Patterns of Neuronal Injury Quiz

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Questions and Answers

What is the typical pattern of neuronal injury observed in slower, progressive diseases like ALS or Alzheimer's disease?

  • Microglial cell activation without changes in astrocytes
  • Proliferation of neurons and absence of gliosis
  • Cell loss and reactive gliosis (correct)
  • Neuronal regeneration and hypertrophy of astrocytes

What defines gemistocytic astrocytes in response to injury?

  • Decreased nucleoli prominence in astrocytes
  • Shrinkage of astrocyte nuclei with reduced cytoplasmic eosinophilia
  • Elongation of astrocyte processes and reduced cell size
  • Hyperproliferative and hypertrophic astrocytes (correct)

How do activated microglial cells respond to injury?

  • They fuse with astrocytes to form giant cells
  • They become dormant and lose their ability to proliferate
  • They increase in number but remain unchanged in morphology
  • They undergo morphological changes with fatter and shorter processes (correct)

Why is it often easier to observe gliosis compared to neuronal cell loss?

<p>Cell loss occurs gradually over time in specific functional areas (A)</p> Signup and view all the answers

What is the main reason for the subtle histologic findings associated with neuronal cell loss?

<p>Cell loss usually occurs due to apoptosis without an inflammatory reaction (A)</p> Signup and view all the answers

What is the role of gemistocytic astrocytes in response to injury?

<p>Help with synaptogenesis after injury (C)</p> Signup and view all the answers

What is a common early sign or symptom that can precede a migraine?

<p>Unusual food cravings (B)</p> Signup and view all the answers

Which visual symptom can occur during a migraine aura?

<p>Blind spots with flashing lights (C)</p> Signup and view all the answers

According to the diagnostic criteria for migraines, how long can a headache last during an attack?

<p>Between 4 and 72 hours (A)</p> Signup and view all the answers

Which of the following is a common characteristic of the pain experienced during a migraine attack?

<p>Throbbing pain on one side of the head (D)</p> Signup and view all the answers

What is NOT one of the POUND criteria used to screen for migraines?

<p>Occipital location (C)</p> Signup and view all the answers

Which symptom is NOT commonly associated with the aura phase of a migraine?

<p>'Seeing stars' (C)</p> Signup and view all the answers

What is a characteristic feature of non-communicating hydrocephalus?

<p>Blockage of the cerebral aqueduct (D)</p> Signup and view all the answers

Which symptom is more likely to be observed in the morning in patients with hydrocephalus?

<p>Headaches (A)</p> Signup and view all the answers

What is a common symptom in children with hydrocephalus associated with hypothalamic impairment?

<p>Stunted growth (B)</p> Signup and view all the answers

Which type of hydrocephalus is relatively common but very rare in individuals under 60 years old?

<p>Normal pressure hydrocephalus (A)</p> Signup and view all the answers

What distinguishes the pathogenesis of normal pressure hydrocephalus from other forms of hydrocephalus?

<p>Impaired absorption at the arachnoid granulations (C)</p> Signup and view all the answers

What physical sign is commonly associated with double vision in cases of hydrocephalus?

<p>6th cranial nerve palsy (A)</p> Signup and view all the answers

What is the primary role of CGRP in migraine pathophysiology?

<p>Increasing pain sensation at the trigeminal ganglion (C)</p> Signup and view all the answers

Which area of the brain is thought to be refractory to synaptic excitation after a spreading depression wave passes through?

<p>Cortex (C)</p> Signup and view all the answers

What is the main challenge in identifying candidate genes for migraine etiology?

<p>Difficulty in targeting VG calcium channels (B)</p> Signup and view all the answers

In migraine pathophysiology, what is the function of monoclonal antibodies that bind to CGRP?

<p>Eliminate CGRP, preventing it from binding to its receptor (C)</p> Signup and view all the answers

Which of the following is believed to lead to activation of the trigeminal complex in migraine pathophysiology?

<p>Wave of spreading excitation in the cortex (C)</p> Signup and view all the answers

What is the most accepted theory regarding the pathophysiology of 'other' neurologic findings in migraines?

<p>'Spreading depression' wave linking to visual changes and aura findings (C)</p> Signup and view all the answers

What is the most common feature of idiopathic intracranial hypertension?

