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LECOM Path 28 CNS ?

LECOM Path Ch 28 CNS questions

What is the causative organism most likely to cause meningitis in an IV drug user if the lab findings show increased protein and decreased glucose? Increased protein and low glucose would indicate bacterial, fungal or TB meningitis (pg 178), but someone who is an IV drug user most likely is STAPH
What is most common histological finding in someone w/ CJD? Spongiform encephalopathy - where the normal cellular protein (PrPc) prion protein is turned to (PrPsc) which resists degradation resulting in spongiform encephalopathy pg 176
Which vitamin deficiency is seen in chronic alcoholics? What is the name of this dementia Thiamine, B1 - Wernicke - confusion, opthalmoplegia, and ataxia (wernicke's encephalopathy.) Korsakoff if confabulation and personality change and memory problems pg 449
A person w/ diabetes melliitus is most likely prone to which type of dementia? Vascular dementia - stepwise loss of cognitive function
Grand mal seizure, doctors find melanoma, diagnosis? Metastases from malignant melanoma
PP w/ tonic-clonic seizure from left hemorrhage in temporal lobe. Normal glucose and normal protein. What organism caused this disease? what is seen histologically? Normal protein and normal glucose indicate a viral infection. HSV can cause hemorrhagic legions in the temporal lobe. Known as most common cause of sporadic encephalitis in the US (called temporal lobe enchelphaltis) Cowdry A inclusions
Most common cause of meningitis in 20 year old male? How would brain appear histologically? Neisseria meningitidis (6-60 yrs of age) -- purulent exudate on the cerebral convexities indicitve of a bacterial infection pg 178
A person presenting w/ asterixis (flapping hand) is seen in what condition? What is cause? Liver failure w/ hepatic encephalopathy - hyperammonemia pg 234 - asterixis is also seen in Wilsons
What is most important factor in the development of alzheimers? What are some histological findings? Inheritance of the e4 allele oat the ApoE4 gene - numerous plaques, amyloid in peripheral cerebral arteries pg 422
Which type of intracranial hemorrhage is most common from tripping or trauma? what would CT scan show? Subdural hematoma- tearing of the bridging veins beneath the dura (mainly in elderly or children) Crescent-shaped hemorrhage that crosses suture lines (gyr iar preserved)pg 402
What is most typical cause of aseptic or acute lymphocytic meningitis? West Nile, or an echovirus - usually self-limited pg 178
What presentation would you see w/ a saccular aneurysm in the right middle cerebral artery? How would PP? what would you see on CT scan? lucid interval, often fracture to temporal bone, CN III palsy biconvex disk - can cross falx, tentorium (wheras subdural cannot) pg 402
Which disease causes loss of UMN leading to progressive muscular weakness from grouped atrophy of skeletal muscle fibers -- what is the defect? ALS or Lou Gerigs disease - defect in superoxide dismutase 1 (SOD1) - commonly presents as fasiculations pg 407
A pt hits head, becomes unconscious then becomes comatose - which type of hematoma? Epidural - talk and die
PP w/ decreased vision, papilledema, hyperpigmented skin which type of mass or "oma"? What is positive? Schwannoma - pt has NF1 so they have multiple skin schwannomas or neurofibromas. Basically, which type of brain tumor is found in NF2? Schwannoma bilaterally to effect CNVIII (3rd most common brain tumor) pg 425 S-100
Which pathologic findings will a brain present with in Parkinson's? Loss of pigmented neurons in substantia nigra, Lewy bodies (composed of a-synuclein) pg 397
Severe blunt head truama that results in death from a midbrain hemorrhage arranged in a linear ventral -to-dorsal direction and bilateral incal herniation, which artery mostly likely? Basilar artery branches - lead to hemorrhagic infarcts in midbrain and pons Called "locked-in" syndrome pg 401
