CNS Pathology PDF

CNS Pathology Dr. Mohammed Fathalla  Pathology of 1- CNS Infections Meningitis Bacterial Encephalitis Viral Fungal Brain Parasitic Abscess Dr. Mohammed Fathalla  Routes...

CNS Pathology Dr. Mohammed Fathalla  Pathology of 1- CNS Infections Meningitis Bacterial Encephalitis Viral Fungal Brain Parasitic Abscess Dr. Mohammed Fathalla  Routes of infections By blood Direct ( trauma) Local extension: eg from otitis media By nerves: rabies and herpes  Pyogenic Meningitis Acute infection of the meninges Anatomical types : Leptomeningitis  pia + arachnoid matter pachymeningitis  dura 12/17/2024 Dr. Mohammed Fathalla 4 Causes 1. Group B streptococci, E coli, and Listeria monocytogenes (neonates) 2. (children and teenagers). Streptococcus- pneumoniae (adults and elderly), and H influenza (non vaccinated infants) 3. Coxsackie virus (children; fecal-oral transmission) 4. Fungi 12/17/2024 (immunocompromised Dr. Mohammed Fathalla individuals) 5  C/F. Fever, severe headache, and neck stiffness are the hallmark symptoms of meningitis. Others include: Nausea and vomiting. Confusion and disorientation photophobia, and altered mental status may also be present Complications……… 1. Death—herniation secondary to cerebral edema 2. Hydrocephalus, hearing loss, and seizures— sequelae 12/17/2024 related to fibrosis Dr. Mohammed Fathalla 6 Meningitis: Pathology Sub arachnoid pus Organization Turbid CSF Hydrocephalus Normal cortex 12/17/2024 Dr. Mohammed Fathalla 7  A septic ( Viral) meningitis Usually mild with complete recovery HSV, CMV. Enteroviruces, mumps Pathology : – inf – CSF: clear, lymphocytosis, N sugar, protein 12/17/2024 Dr. Mohammed Fathalla 8 12/17/2024 Dr. Mohammed Fathalla 9  TB. meningitis Pathology on surface of pia/ arachnoid) Early: exudates with lymphocytes & neutrophils Then : granuloma+ fibrocaseous exudates Later: fibrosis+ adhesion  spread Finally : Tuberculoma – In cerebrum( adults) or cerebellum ( children) – Encapsulated mass  SOL 12/17/2024 Dr. Mohammed Fathalla 10 Diagnosis and management ? Biopsy of the brain or meninges (rare) Blood culture. Chest x-ray. CSF examination for cell count, glucose, and protein. CT scan of the head. Gram stain, other special stains, and culture of CSF. 12/17/2024 Dr. Mohammed Fathalla 11 Brain Abscess Localized collection of capsulated pus Causes : bacterial , fungal, parasitic, tumor Source of infection: direct, metastatic Clinical effects As SOL, ICP Scar formation ( epilepsy) Rupture  spread Diagnosis and TTT? 12/17/2024 Dr. Mohammed Fathalla 12  Encephalitis Inflammation of the brain tissue ( usually viral). Three forms Acute: HSV, HZV, rabies,… Persistent: PMLE (CJ virus) , SSPE ( rubella& measles) Slow : prion disease, ( cow madness) Clinically  Sever mental signs & focal neurological defects ( fatal) 12/17/2024 Dr. Mohammed Fathalla 13  Acute Encephalitis: Pathology Perivascular infl Glial hyperplasia Inclusion bodies Neuronal damage In HSV : Temporal lobe necrosis In CMV : Disseminated necrosis In Rabies : Negri bodies 12/17/2024 Dr. Mohammed Fathalla 14  Negri body CMV inclusion 12/17/2024 bodies Dr. Mohammed Fathalla 15  Slow Encephalitis Prion disease: abnormal infectious proteins Called transmissible Spongiform Encephalopathy Indigenous : due to mutation in PrPc gene Seen in CJD ( Creudzfeldt Jakob disease) Exogenous :by eating meat (cow madness) 12/17/2024 Dr. Mohammed Fathalla 16 12/17/2024 Dr. Mohammed Fathalla 17  Toxoplasmosis This parasitic infection of the brain is caused by Toxoplasma gondii. In neonates, the disease is transmitted transplacentally from the infected mother. It is also spread by ingestion of foods contaminated by animal urine or feces; especially cats 12/17/2024 Dr. Mohammed Fathalla 18  TORCH complex is a group of infections transmitted from the mother to the fetus with similar clinical manifestations. 