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

2. Anencephaly 3. Anencephaly 4. Spinal Cord Defects 5. Meningomyelocele 6. Cerebral Edema 7. Papilledema 8. Results of Increased Intracranial Pressure (ICP) 9. Uncal Herniation 10. Herniation 11. Hydrocephalus -- Causes 12. Hydrocephalus 13. Hydrocephalus - Ventricular Enlargement 14. Hydrocephalus - Results 15. Brain Blood Supply 16. Common Sites of Atherosclerosis 17. Common Sources of Emboli 18. Stroke - Middle Cerebral Artery 19. Thrombosis - Internal Carotid Artery 20. Embolic Stroke with Edema 21. Embolic Stroke with Punctate Hemorrhages 22. Watershed Infarctions 23. Liquefactive Necrosis with Cysts 24. Basal Ganglia Hemorrhage Due to Hypertension 25. AV Malformation 26. Berry AneurysmCarotid bifurcation aneurysm 27. 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 28. Giant Aneurysms 29. Ruptured PCOM Aneurysm 30. Subarachnoid Hemorrhage 31. Subarachnoid Hemorrhage 32. Contusions 33. 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 34. 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 35. Epidural Hematoma 36. Epidural Hematoma 37. Middle Meningeal Artery 38. Bridging Veins 39. Subdural Hematoma 40. Subdural Hematoma 41. Acute Meningitis 42. Acute Bacterial Meningitis 43. Acute Meningitis 44. Infectious causes of chronic meningitis Tuberculosis Cryptococcosis Coccidioidomycosis Histoplasmosis Candidiasis Blastomycosis Syphilis Brucellosis Toxoplasmosis Nocardiosis Lyme disease Actinomycosis 45. Major causes of viral encephalitis in the United States Virus Herpes simplex Mumps St. LouisGeographical 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 46. Seasonal variation in infections capable of causing viral encephalitis 47. HSV Encephalitis 48. Aspergillus 49. Progressive Multifocal Leukoencephalopathy 50. Rabies 51. Animal Cases of Rabies 52. Human Rabies Deaths 53. Poliomyelitis 54. Poliomyelitis 55. Poliomyelitis 56. Poliomyelitis 57. Poliomyelitis 58. Tabes Dorsalis 59. 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 60. 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 61. Propagation of scrapie PrP in neurons of the brain apparently occurs viaa 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). 62. 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 treatmentCausative 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 132C Immersion in 1N NaOH for 1 hour at room temperature *Agents that hydrolyze or modify nucleic acids. **Agents that digest, denature, or modify proteins 63. Spongiform Encephalopathy 64. Metastasis 65. Glioma of Brainstem (midbrain) 66. Glioma - Cerebrum 67. Glioblastoma Multiforme 68. Meningioma 69. Schwannoma 70. Acoustic Nerve Schwannoma 71. Neurofibromatosis 1 72. NEUROFIBROMATOSIS DIAGNOSTIC CRITERIATWO OR MORE OF THE FOLLOWINGNF-1(VONRECKLINGHAUSENSNFT) >6 Cafe-au-lait spots >2 neurofibromas Inguinal/axillary freckles Optic glioma >2 Lisch nodules Sphenoid dysplasia 1st degree relativeNF-2 Bilateral eigth nerve masses or two of the follwing Neurofibroma Meningioma Glioma Schwannoma Juvenile cateract 73. Neurofibromatosis 74. Neurofibromatosis 75. Multiple Sclerosis 76. Cerebral Atrophy - Alzheimers Disease 77. AD - Hydrocephalus Ex Vacuo 78. AD - Neuritic Plaques 79. AD - Neurofibrillary Tangle 80. Huntingtons Disease 81. Huntingtons Disease 82. Huntingtons Disease 83. Parkinsons Disease 84. Characteristics of Parkinsonism Major Features Rest tremorMotor Freezing of gaitAutonomic Cognitive Urinary Slowness in thinking RigidityDystoniaConstipationDementia BradykinesiaMuscle acheImpotence in menDepression Loss of postural Kyphosisreflexes 85. Parkinsons Disease 86. Parkinsons Disease 87. Amyotrophic Lateral Sclerosis (ALS) 88. Upper & Lower Motor Neurons 89. ALS - Corticospinal Tract Degeneration 90. 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