Which neoplasm is likely to present as a mass attached to the dura of the brain w/ occasional psammoma bodies which type of tumor? How common? what are psammoma bodies? Meingiomas - the other conditions where you would see psammoma boddies are: PSaMMoma - Papillary (thyroid), Serous (ovary), Meningioma, Mesothelioma 2ns most common primary brain tumor - spindle cells whorled pattern w/ laminated caclifications pg 425
A person who presents w/ huntingtons and dementia, what would you find histologically in brain? Abnormal prion proteins - CAG repeats (Caudate loses ACH and Gaba) glutamate toxicity pg 397
Baby w/ anencephaly will show what lab findings Elevated maternal serum AFP levels and acetylcholinesterase pg 127
If a pt has hyponatrium and it is corrected to quickly what is the negative outcome? Demyelination in the bais pontis - can lead to death or obtundation (refers to less than full mental capacity in a medical patient, typically as a result of a medical condition or trauma)
Picture of whole in pt's brain after autopsy. She lost consciousness before death, what could have caused the lesion? A remote cerebral infarction - a large area resulted when macrophages had to come clean away liquifactive necrosis
Cerebral atrophy and small brains weights, most likely died from which condition? Progressive dementia or alzheimers
Which congenital infection is most likely to produce findings of a hydropic fetus that died of organomegaly and extensive necrosis w/ focal calcifications? CMV - one of the TORCH infections that especially effects the CNS Toxoplasma gondii, Rubella, CMV, HIV, HSV and syphilis are other torches. pg 179
What are the two most common neoplasms in children, which location of brain? How would the better prognosis present? Posterior fossa - the astrocytoma - would stain postiive for GFAP(better prognosis) and medulloblastoma - pseudoroseette (homer-wright - or small blue cells, cause hydrocehphalus. pg 425
Difficulty initiating movements, dies of pulmonary thromboembolism what are other presentations of a pt w/ a midbrain abnormality? Parkinsons - pill-roll tremors, a-synuclein,
What is the most often complication of an infection that would cause a SOL w/ ring-enhancing lesions? A cerebral abscess ring-enhancing lesions in Metastases, abscesses, toxoplasmosis, AIDS lymphoma, see pg 42 6
Episodes of dysarthria, weakness in hands, diziness that last about 1 hour, what could explain this? Trasient ischemic attacks, generally a prodrome to stroke pg 403
Pt presents w/ paresthesias in arm, difficulty walking and then the problems will go away. Then he has problems seeing and writing. What would you find in CSF? how else does this disease present? how else do you diagnos? MS you would find malignant cellsand oligoclonal bands of IgG SIN - scanning speech, Intention tremor, incontinence, internuclear opthalmoplegia, nystagmus MRI but Dx by Oligoclonal bands (also periventricular plaques seen)
What would you find in CNS of a pt w/ huntingtons? Atrophy and gliosis of the caudate nuclei
A child presents w/ progressive worsening of movement and mental ability and dies, myelin loss is noted.. What could cause this? Metachromatic leukodystrophy - arylsulfatase deficiency w/ buildup of sulfatides- since it is an AR lysosomal storage disesase think of this if you see demylination in babiespg 423
What could cause an 80 year old to go in and out of consciousness who has blood in subdural space? Tear of bridging vein - subdural hematoma
Horrible headache that causes nuchal rigidity , CSF shows numerous RBC's -- associated w/ which conditions? Saccular/berry anerysm pg 402 marfans, ehlers danlos, APCKD****
What is a common opportunistic infection that affects the CNS in pt's w/ aids? Toxoplasmosis - produces abscesses that produce bright rings on CT and MRI pg 182
5 y.o. boy complained of headache for the past week. Ataxic Gait. sudden vomitting becomes comatose. Afebrile CT: 4-cm mass in cerebellar vermis and dilation of cerebral ventricles. CSF: small cells with dark blue nuclei and scant cytoplasm. Medulloblastoma. Pg. 425
27 y.o. woman w/ CSF showing increased IgG levels with prominent oligoclonal bands. Additional problems? Optic Neuritis. This patient has M.S.