1. TORCH stands for toxoplasma, rubella, Cytomegalovirus, and Herpes simplex virus (and others, such as congenital syphilis). 2. TORCH infections can lead to a syndrome characterized by microcephaly, central nervous system (CNS) calcifications, petechial rash, hepatosplenomegaly, and thrombocytopenia. 12/17/2024 Dr. Mohammed Fathalla 19  2-Increased Intracranial Pressure SOL CSF out flow obstruction 12/17/2024 Dr. Mohammed Fathalla 20  Space Occupying Lesions  Examples of SOL – Abscess/ hematoma – Tumors – Recent infarct – Brain edema  Effects  ICP : head ache. Vomiting, papillodema, coma  Brain herniation  Neuron damage 12/17/2024 Dr. Mohammed Fathalla 21 Brain Herniation  Pushing of part of brain due to force  4 sites: 1- Supracallosum ( subfalcine) 2- Tentorial ( temporal)  Rapid coma  Compress 3,6 cranial N ( Eye) 3- Tonsillar Cerebellum into foramina magnum respiratory center 4-Extracranial 12/17/2024 Dr. Mohammed Fathalla 22 Brain Edema Intracellular and extacellular water. Local or general causes Vasogenic ( protein) or cytotoxic ( watery) fluid Effects: – Vascular damage – CSF flow obstruction – Neurons damage Management: …… 12/17/2024 Dr. Mohammed Fathalla 23  Mannitol and hypertonic saline are the main osmotic agents used to treat cerebral edema and work primarily by generating an osmolar gradient between the brain and plasma. Hypertonic saline is available in concentrations ranging from 2% to 23.4% and may be given by bolus or continuous infusion. 12/17/2024 Dr. Mohammed Fathalla 24 Hydrocephalus Increased CSF volume within the cranium Mechanism: – Production:… – Obstruction:… – Reabsorption:…. Congenital abnormalities 12/17/2024 Dr. Mohammed Fathalla 25 Hydrocephalus : Effects In infants:  Head size Dilated ventricles Mental retardation In adults ✔ Dilated ventricle ✔ brain atrophy ✔ ICP 12/17/2024 Dr. Mohammed Fathalla 26  Cerebrovascular Accidents Cerebral infarction Cerebral hemorrhage 12/17/2024 Dr. Mohammed Fathalla 27 Cerebral Infarction Due to ischemia caused by: – Arterial narrowing( thrombosis +atheroma) – Shock, ICP, Site according to artery Pathology: first: swelling Then: collequative necrosis Later: scar, size, ventricle dilatation Clinical 12/17/2024 effects… Dr. Mohammed Fathalla 28  Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body. Sudden confusion, trouble speaking, or difficulty understanding speech. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance, or lack of coordination. 12/17/2024 Dr. Mohammed Fathalla 29  Transient ischemic attacks (TIA) These brief episodes of impaired neurologic function are caused by a temporary disturbance of cerebral circulation. TIAs are not associated with permanent damage, but are considered precursors to more serious occlusive events. 12/17/2024 Dr. Mohammed Fathalla 30  What is a TIA vs a stroke? TIA (transient ischemic attack, also sometimes called a “mini-stroke”) begins just like an ischemic stroke The difference is that in a TIA, the blockage is temporary and blood flow returns on its own. Since blood flow is interrupted only for a short time, the symptoms of a TIA don't last long – usually less than hour. 12/17/2024 Dr. Mohammed Fathalla 31 Cerebral Hemorrhage Causes: HT, tumors, bleeding disorders,.. Arteriovenous malformation Pathology: First bleeding ICP :death Then bleeding with cyst formation Sub archnoid hrag: meningismus, bloody CSF then Xanthochromia (yellow discoloration indicating the presence of bilirubin in CSF) 12/17/2024 Dr. Mohammed Fathalla 