8679901 central-nervous-system-pathology


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8679901 central-nervous-system-pathology

  1. 1. CNSCNS PathologyPathology Melani H. Sionzon, MD, DPSPMelani H. Sionzon, MD, DPSP
  2. 2. Review: Principal cells of theReview: Principal cells of the CNSCNS NeuronsNeurons Glial CellsGlial Cells – AstrocytesAstrocytes – OlidodendrogliaOlidodendroglia – ependymaependyma MicrogliaMicroglia Meningothelial cellsMeningothelial cells
  3. 3. Features Unique to CNSFeatures Unique to CNS Enclosed in a rigid bony compartmentEnclosed in a rigid bony compartment Autoregulation of cerebral blood flowAutoregulation of cerebral blood flow Dependent on glucose and high O2 supplyDependent on glucose and high O2 supply CSF fills ventricles and spacesCSF fills ventricles and spaces Lack a lymphatic circulationLack a lymphatic circulation Cell have limited regenrative abilityCell have limited regenrative ability Immunologically secludedImmunologically secluded BBB and blood CSF barrier separates the brainBBB and blood CSF barrier separates the brain from the rest of the bodyfrom the rest of the body
  4. 4. Intracranial compartmentsIntracranial compartments Epidural spaceEpidural space Subdural spaceSubdural space Subarachnoid spaceSubarachnoid space Cerebral parenchymal compartmentCerebral parenchymal compartment Intravntricular spacesIntravntricular spaces
  5. 5. Pathologic ReactionsPathologic Reactions ““Selective vulnerability”Selective vulnerability” Pathologic reactions of neuronsPathologic reactions of neurons – Acute injuryAcute injury – DegenerationDegeneration – Axonal reactionAxonal reaction – Formation of neuronal inclusionsFormation of neuronal inclusions – Vacuolization of cytoplasm and neurophilVacuolization of cytoplasm and neurophil – Aggregation of abnormal proteinsAggregation of abnormal proteins – NeuronophagiaNeuronophagia
  6. 6. Pathologic ReactionsPathologic Reactions Astrocytes - Gliosis – glial scarAstrocytes - Gliosis – glial scar Microglia - glial nodulesMicroglia - glial nodules – Phagocytosis of dying neuronsPhagocytosis of dying neurons (neuronophagia)(neuronophagia)
  7. 7. Cerebral EdemaCerebral Edema Vasogenic edemaVasogenic edema – blood brain barrier dysfunction, fluid accumulatesblood brain barrier dysfunction, fluid accumulates between neurons and glial cellsbetween neurons and glial cells Cytotoxic edemaCytotoxic edema – fluid accumulates inside the cells (ischemia,fluid accumulates inside the cells (ischemia, hypoxia)hypoxia) Interstitial edemaInterstitial edema – results from increase CSF (dysfunction of brain CSFresults from increase CSF (dysfunction of brain CSF barrier)barrier) – Complication of hydrocephalusComplication of hydrocephalus
  8. 8. Gross Appearance of the brain in vasogenicGross Appearance of the brain in vasogenic edemaedema Common autopsyCommon autopsy findingsfindings – Flattened broad gyriFlattened broad gyri – Narrowed slit-like sulciNarrowed slit-like sulci – Compressed lateralCompressed lateral ventriclesventricles – Brain is heavier thanBrain is heavier than normal, soft; fluid seepsnormal, soft; fluid seeps from cut surfacesfrom cut surfaces – Signs of herniation maySigns of herniation may be seenbe seen
  9. 9. HerniationsHerniations Cingulate herniation/ SubfalcineCingulate herniation/ Subfalcine – Cingulate gyrus compressed underneath the falxCingulate gyrus compressed underneath the falx cerebricerebri – Caused by unilateral hemispheric massCaused by unilateral hemispheric mass Transtentorial herniation/ UncinateTranstentorial herniation/ Uncinate – Uncus gyri herniate in the cerebellar tentoriumUncus gyri herniate in the cerebellar tentorium Tonsillar herniationTonsillar herniation – Cerebellar tonsils are compressed in the foramenCerebellar tonsils are compressed in the foramen magnummagnum – Life threateningLife threatening
  10. 10. Developmental DisordersDevelopmental Disorders Cranial DysraphismCranial Dysraphism – AnencephalyAnencephaly – encephaloceleencephalocele Spinal DysraphismSpinal Dysraphism – Spina bifida occultaSpina bifida occulta – MeningoceleMeningocele – MeningimyeloceleMeningimyelocele – RachischisisRachischisis
  11. 11. Physical InjuriesPhysical Injuries Contusions (bruising)Contusions (bruising) – ““Coup lesions” and “contre coup” contusionCoup lesions” and “contre coup” contusion – Rapid accelaration/ decelerationRapid accelaration/ deceleration Laceration (tearing)Laceration (tearing) Diffuse Axonal InjuryDiffuse Axonal Injury Traumatic vascular injuryTraumatic vascular injury Penetrating woundsPenetrating wounds
  12. 12. Spinal Cord InjuriesSpinal Cord Injuries Hyperextension injuryHyperextension injury – Cervical spinalCervical spinal – Sudden posterior displacement of the headSudden posterior displacement of the head – Rupture of anterior spinal ligamentRupture of anterior spinal ligament Hyperflexion injuryHyperflexion injury – Impact force driving the head down andImpact force driving the head down and forwardforward – Anterior contusion of the cervical spineAnterior contusion of the cervical spine
  13. 13. Intracranial BleedingIntracranial Bleeding Epidural hematomaEpidural hematoma Subdural hematomaSubdural hematoma Subarachnoid hematomaSubarachnoid hematoma Intracerebral hemorrhageIntracerebral hemorrhage Intraventricular hemorrhageIntraventricular hemorrhage “hydrocephalus internus”“hydrocephalus internus”