<p>Headache (A)</p> Signup and view all the answers

What is the proposed pathogenesis of idiopathic intracranial hypertension?

<p>Increased arterial inflow without corresponding venous outflow (B)</p> Signup and view all the answers

Which of the following is NOT a common sign or symptom of idiopathic intracranial hypertension?

<p>Seizures (D)</p> Signup and view all the answers

Which of the following is the most effective treatment for idiopathic intracranial hypertension?

<p>Weight loss (B)</p> Signup and view all the answers

What is the most common type of herniation seen in increased intracranial pressure?

<p>Tonsillar herniation (C)</p> Signup and view all the answers

What is the hallmark feature of acute neuronal injury?

<p>Eosinophilic cell bodies (B)</p> Signup and view all the answers

Which of the following is NOT a common intracellular inclusion seen in neurological diseases?

<p>Lipofuscin (D)</p> Signup and view all the answers

What is the proposed mechanism of neuronal injury during cerebral ischemia?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is NOT a typical clinical feature of normal pressure hydrocephalus?

<p>Seizures (A)</p> Signup and view all the answers

What is the primary cause of hydrocephalus?

<p>All of the above (D)</p> Signup and view all the answers

Which type of migraine is characterized by the presence of an aura but no headache?

<p>Acephalgic migraine (A)</p> Signup and view all the answers

Which feature is NOT typically associated with a tension-type headache?

<p>Throbbing pain and aggravation with movement (B)</p> Signup and view all the answers

What is the maximum time interval between the onset of an aura and the start of a migraine headache?

<p>60 minutes (B)</p> Signup and view all the answers

Which of the following is a characteristic feature of complicated migraine?

<p>Severe or persistent (reversible) sensorimotor deficits (C)</p> Signup and view all the answers

Which of the following is NOT a common symptom associated with the aura phase of a migraine?

<p>Nausea and vomiting (C)</p> Signup and view all the answers

What is the most likely explanation for the increased muscle tension in tension-type headaches?

<p>Unknown, but possibly related to stress or anxiety (B)</p> Signup and view all the answers

Why would brain tissue deprived of blood flow (ischemia) become depolarized?

<p>Lack of oxygen leads to decreased ATP production, which disrupts the sodium-potassium pump, causing membrane depolarization. (A)</p> Signup and view all the answers

How could depolarization be linked to 'unregulated' neurotransmitter release?

<p>Depolarization activates voltage-gated calcium channels, leading to an influx of calcium and triggering exocytosis of neurotransmitter-containing vesicles. (A)</p> Signup and view all the answers

How can unregulated neurotransmitter release impact free radical production?

<p>Unregulated neurotransmitter release leads to excitotoxicity, which activates NADPH oxidase and increases free radical generation. (A)</p> Signup and view all the answers

What is the hallmark feature of acute neuronal injury, as described in the text?

<p>Pyknosis, eosinophilic cell body, cell shrinkage, and loss of Nissl substance. (C)</p> Signup and view all the answers

What is the proposed mechanism of neuronal injury during cerebral ischemia?

<p>A combination of decreased ATP, membrane depolarization, and calcium influx. (B)</p> Signup and view all the answers

Which of the following statements about primary and secondary headaches is correct?

<p>Primary headaches are the disorder itself, while secondary headaches are caused by an underlying condition. (C)</p> Signup and view all the answers

Which of the following is NOT a proposed mechanism for the pathogenesis of migraine headaches?

<p>Chronic inflammation of the meninges. (C)</p> Signup and view all the answers

Which of the following is a common cause of secondary headaches associated with elevated intracranial pressure?

<p>Idiopathic intracranial hypertension. (D)</p> Signup and view all the answers

Which of the following is a common feature of idiopathic intracranial hypertension?

<p>Papilledema. (C)</p> Signup and view all the answers

What is the proposed mechanism of action for monoclonal antibodies that bind to CGRP in the treatment of migraine headaches?

<p>Blockade of CGRP-mediated vasodilation. (D)</p> Signup and view all the answers

Which of the following statements about tension headaches is correct?

<p>They are more variable in duration and less severe than migraines. (C)</p> Signup and view all the answers

Which of the following is NOT a diagnostic criterion for cluster headaches?

<p>Attacks must be accompanied by bilateral nasal congestion or rhinorrhea. (C)</p> Signup and view all the answers

Which of the following best describes the pathogenesis of cluster headaches and trigeminal autonomic cephalalgias (TACs)?