32  Head Injury Any trauma to the scalp, skull, or brain. Effects Early: concussion , skull fracture , lobes contusion Delayed : odema , CSF leak , hematoma/ hrage – Extradural( epidural) – Epidural – Intracerebral Latter : scarring and shrinking epilepsy 12/17/2024 Dr. Mohammed Fathalla 33 Extradural Hematoma In linear skull # Rupture of middle meningeal artery Rapid recovery – lucid period- ↑ICP Surgical draining :( Burr 12/17/2024 Dr. Mohammed Fathalla 34  Sub dural Subdural hematoma Due to rupture of small bridging veins Can reach large size Lead to herniation Can be chronic 12/17/2024 Dr. Mohammed Fathalla 35  Intracerebral hrge In sever trauma ( contusion) Mainly in temporal lobe Fatal 12/17/2024 Dr. Mohammed Fathalla 36 12/17/2024 Dr. Mohammed Fathalla 37  Degenerative Diseases Alzheimer's Disease Parkinsonism Prion Diseases Others………… 12/17/2024 Dr. Mohammed Fathalla 38  Degenerative Diseases loss of functional neurons resulting in dementia and abn movement. Dementia impaired memory, intelligence and personality without loss of consciousness Causes 1-Aging 2- multi infarct 3- hereditary 4- AIDS 5- post infectious 6-…… 12/17/2024 Dr. Mohammed Fathalla 39  Alzheimer's Disease Senile or pre senile Causes : a combination of genetic, lifestyle and environmental factors that affect the brain over time also trauma, toxins and vascular. Clinically: Progressive dementia Impairment of recent memory Memory loss that disrupts daily life.... Challenges in planning or solving problems.... Difficulty completing familiar tasks.... Confusion with time or place.... Trouble understanding visual images and spatial relationships.... New problems with words in speaking or writing. 12/17/2024 Dr. Mohammed Fathalla 40 AD : Pathology Gross brain atrophy: (neuronal loss) ↑sulci, ↓gyri senile (neuritic) plaques (B- amyloid) Neurofibrillary tangles 12/17/2024 Dr. Mohammed Fathalla 41  Parkinsonism Loss of pigmented neurons in basal ganglia ↓↓dopamine secretion Causes : - Idiopathic ( PD) - secondary : trauma,post infection, toxins, infarction 12/17/2024 Dr. Mohammed Fathalla 42 PD: Clinical Tremor (rest) Rigidity (cogwheel) , Bradykinesia (mask-facies, ↓ arm-swing, bending) Festinating gait (loss of righting reflexes) 12/17/2024 Dr. Mohammed Fathalla 43  PD : Pathology Degeneration of basal ganglia ↓Dopamine secretion Lewy inclusion bodies 12/17/2024 Dr. Mohammed Fathalla 44  Metabolic disorders Brain damage due to deposition of materials or deficiency. Vit B12: sub acute combined degeneration Vit B1 ( thiamin) beriberi Wilson's Disease a rare inherited disorder that causes copper to accumulate in your liver, brain and other vital organs Alcohol: Whernick- korsakoff (alcohol- related dementia) 12/17/2024 Dr. Mohammed Fathalla 45  Diseases Of Myelin Congenital : Dysmyelinating (leukodystrophy) Acquired : Demyelinating ( MS) 12/17/2024 Dr. Mohammed Fathalla 46  Multiple Sclerosis Episodes of neurological defects due to selective demyelimation of white matter. Etiology 1- unknown: mainly ( immune??) 2-Environmental: younger age 3-Genetic: HLA-DR2 4-Chemical 5- Viral 12/17/2024 Dr. Mohammed Fathalla 47 Clinically : Progressive with relapse/ remission > 50 yrs. F>M Variable neurological S&S ( sensory and motor) Pathology : Loss of myelin sheath Plague formation Macrophage and inflammatory cell 12/17/2024 Dr. Mohammed Fathalla 48 12/17/2024 Dr. Mohammed Fathalla 49  Diseases Of Peripheral Nerves (Neuropathy) Demeylinating : – Gillian_ Barre – Chronic inflammatory demyelinating polyneuropathy Axonal : – hypertrophic neuropathies, – herpes zoster, HIV, …. – alcoholic , drugs – diabetic neuropathies 12/17/2024 Dr. Mohammed Fathalla 50  Guillain-Barré syndrome (GBS) is a rare, autoimmune disorder in which a person's own immune system damages the nerves, causing muscle weakness and sometimes paralysis. GBS can cause symptoms that last for a few weeks to several years. Most people recover fully, but some have permanent nerve damage The most commonly used treatment for Guillain-Barré syndrome is intravenous 12/17/2024 Dr. Mohammed Fathalla 51 immunoglobulin (IVIG).  