neuropathology

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Author:
ghrelin23187
ID:
225947
Filename:
neuropathology
Updated:
2013-07-12 12:52:06
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SELECTED FACETS OF NEUROPATHOLOGY
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  1. Alzheimer -etiology
    • AMYLOID PRECURSOR PROTEIN IS ABNORMALLY CLEAVED
    • Normal cleavage : Abeta 40 --> cannot aggregate
    • Abnormal cleavage: Abeta 42 --> senile plaque
  2. Genes associated with Alzheimers
    Amyloid precursor protein (APP)‏

    Presenilin 1, presenilin 2 (early onset)‏

    E4 allele of apolipoprotein E

    • Genetic or acquired defects in APP processing result in accumulation of amyloid
    • containing A4Beta. 

    • ? Amyloid is a primary or secondary event. 
    • Amyloid plaques and cerebral amyloid angiopathy.

    Neurofibrillary tangles- Paired helical filaments with hyperphosphorylated tau in neurons.
  3. In Alzheimer, Genetic or acquired defects in APP processing result in
    accumulation of amyloid containing A4Beta.
  4. In Alzheimer, Paired helical filaments with hyperphosphorylated tau in neurons.
    Neurofibrillary tangles
  5. Alzheimer's 4 features
    Plaques

    Neurofibrillary tangles (***correlate best with disease)

    • Congophilic amyloid angiopathy   
    • (cerebral amyloid angiopathy, CAA)‏

    Granulovacuolar Degeneration of Simchowicz
  6. ALZHEIMER DISEASE - what is it, its etiology, its microscopic presentation, cause of death
    SLOWLY EVOLVING DEMENTIA

    PLAQUES AND AMYLOID ANGIOPATHY CONTAIN A4-Beta

    NEUROFIBRILLARY TANGLES CONTAIN TAU PROTEIN

    TANGLES CORRELATE WITH DZ

    DEATH FROM PNEUMONIA, SEPSIS
  7. Amyotrophic Lateral Sclerosis
    • Rapidly progressive, fatal disorder that attacks neurons (brain, spinal) controlling
    • voluntary muscles

    Causes wasting of muscle resulting in respiratory failure
  8. ALS- results in
    denervation atrophy
  9. ALS - genetic component
    SOD1- antioxidant functions implicated in some familial forms.  TDP43 in sporadic ALS.
  10. True or false

    Elevated glutamate (neurotransmitter toxicity) may mediate ALS
    True
  11. True or False

    In ASL, the disease affects both muscle and sensory fxn because of the demylination
    false
  12. Definition of Stroke
    Rapidly progressive

    Irreversible

    Non-convulsive neurologic deficit >24 hr

    • 70-80% from infarcts  and 20-30% from
    • hemorrhages in Western world

    Includes cerebral infarcts and hemorrhages

    • Cerebral infarcts (localized injury related to ischemia/hypoxia) include thrombotic,
    • embolic, and hemorrhagic reperfusion injuries
  13. Stroke: TIA
    This is a transient ischemic attack in which neurologic symptoms are from transient vascular obstruction. < 24 hrs 

    1/3 of TIA patients will have significant infarcts in 5 years
  14. Stroke: F.A.S.T.
    F= FACE  Ask them to smile. Does one side droop?

    • A= ARMS  Ask to raise both arms. Does
    • one arm drift downward?

    S= SPEECH  Ask the person to repeat a simple   phrase.  Does the speech sound   strange or slurred?

    T= TIME  See any of these signs. Time to   CALL 911.
  15. Stroke: INFARCTS
    Local interruption of blood flow

    Risk factors: 70 yo, male, atherosclerosis (hypertension, diabetes, smoking)‏

    Thrombosis in atherosclerotic vessels

    Emboli from heart or atherosclerotic vessels

    Extensive vascular anastomoses in the Circle of Willis may mitigate a stroke

    Edema maximal at 3-4 days

    Cystic and liquified by 6 months
  16. Stroke: Hemorrhages
    Hypertension/Atherosclerosis

    Coagulopathies (Blood thinners, liver failure, defective coagulation factors)‏

    Saccular Aneurysms
  17. STROKE - risk factor
    Atherosclerosis, hypertension, and coagulopathies are important risk factors
  18. Stroke - causes
    Hemorrhage and infarct
  19. BRAIN TUMORS
    Prevalence:  360,000 primary brain tumors

    Most common intraaxial/intrinsic brain tumor is glioblastoma

    Most common extraaxial/meninges-based tumor is meningioma
  20. Glioblastoma
    MEDIAN SURVIVAL: 1 year

    AGGRESSIVE INFILTRATIVE INTRAXIAL (PARENCHYMAL) TUMOR

    HIGH GRADE
  21. Extraaxial Tumors
    Most common is meningioma

    A tumor derived from arachnoidal cells

    Mostare benign- slow growing. Grade I can recur. Some are aggressive and can metastasize distantly.
  22. Brain tumor morphology
    • FALCINE
    • Convexity
    • WHORLS ARE TYPICAL OF MENINGIOMA
    • Can be fibrous with much collagen
  23. Intraaxial vs extraaxial: which one is better to cure
    extraaxial
  24. BRAIN TUMOR's intraaxial
    Glioblastoma- malignent -
  25. Brain tumor - extraaxial
    Menigioma - often beign
  26. In Multiple Sclerosis, The neurologic symptom progress
    Waxing and waning 

    Sharply demarcated demyelinated plaques are typical (Axons are intact)

    Dawson’s fingers
  27. Multiple Sclerosis is probably caused by
    • autoimmune and Sharply
    • demarcated demyelinated plaques are typical (Axons are intact
  28. MS's brain scan presentation
    Dawson finger

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