<p>They are caused by hypothalamic/circadian circuit dysregulation, with vasodilation as a result, not a cause. (B)</p> Signup and view all the answers

Which of the following is NOT a characteristic feature of cluster headache attacks?

<p>Autonomic symptoms are bilateral, not unilateral. (B)</p> Signup and view all the answers

Which of the following structures is insensitive to pain and cannot cause headaches?

<p>Brain parenchyma (B)</p> Signup and view all the answers

Which of the following is a criterion for classifying a headache as low-risk?

<p>The patient is younger than 30 years old. (C)</p> Signup and view all the answers

Which of the following best describes the relationship between tension headaches and migraines?

<p>Tension headaches and migraines are two distinct types of primary headaches. (A)</p> Signup and view all the answers

Which of the following statements about secondary headaches is correct?

<p>They have a clearly defined underlying cause, unlike primary headaches. (B)</p> Signup and view all the answers

Which of the following statements about the pathophysiology of tension headaches is correct?

<p>They are likely due to dysregulation of pain sensation in the central nervous system, with no clear pathophysiology yet. (C)</p> Signup and view all the answers

Which of the following statements about the clinical features of tension headaches is NOT correct?

<p>They are always accompanied by both photophobia and phonophobia. (A)</p> Signup and view all the answers

Which of the following describes the proposed mechanism for increased intracranial pressure in idiopathic intracranial hypertension?

<p>Subtle problems with venous sinus drainage and increased rate of arterial inflow exceeding venous outflow (A)</p> Signup and view all the answers

What is the proposed mechanism by which glutamate contributes to neuronal injury during cerebral ischemia?

<p>Glutamate overstimulates and causes persistent opening of NMDA receptors, allowing calcium influx. (A)</p> Signup and view all the answers

Which of the following best describes the appearance of acute neuronal injury on H&E staining?

<p>Neurons exhibit pyknosis, eosinophilic cell bodies, and loss of Nissl substance. (C)</p> Signup and view all the answers

What is the primary function of gemistocytic astrocytes in response to injury?

<p>To buffer excitotoxins, maintain the blood-brain barrier, and support neuron metabolism. (B)</p> Signup and view all the answers

Which of the following best describes the role of activated microglial cells in response to injury?

<p>They lose their processes, become ameboid, secrete cytokines, and phagocytose debris. (C)</p> Signup and view all the answers

Which of the following best describes the pattern of neuronal injury in slower, progressive diseases like ALS or Alzheimer's disease?

<p>Subacute/chronic neuronal degeneration with cell loss and reactive gliosis. (C)</p> Signup and view all the answers

Which of the following best describes the mechanism by which a cell may depolarize during ATP depletion in ischemia?

<p>Failure of the $Na^+/K^+$ ATPase pump leads to increased intracellular $Na^+$ and depolarization. (D)</p> Signup and view all the answers

Which of the following best describes the role of astrocytes in mediating synaptogenesis and neurogenesis after injury?

<p>The role of astrocytes in mediating synaptogenesis and neurogenesis remains controversial. (A)</p> Signup and view all the answers

Which of the following best describes the primary cause of hydrocephalus?

<p>Obstruction of cerebrospinal fluid flow or impaired reabsorption. (A)</p> Signup and view all the answers

Why would brain tissue deprived of blood flow (ischemia) become depolarized?

<p>Depletion of ATP due to lack of oxygen and nutrients results in failure of the Na+/K+ ATPase pump (C)</p> Signup and view all the answers

How can unregulated neurotransmitter release impact free radical production?

<p>Excess neurotransmitter stimulation can lead to increased intracellular calcium, which activates nitric oxide synthase and free radical generation (A)</p> Signup and view all the answers

What is the hallmark feature of acute neuronal injury, as described in the text?

<p>Pyknosis and eosinophilic cell body (B)</p> Signup and view all the answers

How do activated microglial cells respond to injury?

<p>Microglial cells proliferate and secrete inflammatory cytokines (C)</p> Signup and view all the answers

What is the proposed mechanism of neuronal injury during cerebral ischemia?

<p>Excitotoxicity from unregulated neurotransmitter release causes calcium overload and apoptosis (D)</p> Signup and view all the answers

What is the primary difference between primary headaches and secondary headaches?

