Difference between revisions of "Neuropathology"
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====Other==== | ====Other important histological features==== | ||
*Rosenthal fibres = worm-like or corkscrew-like (brightly) eosinophilic bodies; 10-40 micrometers. | *Rosenthal fibres = worm-like or corkscrew-like (brightly) eosinophilic bodies; 10-40 micrometers. | ||
**Key feature: variable thickness; helps separate from RBCs. | **Key feature: variable thickness; helps separate from RBCs. | ||
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Image:Rosenthal_fibers.jpg | Rosenthal fibres - smear (WC/AFIP) | Image:Rosenthal_fibers.jpg | Rosenthal fibres - smear (WC/AFIP) | ||
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*Eosinophilic granular bodies = related to Rosenthal fibres; round cytoplasmic hyaline droplets in | *Eosinophilic granular bodies = related to Rosenthal fibres; round cytoplasmic hyaline droplets in [[astrocyte]]s.<ref>{{Ref MBNP|11}}</ref> | ||
<gallery> | |||
File:Pilocytic Micro.jpg | Eosinophilic granular bodies in pilocytic astrocytoma smear (WC/AFIP) | |||
File:PXA HE x20.jpg | Eosinophilic granular body in a pleomorphic xanthoastrocytoma (WC/jensflorian) | |||
</gallery> | |||
*Pseudopalisading - picket fence-like alignment of cells; long axis of cells perpendicular to interface with other structures/cells. | *Pseudopalisading - picket fence-like alignment of cells; long axis of cells perpendicular to interface with other structures/cells. | ||
**Pseudopalisading of tumour cells (around necrotic regions) is seen in [[glioblastoma]]. | **Pseudopalisading of tumour cells (around necrotic regions) is seen in [[glioblastoma]]. | ||
<gallery> | |||
File:GBM pseudopalisading necrosis.jpg | Pseudopalisading necrosis in a glioblastoma (WC/jensflorian) | |||
</gallery> | |||
*Perivascular lymphocytic cuffing - Lymphocytes surrounding vessels. | |||
** Seen in many inflammatory conditions including MS. | |||
** Often seen in [[ganglioglioma]] and [[pleomorphic xanthoastrocytoma]]. | |||
** Less common in some gemistocytic [[astrocytoma]]. | |||
*** No association with survival. <ref>{{Cite journal | last1 = Rossi | first1 = ML. | last2 = Jones | first2 = NR. | last3 = Candy | first3 = E. | last4 = Nicoll | first4 = JA. | last5 = Compton | first5 = JS. | last6 = Hughes | first6 = JT. | last7 = Esiri | first7 = MM. | last8 = Moss | first8 = TH. | last9 = Cruz-Sanchez | first9 = FF. | title = The mononuclear cell infiltrate compared with survival in high-grade astrocytomas. | journal = Acta Neuropathol | volume = 78 | issue = 2 | pages = 189-93 | month = | year = 1989 | doi = | PMID = 2750489 }}</ref> | |||
<gallery> | |||
File:Ganglioglioma lymphocytic cuffing PAS.jpg | Lymphocytic cuffing in [[ganglioglioma]] (WC/jensflorian) | |||
</gallery> | |||
Note: | Note: | ||
Revision as of 06:21, 20 July 2015
Gross image showing changes of a stroke. (WC/Marvin 101)
This article is an introduction to neuropathology. There are separate articles for brain tumours, the pituitary gland, the spine, the eye, muscle pathologies, neurohistology and neuroanatomy.
Neuropathology is the bane of many anatomical pathologists in teaching hospitals... 'cause they have to fill in for the neuropathologist when he or she is on vacation.
Neuroanatomy
Main article: Neuroanatomy
This is a large topic. It covered in a separate article, that also covers grossing.
Neuroradiology
Key factors to consider in evaluation:
- Location.
- Number of lesions - single versus multiple.
- Cystic versus solid lesion.
- Enhancement.
Lesion location
In neuroradiology and neuropathology, real estate is crucial. Lesion location can often narrow your differential.
Cortical lesions (gray matter):
- Oligodendroglioma.
- DNET.
- Ganglioglioma.
- Pleomorphic xanthoastrocytoma.
- Extraventricular ependymoma.
Cortical-subcortical junction:
- Metastases.
- Abscesses (hematogenous spread).
Subcortical lesions (white matter):
- Glioblastoma.
- Diffuse gliomas.
- Demyelinating plaques.
Deep gray matter lesions (e.g. basal ganglia):
- Gliomas.
- Hypertensive hemorrhage
Cerebellar lesions:
Intraventricular lesions:
- Ependymoma.
- Subependymoma.
- Pilocytic astrocytoma.
- Central neurocytoma.
- Rosette forming glioneuronal tumour of the fourth ventricle.
Suprasellar (above the pituitary):
Number of lesions
If single lesion = think primary, neoplastic If multiple lesions = think metastatic, neoplastic or infectious NB: glioblastoma can be multifocal (and the foci can be quite far apart)
Cystic vs. solid lesions
Some tumours are classically cystic with a small solid component (so-called cyst with a mural nodule) -- e.g. pilocytic astrocytoma, ganglioglioma, hemangioblastoma
Enhancing vs. non-enhancing:
- In adults, enhancing generally = high grade.
- In pediatrics, it often depends on the pattern.
Two main patterns to be mindful of -- ring enhancing lesions, and cystic lesions with a mural nodule.