60 y.o. man with sudden loss of conciousness. Examination: left hemiplegia. Did not regain conciousness and died of pneumonia. Pateint had a previous group A beta-hemolytic streptococci infection. What is the condition? Rheumatic heart disease with left atrial mural thrombosis. Pg. 272
55 y.o. man suddenly loses conciousness. Examination: Bilateral Papilledema. No spontaneous movements. What underlying condition caused this? Systemic Hypertension. Pg. 418
49 y.o. woman several headaches for 2 days. Afebrile and normotensive. Papilledema on the right. x1d patient has right pupillary dilation and impaired ocular movement becomes Obtunded ( What's the condition? Transtentorial medial temporal herniation. Pg. 426
56 y.o. single episode of grand mal seizure. Afebrile and Normotensive. Nrm motor/touch CNs intact. Nrm Mental Function MRI three solid 3cm mass lesions w/o ring edema at the gray-white junction in b/l frontal lobes Cerebral ventricles are normal in size. Metastatic Carcinoma. Pg. 225
CT 2cm mass in the right frontal lobe. Stereotactic biopsy: only gliosis and evidence of recent and remote hemorrhage. The mass is removed, and histologic exam: conglomerate of various-sized tortous vessels surrounded by gliosis. What is this caused from? AV malformation. NFA
PP Primary Brain Tumor that on microscopy looks like spindle cells concentrically arranged in a whorled pattern (psmammoma bodies: laminated calcifications). What is it? Meningioma.Pg. 425.
A previously healthy 16 y.o. boy has complained of headaches for the past 9 months. Enlargement of 4th Ventricle. What is it? Ependymoma. Look at vignette and explanation for 60.Pg. 425
Pt. has contralateral homonymous hemianopia. What's the cause? Uncal Herniation that is caused from compression of ipsilateral posterior cerebral artery (PCA). Uncus = medial temporal lobe Pg. 426
Sensorineural Hearing Loss example and explain the location? Schwannoma. Aka in this location is a cerebellopontine angle tumor. Schwannomas in this location arise from cranial nerve VIII (internal acoustic meatus). Also called Acoustic Neuromas. Pg. 392
Pt. has mass in brain. Stereotactic biopsy of the mass shows areas of necrosis surrounded by nuclear pseudopalisading. The neoplastic cells within the mass are hyperchromatic. Neoplasm? Glioblastoma Multiforme. Similar to 68. Pg. 425
HIV Patient has Pneumocystis Jiroveci. Brain MRI: diffuse cerebral atrophy, and no focal lesions are identified. What would be seen in brain? White matter microglial nodules with multinucleate cells. Patient has AIDS dementia complex late in the course of his HIV infection. NFA
Term infant born has tuft of hair on his back. What is it? Spina Bifida Oculta. Pg. 127
5 y.o. boy has meningitis. What would be seen on gram stain? Gram-positive cocci. Patient has acute bacterial meningitis. For his age group, the most common organism is Streptococcus Pneumoniae, which is gram-positve coccus.
55 y.o. who had been healthy all his life now has progressive, symmetric muscular weakness. What is the condition? Amyotropic Lateral Sclerosis aka ALS aka Lou Gehrig's Disease.
neonate is born prematurely at 28 weeks and becomes severely Hypoxemic 24 hours later, and seizure activity is observed. Poor neurologic development. Head CT: Symmetrically enlarged cerebral ventricles at 8 months of age. What is the cause? Germinal Matrix Hemmorhage.
79 y.o. woman was driving her automobile when she had a sudden, severe headache. She was taken to the ER, where she remained comatose and died 6 hours later. What was the cause? Rupture of Berry Aneurysm. Aneurysm in the circle of Willis and extensive subarachnoid hemmorhage.
red, shrunken neurons, decreased number of neurons, or absent neurons subset of pt have hippocampal pyrimidal cells, the cerebellar Purkinje cells, and the superior parasagittal neocortical pyramid cells are affected. Cause of neuronal loss? Global Hypoxia. "Red" shrunken neurons, especially in the areas mentioned, are typically seen in the early stages of global hypoxia, as may occur in a severe hypotensive episode. Ischemic brain disease
83 yo f falls backwards hits head Taken to the ER, and examination reveal a 3-cm reddish, slightly swollen area over the occiput. She is arousable but somnolent (drowsy). No motor or sensory deficits. No Papilledema. Head CT: acute hemmorhage where? Inferior Frontal Lobe. Classic "Contrecoup" type of injury, in which the moving head strikes an object, and the force is transmitted to the opposite side of the head.