<p>Primary headaches are the disorder itself, while secondary headaches are caused by an exogenous disorder. (D)</p> Signup and view all the answers

Which of the following best describes the classification of a low-risk headache according to the text?

<p>Headaches that are unlikely to cause significant pathology or harm. (C)</p> Signup and view all the answers

What distinguishes normal pressure hydrocephalus from other forms of hydrocephalus?

<p>The lack of enlarged ventricles in imaging studies. (C)</p> Signup and view all the answers

What is a characteristic feature of the pain experienced during a migraine attack?

<p>Dull throbbing pain that radiates throughout the head. (C)</p> Signup and view all the answers

How do secondary headaches differ from primary headaches?

<p>Secondary headaches are always associated with some underlying exogenous disorder. (C)</p> Signup and view all the answers

What is the most common type of hydrocephalus that is relatively common but very rare in individuals under 60 years old?

<p>Normal pressure hydrocephalus (D)</p> Signup and view all the answers

Which of the following is NOT a typical clinical feature of normal pressure hydrocephalus?

<p>Headache (C)</p> Signup and view all the answers

What physical sign is commonly associated with double vision in cases of hydrocephalus?

<p>Sixth cranial nerve palsy (D)</p> Signup and view all the answers

In non-communicating hydrocephalus, what is an example of the type of obstruction that can cause the condition?

<p>Blockage of the cerebral aqueduct (B)</p> Signup and view all the answers

What is the primary cause of hydrocephalus?

<p>Impaired absorption of cerebrospinal fluid at the arachnoid granulations (B)</p> Signup and view all the answers

Which symptom is more likely to be observed in the morning in patients with hydrocephalus?

<p>Vomiting (A)</p> Signup and view all the answers

What is the primary mechanism by which transtentorial herniation can lead to life-threatening consequences?

<p>Compression of the cerebral peduncles, causing bilateral hemiparesis (A)</p> Signup and view all the answers

What is the primary concern with tonsillar herniation, a condition where the cerebellar tonsils are significantly displaced through the foramen magnum?

<p>Compression of the brainstem, compromising vital respiratory and cardiac centers (C)</p> Signup and view all the answers

Which of the following is a proposed mechanism of neuronal injury during cerebral ischemia (lack of blood flow)?

<p>Excessive release of the excitatory neurotransmitter glutamate, leading to increased intracellular calcium levels (A)</p> Signup and view all the answers

What is the proposed mechanism by which monoclonal antibodies that bind to CGRP (Calcitonin Gene-Related Peptide) can help in the treatment of migraine headaches?

<p>Blocking the vasodilatory effects of CGRP, thereby reducing neurogenic inflammation (D)</p> Signup and view all the answers

Which of the following best describes the role of activated microglial cells in response to injury in the central nervous system?

<p>They release inflammatory mediators and can contribute to neuroinflammation and tissue damage (C)</p> Signup and view all the answers

What is the proposed role of gemistocytic astrocytes in response to injury in the central nervous system?

<p>They promote neuronal survival and support synaptogenesis and neurogenesis (D)</p> Signup and view all the answers

Which key pathway is involved in the pain of migraine?

<p>The trigeminovascular input from the meningeal vessels (D)</p> Signup and view all the answers

What is the proposed mechanism of action for medications that act on the 5-HT1 receptors in the treatment of migraine?

<p>They bind to serotonin (5-HT) receptors in the trigeminal nucleus and thalamus, modulating pain sensation. (D)</p> Signup and view all the answers

Which of the following is NOT a typical clinical feature of migraine attacks according to the text?

<p>Hypertension (C)</p> Signup and view all the answers

What is the proposed role of the midbrain nuclei (dorsal raphe nucleus, locus coeruleus, and nucleus raphe magnus) in the pathophysiology of migraine?

<p>They modulate the pain sensation from the trigeminal afferents, contributing to the abnormal pain sensation. (A)</p> Signup and view all the answers

Which of the following statements about the epidemiology of migraine is correct according to the text?

<p>Migraine affects 15% of men and 6% of women over a one-year period. (D)</p> Signup and view all the answers

What is the proposed mechanism for the abnormal pain sensation in migraine related to vascular changes?

<p>Abnormal pain sensation related to vascular dilation and constriction (vasomotion). (C)</p> Signup and view all the answers

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