Brain Tumors Secondary Primary 12/17/2024 Dr. Mohammed Fathalla 52 General Points Secondary > primary adult: supratentorial. Child: infratentorial Benign: also dangerous ( why?) Malignant : rarely metastasis 12/17/2024 Dr. Mohammed Fathalla 53  WHO Classification 1.Tumors of neuroepithelial tissue {Embryonic. Glial , mixed} 3. Tumors of meninges {Meningiomas. Others} 2. Tumors of cranial and spinal nerves { Schwannoma and Neurofibroma } 4. Lymphomas and hematopoietic neoplasms 12/17/2024 Dr. Mohammed Fathalla 54  WHO : CNS tumors 5. Germ cell tumors 6. Cysts and tumor-like lesions 7. Tumors of sellar region 8. Local extensions from regional tumors 9. Metastatic tumors 10. Unclassified tumors 12/17/2024 Dr. Mohammed Fathalla 55 1-Gliomas 1. Astrocytoma 2- Oligodendroglioma 3. Ependymoma 4-Mixed 1-Astrocytomas Commonest 1ry tumor Many histological grades Fibrillary -Pilocytic -Anaplastic -Glioblastoma multiform ,,,, others 12/17/2024 Dr. Mohammed Fathalla 56 Pathology  Cystic or solid  Mitosis and necrosis: higher grade  Rosenthal fibres ( is a thick, elongated, worm-like) Clinically : Adult or child Headache, seizures & neurological deficits. SOL 12/17/2024 Dr. Mohammed Fathalla 57 2- Ependymoma  Around the ventricles and in spinal cord  Benign. 20- 40 yrs  CSF spread 3- Olegodendroglioma  Rare  In cerebral white matter  Better 12/17/2024 prognosis Dr. Mohammed Fathalla 58  2-Meningiomas from arachnoid granulations Nodular, capsulated, slow growing- benign Micro: whorls of cells, Psammoma bodies Many forms Clinically : as SOL 12/17/2024 Dr. Mohammed Fathalla 59 3-Medulloblastoma Origin: primitive neuroectodermal cells Age: 1st decade of life. Most common brain tumor in children. Site: vermis of cerebellum May cause hydrocephalus Mic: rosettes formation 12/17/2024 Dr. Mohammed Fathalla 60  4-Peripheral Nerve (Sheath) Tumors 1- Schwannoma – Schwannoma grows from cells called Schwann cells. Schwann cells protect and support the nerve cells of the nervous system. – Schwannoma tumors are often benign, which means they are not cancer. But, in rare cases, they can become cancer. 12/17/2024 Dr. Mohammed Fathalla 61  Neurofibromatosis Neurofibromatosis is a genetic disorder of the nervous system. It mainly affects how nerve cells form and grow. It causes tumors to grow on nerves. You can get neurofibromatosis from your parents, or it can happen because of a mutation (change) in your genes. Once you have it, you can pass it along to your children There isn't a cure for neurofibromatosis, but signs and symptoms can be managed. Generally, 12/17/2024 Dr. Mohammed Fathalla 62  neural tube defects This group of disorders is characterized by failure of closure of the neural tube. The resulting defects can involve the vertebrae or skull with or without involvement of the underlying meninges, spinal cord, or brain. They are also linked with maternal folic acid deficiency. 12/17/2024 Dr. Mohammed Fathalla 63 Neural tube defects include: a. spina bifida: failure of posterior vertebral arches to close b. spina bifida occulta: spina bifida with no clinically apparent abnormalities; vertebral arch defect most often limited to one or two vertebrae 12/17/2024 Dr. Mohammed Fathalla 64 12/17/2024 Dr. Mohammed Fathalla 65