruction & repair
  24. Copoar amylacea
    • Glucose polymers inclusion of astrocytes
    • Located in subpial, subependymal, and perivascular, and olfactory tracts.
  25. rosenthal fibers
    • Astrocytes cytoplasmic inclusion bodies.
    • densely compacted glial intermediate filaments with entrapped cytosolic proteins and form in long standing astrogliosis.
  26. Oligodendrocytes reaction to injury
    • Viral inclusion in progressive multifocal leukoencephalopathy.
    • Multiple system atrophy- glial cytoplasmic inclusions composed of a-synulein.
  27. Ependymal cells to injury
    • Lines ventricles.
    • Disruption leads to prolferation of subependymal astrocytes --> irregularities of ventricular surface.
    • CMV is a cause
  28. 3 types of alzheimers glia
    Type I (astrocytes) - multinucleated, eosinophilic, giant cells. WHERE: white matter
  29. Type II (liver glia)- nuclei > 20Mm & liver disease related(chronic liver disease, Wilsons disease, or hereditary metabolic disorder of urea cycle. Lobular nucleus & thick membrane
  30. Type III glia - devoid of cytoplasm. naked nuclei glia.
  31. How do microglia turn into foamy cells
    • activated into rod cells - lipid accumulation -> foamy cells
    • Also form microglial nodules (aggreagates around tissue necrosis)
    • neuronophagia (congregation around cell bodies of dying neurons)
  32. Types of brain edema
    • Vasogenic
    • cytotoxic
    • interstitial
  33. Brain edema
    What causes it
    What does it cause
    • BY: no lymphatic drainage & damage to BBB
    • CAUSES: ischemia & herniation
  34. Focal cerebral edema
    Unilateral
  35. Brain swelling after global edema
    Widened gyri, engorged veins, compressed sulci.
  36. TBI
    • Traumatic brain injury
    • disruption of brain functions with 1 or more:
    • LOC
    • loss of memory
    • AMS
    • Focal neurological changes
  37. 2 main complications of blunt trauma
    • Primary: trauma is the main cause
    • results in Diffuse axonal injury
    • Secondary: Blunt trauma leads to something else that causes brain problems
    • - Intracranial hematoma, edema, herniation, infection, infarction
  38. Penetrating Trauma
    • Functional impairments related to site of injury
    • Spinal cord transection or crush injury
  39. DAI definition
    • Small hemorrhagic lesions & diffuse damage to axons
    • No fracture involved
    • Microscopically: axon is swollen & looks like neuron (retraction ball) Present 12-24 hours later
  40. DAI grading
    • Grade I = DAI
    • Grade II = DAI & hemorrhage in corpus callosum
    • Grade III = DAI, hemorrhage in corpus callosum & lesions to DLR brainstem
  41. Concussion definition
    • altered consciousness after blunt head trauma
    • Presents with:
    • Transient LOC
    • Paralysis
    • Siezures
    • Recovery can take hours to days
  42. Contusion defintion
    • Blunt trauma with microhemorrhage without cavity formation
    • No hematoma present and continuity is preserved
    • Clincal:
    • LOC
    • transient --> permanent focal neurological defect
    • INC ICP
    • Coup vs countercoup
  43. Contusion timeline
    • DAI- 24 hours
    • Cerebral edema - 3 days
    • Delayed subdural hematoma ischemic injury- years
  44. Brain commotion
    • Pathology of concussion
    • Involves: Dysfx of reflexes
    • altered consciousness
    • widespread depolarization
    • no morphological findings
  45. Extrdural hemorrhage
    • Epidural hematoma caused by middle meningeal artery ->inc ICP -> mass effect
    • Course: drowsy-> coma-> death
  46. Subdural hemorrhage
    • small trauma -> veins damaged -> fibroblastic organization or cyst formation -> attracts water -> edema -> Inc ICP -> herniation or cerebral ischemia
    • Clinical: Biphasic LOC
  47. Post concussion symptoms
    • headache
    • irritability
    • dizziness
    • dec concentration
    • memory problems
    • fatigue
    • visual disturbance
    • Noise sensitivity
    • judgement problems
    • anxiety & depression
  48. Caput Hemorrhage
    • Birth Injury
    • Between skin & epicranial aponeurosis
    • Crosses midline
    • asymptomatic
    • gradually resolves
  49. cephalhematoma
    • Birth injury
    • collection of blood between Periosteum and skull
    • Common over parietal or occipital bones
    • limted by skull sutures -> does not cross midline
    • may lead to anemia or jaundice
    • gradually resolves
  50. Subgaleal hemorrhage
    • Birth injury
    • Collection of blood between epicranial aponeurosis & periosteum of skull
  51. Intracranial hemorrhage
    • Intracerebral bleeding from dural sinuses or brain substances
    • devastating
  52. Periventricular leukomalacia
    • Holes in white matter surrounding the ventricle.
    • Caused by change in blood flow or infection.
  53. Multicystic encephalopathy
    Formation of large multicoular cavities throughout the cerebral hemispheres

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