Diseases of the Nervous System

Central nervous system Cerebral Edema

Brain is a prisoner
Injury to brain
Basic cellular elements
Tumor
Neurons, location means everything
Rubor
Neuronal reaction to injury, very limited
Swelling cant go
Axonal growth
anywhere

No regeneration of lost cells

Accumulation of junk within the cells can be harmful. Compression of vital
Glial component, supportive structures
Microglia, the police force of the CNS Herniation
Astrocytes, structural like fibroblasts elsewhere Sublax
Gemistocytes are reactive astrocytes Transtentorial
Oligodendrocytes, make myelin (the insulation) Cerebellar tonsils
Meninges

Brainstem Hemorrhages CSF Flow

Made in the ventricles

Flows down aqueduct
Into 4th ventricle
Out into the
subarachnoid space
Up to the arachnoid
granulations
Back into the blood
Obstructions in
movement will lead to
hydrocehpalus

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 Hydrocephalus Hydrocephalus
Noncommunicating: Cant get out of ventricles
Obstruction to flow of CSF Communicating: CSF cant get to arachnoid granulations
Over production of CSF
Inability of arachnoid
granulations to restore
water of CSF back into
circulation

Trauma

Birth trauma
Hemorrhage
Permanent loss

Trauma Contusions

Closed head
Coup
Contra-
Contra-coup
Penetrating
Hemorrhage
Contusion
Laceration

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 Subdural Hemorrhage
Rotational injury tears little veins
Slow venous bleeding

Subarachnoid
Epidural Hemorrhage Hemorrhage

Not as commonly due

Trauma with skull fx to trauma, but maybe.
Middle meningeal a. Arterial bleeding
Hemorrhage Typically from Circle of
Willis
compresses brain
Blood in subarachnoid
space

Vascular Disease

Hypoxic
TIA
Stroke
Infarction
Hemorrhagic
Vascular blowout
Trauma

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 Ischemic Infarcts Hypertensive
Hemorrhages

Berry aneurysm
Subarachnoid
Parenchymal

Berry Aneurysm Subarachnoid

Hemorrhage

Lacunar Infarcts Chronic Ischemia

Hypertensive vascular disease
Watershed infarcts Chronic vascular
insufficiency
Atherosclerosis
Marked cerebral atrophy

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 Infections

Brain proper
Minenges
Bug
Bacteria
Virus
Spirochtes
Parasites
Prions

Bacterial Meningitis Bacterial Meningitis

Exudate over cerebral

hemispheres
Bacteria grow in CSF
CSF
Cell count
Glucose
Protein
Age of patient
Complications
Scarring
Epilepsy
Abscess

Cerebral Abscess Viral Encephalitis

Septic endocarditis
Infection of brain
Blood borne pathogens
substance
Must surgically drain
Herpes ->
Absent temporal
lobes
Sporadic
Immunsuppressed
HIV

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 HIV Encephalopathy
Tertiary Syphilis
Meningitis
Neuronal Years after initial infection
Both cognitive motor Obliterative end arteritis
Diffuse cortical atrophy Meningitis
Microglia at site of dead Brain proper
neurons Tabes dorsalis
GP120 protein is directly
toxic

Prion Disease Prion Disease

No nucleic acid
Sporadic or genetic
Accumulation of
abnormally folded
protein
Variety of
conformations of the
diseased protein
Spongioform
encephalopathy
Kuru

Degenerative Diseases

Not just aging changes

Neuronal Death
Gray matter
White matter changes are secondary
Selective or generalized loss
Atrophy (local or global)
Histological features
Neurofibrillary tangles
Intracellular or intranuclear inclusions

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 Alzheimers Disease
Alzheimers Disease
True dementia
Marked atrophy Progressive loss
Memory
Protein alterations
Cognitive
Tau protein
Amyloid related
5-15 years
protein Eventually loss of
Senile plaques language
Amyloid Higher functions
angiopathy
Parkinsons in a few
Pneumonia is often cause
of death

Alzheimers Disease Alzheimers Disease

Senile plaques
Vascular amyloid changes

Parkinsons Disease Huntignton Disease

Parkinsonism, collection of symptoms
Rigidity, stooped posture, gait disturbances, pill rolling, face Hereditary
Drug induced
Progressive
Parkinsons Disease Extrapyramidal motor
Choreaform movements
Huntington gene
Trinucleotide repeats
CAG
Normal 6-
6-34 copies
HD has 50-
50-70 repeats
Caudate nucleus
atrophy
Suicide and infections

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 Amyotrophic Lateral Sclerosis (ALS)

Sporadic loss of
motor neurons
Spinal
Bulbar
Poor swallowing
Pneumonia

Multiple Sclerosis
Demyelinating Disorders
Lesions dispersed in
space and time
White matter Come and goes
Disease of oligodendrocytes Symptoms
Optic nerve
Autoimmune most times Urination
Heat makes worse
Weakness
Degeneration of white
matter
Plaques

Multiple Sclerosis Multiple Sclerosis

Areas of demylinization
Plaques
Active repair
Quiescent

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 Toxic and Vitamin Deficiencies

Thiamine Deficiency
B12 Deficiency
Beriberi
Alcohol abuse
Abrupt psychotic changes
Inability to maintain myelin
Wernickes encephalopathy Posterior column degeneration
Hemorrhages in mamillary bodies
Confusion
Paralysis of extraoccular muscles
Ataxia
Korsakoffs
Inabilbity to form new memories
Confabulation

Ethanol
Acutely, neural depressant
Inhibitions go first
Loss of depth perception
Chronic
Degeneration of granular cell layer of cerebellum
Loss of Purkinje cells
Bergmans gliosis
Fetal alcohol syndrom
Microcephaly
Growth retardation
Facial abnormalities
Mental retardation
Abnormal migration of neurons during development

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 CNS Tumors Astrocytoma

Primary vs. metastatic Astrocytic origin

Benign vs. malignant Above tentorum most times
in adults
Focal vs. diffuse
Above or below tentorum Multiple grades
Not too common in adults Compresses surrounding
About 20% of childhood malignancies tissue
Location is critical Hemorrhage and necrosis
Cell type With higher grade
None are of neuronal origin
Astocytoma,
Astocytoma, most malignant tumors,
Oligodendrocytoma Look for vascular growth
Microgliomatosis
Ependymoma

Astrocytoma Astrocytoma

Ependymoma Meduloblastoma
Children
Midline cerebellum
Subarachnoid spread

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 Meduloblastoma Meningioma
Arise from meninges
Benign in a biological
sense
Consider where it is
Fibroblast looking
Cells in whirls and
clusters
Psammoma bodies

Meningioma

Psammoma bodies
Little calcifications
Microscopic
Within the tumor
Can spot on X- X-ray
Concentric layers ->

Peripheral Nerves Guillian-

Guillian-Barr
Barr Syndrome
Axon vs. Schwann cells
Autoimmune?
Motor
Sensory Follows
Infection
Inflammatory, autoimmune
viral
Toxic Mycoplasma
Trauma Allergic reaction
Vascular, especially diabetes Demylinization
Tumors Ascending paralysis
Phrenic nerve involvement is life threatening

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Peripheral Nerve Neurofibromatosis
Tumors

Actually nerve Two types

sheath tumors No capsule
Schwann cells Type 1
Genetic
Cranial nerves too

All over the body

V & VIII Glioma of optic n. (rare)
Meningioma
Caf
Caf-au-
au-lait spots
Pigmented nodules of iris

Neurofibromatosis

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