56 yo f MVA contusions and abrasions head, torso, and extremeties. No papilledema, normal posture, no spontaneous movements. Unconcious. Head CT: no intracranial hemmorhage or edema and no skull fractures. Remains in persistent vegetative state. Lesion? Diffuse axonal injury. Angular acceleration with torsional forces applied to white matter tracts can cause stretching and tearing of axons, followed by axonal swelling or "retraction balls" within hours.
4 yo f developed clumsiness and difficulty ambulating over 6 months past 5 months developed CHF from hypertrophic cardiomyopathy. and hyperglycemia. Autopsy: perinuclear iron deposition within cardiac myocytes. Which genetic abnormalities with TNRE? GAA repeats in the frataxin gene. Has Friedrich's ataxia, autosomal recessive progressive illness onset in first 10y The frataxin gene encodes for a protein involved in iron regulation in cells. Friedreich is Fratastic (frataxin): he's your favorite frat
63 y.o. man had increasing irritability over 3 years. Then marked memory loss. Autopsy: Frontal cortex shows extensive neoronal loss on microscopy and some remaining neurons show intracytoplasmic, faintly eosinophilic, rounded inclusions that stain IHC fo Pick Disease aka Frontotemporal Dementia. Has clinical features similar to Alzhemier's disease, but initially it causes less memory loss and more behavorial changes.
20 y.o. mentally retarded woman saw physician because of flank pain for 1 week. Patches of leathery (shagreen patches) and hypopigmented (ash-leaf patches) skin were scattered over her body. What is it? Tuberous Sclerosis is one of the phakomoatoses (or "neurocutaneous syndromes").
40 y.o. man, who rarely has headaches, now experiences headaches for the past 6 months. Dies. Microscopy: mass consists of cells with round nuclei with clear cytoplasm. What's the prognosis? Oligodendroglioma. Usually in frontal lobe. Chicken-wire capillary pattern.
PP with a primary brain tumor that has characteristic perivascular pseudorosettes and rod-shaped blepharoplast (basal ciliary bodies) found in nucleus. What is it? Ependymoma. The tumors arise in the ventricles (usually 4th ventricles) are more common in first 2 decades of life. Poor prognosis and can cause hydrocephalus.
AIDS patient presents with a demyelinating condition that resulted due to a latend virus. What is it? JC papovavirus. Patient has progressive multifocal leukoencephalopahty (PML), which is caused by JC virus and occurs in immunocompromised individuals, including people with AIDS.
PP w/ cell study: large cells with large nuclei and scant cytoplasm that mark CD19, but no GFAP or cytokeratin. What is it? Diffuse Large B-cell Lymphoma. Most common adult Non-Hogkin Lymphoma
60 y.o. woman with Parkinsons. IHC stain for what type of protein is positive? alpha-synuclein. Pg. 397
70 y.o. pt. has acute cerebral infarction due to atherosclerosis. Risk factor? Hypercholesterolemia.
PP with cerebellar tonsillar herniation through foramen magnum with aqueductal stenosis and hydrocephaly. Brain MRI would show what malformation? Arnold-Chiari Type II malformation. Often presents with syringomyelia, thoraco-lumbar myelomenigocele. Pg. 127
Infant born at 36 weeks gestation is suffering from cyclopia. The infant died 1 hour after birth. What did the baby have and what condition is this seen in.? Holoprosencephaly. Trisomy 13 (Patau's) M.C. but can be seen in maternal DM and fetal alcohol syndome as well. Pg. 127
86 y.o. man. Histological Exam of the brain: numerous neocortical neuritic plaques and neurofibirllary tangles. What is seen histologically in plaques and what is seen histologically in tangles? Plaques: Aggregation of AB peptide. Tangles: tau protein Alzheimer's disease.
PP with brain tumor in cerebral hemisphere. "Pseudopalisading" Pleomorphic cells positive for GFAP. Neoplasm? Glioblastoma Multiforme. Most common primary brain tumor. Pg. 425.
Created by: csheck