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Information about NEUROPATHOLOGY LECTURE 2009*
Health & Medicine

Published on February 19, 2014

Author: MichaelThomas29




MEDEX 452: Pathophysiology for Primary Care Henry Stoll, PA-C



Spinal Cord Defects


Cerebral Edema


Results of Increased Intracranial Pressure (ICP)

Uncal Herniation


Hydrocephalus -- Causes


Hydrocephalus - Ventricular Enlargement

Hydrocephalus - Results

Brain Blood Supply

Common Sites of Atherosclerosis

Common Sources of Emboli

Stroke - Middle Cerebral Artery

Thrombosis - Internal Carotid Artery

Embolic Stroke with Edema

Embolic Stroke with Punctate Hemorrhages

Watershed Infarctions

Liquefactive Necrosis with Cysts

Basal Ganglia Hemorrhage Due to Hypertension

AV Malformation

Berry Aneurysm Carotid bifurcation aneurysm

Figure 23-9 Relative frequency of common sites of saccular (berry) aneurysms in the circle of Willis. Downloaded from: StudentConsult (on 22 August 2008 07:07 PM) © 2005 Elsevier

Giant Aneurysms

Ruptured PCOM Aneurysm

Subarachnoid Hemorrhage

Subarachnoid Hemorrhage


Cerebral contusions. Primary impact damage has caused severe hemorrhagic contusion of the left frontal lobe (C) - coup lesion, with smaller contusions on the right parietal lobe (P) contrecoup lesion. Swelling of the left side of the brain has caused cerebral herniation with compression of the midbrain

Figure 23-13 Traumatic intracranial hemorrhages. A, Epidural hematoma (left) in which rupture of a meningeal artery, usually associated with a skull fracture, leads to accumulation of arterial blood between the dura and the skull. In a subdural hematoma (right), damage to bridging veins between the brain and the superior sagittal sinus leads to the accumulation of blood between the dura and the arachnoid. B, Epidural hematoma covering a portion of the dura. C, Large organizing subdural hematoma attached to the dura. (B, Courtesy of Dr. Raymond D. Adams, Massachusetts General Hospital, Boston, Massachusetts.) Downloaded from: StudentConsult (on 22 August 2008 07:07 PM) © 2005 Elsevier

Epidural Hematoma

Epidural Hematoma

Middle Meningeal Artery

Bridging Veins

Subdural Hematoma

Subdural Hematoma

Acute Meningitis

Acute Bacterial Meningitis

Acute Meningitis

Infectious causes of chronic meningitis • Tuberculosis  Cryptococcosis  Coccidioidomycosis  Histoplasmosis  Candidiasis  Blastomycosis  Syphilis  Brucellosis  Toxoplasmosis  Nocardiosis  Lyme disease  Actinomycosis

Major causes of viral encephalitis in the United States Virus  Herpes simplex  Mumps  St. Louis Geographical distribution Nationwide Nationwide Nationwide (esp. south and central)  California/La Crosse Central and eastern US  Western equine Western US  Eastern equine Atlantic and Gulf coasts  Colorado tick fever Western US  Venezuelan equine Texas and Florida  Rabies Nationwide

Seasonal variation in infections capable of causing viral encephalitis

HSV Encephalitis


Progressive Multifocal Leukoencephalopathy


Animal Cases of Rabies

Human Rabies Deaths






Tabes Dorsalis

Signs and symptoms of tabes dorsalis                 Signs and symptoms Pupillary abnormalities (Argyll Robertson pupils) Absent reflexes, lower extremities Lightning pains Romberg's sign Impaired position sense Ataxia Bladder disturbances Visual loss Impaired vibratory sense Visceral crisis Impaired pain sense Cranial nerve palsy Paresthesias Charcot joints Anal sphincter atony Perforating ulcers (mal perforans) Range, % 94-97 78-94 70-75 51-55 44-45 42-46 28-33 16-43 17-52 15-18 13-18 9-10 7-24 6-7 3-14 5-6

Prion diseases of humans and animals           Disease Scrapie Transmissible mink encephalopathy (TME) Chronic wasting disease Bovine spongiform encephalopathy (BSE) Feline spongiform encephalopathy (FSE) Kuru Creutzfeldt-Jakob disease (CJD) New variant CJD (nvCJD) Gerstmann-Straussler syndrome (GSS) Fatal familial insomnia (FFI) Host Sheep, goats Mink Mule deer, elk Cattle Cats Humans Humans Humans Humans Humans

 Propagation of scrapie PrP in neurons of the brain apparently occurs via a domino effect on an internal membrane. A favored hypothesis holds that the process begins (a) when one molecule of scrapie (red) contacts a normal PrP molecule (brown) and (b) induces it to refold into the scrapie conformation. Then, the scrapie particles attack other normal PrP molecules (c). Those molecules, in turn, attack other normal molecules and so on (broken arrow) until scrapie PrP accumulation reaches dangerous levels (d).

Characteristics of prion diseases and agents  Prolonged incubation period of months to years  Progressive course of weeks to months to death  No host immune response (except astrocytosis)  Pathologic lesions confined to the central nervous system  Similar histopathology  No specific treatment Causative agents (prions) have specific properties:  No detectable nucleic acid  Resistant to alcohol, formalin, heat, ultraviolet (UV) irradiation, nucleases*  Susceptible to proteolytic enzymes, denaturing agents, organic solvents** Sterilized by:  Steam autoclaving 1 hour at 132ºC  Immersion in 1N NaOH for 1 hour at room temperature *Agents that hydrolyze or modify nucleic acids. **Agents that digest, denature, or modify proteins

Spongiform Encephalopathy


Glioma of Brainstem (midbrain)

Glioma - Cerebrum

Glioblastoma Multiforme



Acoustic Nerve Schwannoma

Neurofibromatosis 1

NEUROFIBROMATOSIS DIAGNOSTIC CRITERIA TWO OR MORE OF THE FOLLOWING NF-1(VONRECKLINGHAUSENS’NFT) >6 Cafe’-au-lait spots >2 neurofibromas Inguinal/axillary freckles Optic glioma >2 Lisch nodules Sphenoid dysplasia 1st degree relative NF-2 Bilateral eigth nerve masses or two of the follwing  Neurofibroma  Meningioma  Glioma  Schwannoma  Juvenile cateract



Multiple Sclerosis

Cerebral Atrophy - Alzheimer’s Disease

AD - Hydrocephalus Ex Vacuo

AD - Neuritic Plaques

AD - Neurofibrillary Tangle

Huntington’s Disease

Huntington’s Disease

Huntington’s Disease

Parkinson’s Disease

Characteristics of Parkinsonism Major Features  Rest tremor Motor Freezing of gait Autonomic Cognitive Urinary Slowness in thinking  Rigidity Dystonia Constipation Dementia  Bradykinesia Muscle ache Impotence in men Depression  Loss of postural Kyphosis reflexes

Parkinson’s Disease

Parkinson’s Disease

Amyotrophic Lateral Sclerosis (ALS)

Upper & Lower Motor Neurons

ALS - Corticospinal Tract Degeneration

Wernicke's encephalopathy. In this coronal section of brain the mammillary bodies (arrows) show petechial hemorrhages characteristic of acute Wernicke's encephalopathy caused by thiamine deficiency

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