Ring enhancing lesions
In HIV/AIDS patients... mass on CT if infection:
- Toxoplasmosis - most common.[1]
Ring enhancing lesion (DDx) - mnemonic MAGICAL DR:[2]
- Metstasis.
- Abscess.
- Glioblastoma.
- Infarct.
- Contusion.
- AIDS-related.
- Lymphoma + HIV assoc. disease (toxoplasma).
- Demyelination (e.g. multiple sclerosis).
- Resolving hematoma.
Cyst with enhancing mural nodule
- hemangioblastoma (#1 in adults)
- pilocytic astrocytoma (#1 in peds)
- pleomorphic xanthoastrocytoma
- ganglioglioma
Grossing
This is covered in the neuroanatomy article.
Gross pathology
The gross usually useless for arriving at a definitive diagnosis.
Exceptions:[3]
- Sausage shape lesion of filum terminale = myxopapillary ependymoma.
- Soft & tan colour = pituitary adenoma.
Normal histology
Main article: Neurohistology
This is a big topic. It is covered in a separate article called neurohistology.
Histopathology
Neuronal changes
Anoxic neurons
- AKA red neurons.
Features:
- Intensely red cytoplasm.
- Pyknosis = nuclear shrinkage + darker staining.
Images
Anoxic neurons (WC)
Neurons in an acute stroke. (WC)
www:
Central chromatolysis
Features:[6]
- Central clearing.
- Nucleus and Nissl substance are pushed to cell periphery.
DDx:
Images
Central chromatolysis - intermed. mag. (WC)
Central chromatolysis - NF stain - very high mag. (WC)
Axonal swellings
H&E:
- Eosinophilic (light pink) - ground glass-like appearance.
- Shape:
- Round if sectioned perpendicular to axis of axon.
- Bound by cell membrane.
- Large ~ typically 2-4x RBC diameter.
- Sausage-shaped if cut in along axis.
- Round if sectioned perpendicular to axis of axon.
Images:
IHC
- APP.
Image:
Glial changes
Astrocyte changes
Reactive astrocytes:
- Approximately equally-spaced; distance between neighbouring astrocytes is ~2x (or more) the cell size.
- Well-defined cell border.
- Eosinophilic cytoplasm with many branching processes.
- Classically described as "funnel-shaped" in benign astrocytes.[11]
- Peripheral nucleus.
Reactive astrocytes - high mag. (WC)
Alzheimer type II astrocyte:[12]
- Large cleared nucleus - key feature.
- Indistinct cytoplasm.
- Found in the context of hepatic encephalopathy in basal ganglia and lower layers of cortex.[13]
- Images:
Alzheimer type II astrocytes. (WC)
Creutzfeldt cell:[14]
- Astrocyte that mimics a mitoses; has moderate (identifiable) cytoplasm.
- Finding associated with demyelinating disease.
- Image: Crutzfeldt cell (upmc.edu).[15]
Gemistocytic astrocytes:[16]
- Distinct eosinophilic cytoplasm - with ground-glass appearance.
Tufted astrocytes:[17]
- Cellular processes loaded with tau protein (as may be seen with tau IHC or Gallyas silver stain); Parisian-star-like appearance with special stain.
- +/-Multinucleated.
- A classic feature of progressive supranuclear palsy.
Other glial
Bergmann gliosis (in the cerebellum):[14]
- Thin layer of cells (2-3 cells) with open nuclei that are larger than granular cell layer nuclei; seen with Purkinje cell loss.
Bergmann gliosis - intermed. mag. (WC)
Bergmann gliosis - high mag. (WC)
Bergmann gliosis due to compression by metastasis - intermed mag. (WC)
Image:
Reactive change vs. malignancy
Reactive changes vs. malignancy (mnemonic MIMICS):[18]
- MIcrovesicular pattern.
- Mitoses.
- Irregular spacing.
- Calcifications.
- Satellitosis, perineuronal.
- Large "crowds" of glial cells associated with nuclei.
Inflammatory
DDx:
- Autoimmune - Multiple sclerosis.
- Neoplastic - CNS lymphoma.
- Infectious - HSV.
Encephalitis
General
DDx:
- Viral encephalitis.
- Paraneoplastic syndromes.
Gross
- Frontal and temporal lobe - most common for HSV encephalitis.[19]
Microscopic
Features:[20]
- Perivascular inflammation.
- Microglia.
- +/-Neuronophagia.
- Phagocytosis of neurons.[21]
- +/-Viral cytopathic changes.
- +/-Perineuronal inflammation.
Notes:
- Hemorrhage[22] and necrosis - characteristic of HSV encephalitis.
Image:
IHC
IHC stains for:
- Viral etiologies, e.g. HSV, CMV.
- Parasites, e.g. toxoplasma.
- Fungi, e.g. PASD.
Intraoperative appearance of a lymphocytic encephalitis (WC/jensflorian)
Perivascular inflammation in a lymphocytic encephalitis (WC/jensflorian)
Hemorrhage in HSV encephalitis (WC/jensflorian)
HSV encephalitis, higher magnification (WC/jensflorian)
Neonatal brain with migration disturbances due to CMV infection (WC/jensflorian)
Neuronal nuclear inclusions in a neonatal CMV infection (WC/jensflorian)
Rabies encephalitis (CDC.gov)
Architecture
Rosettes
- Rosette = circular/flower-like arrangement of cells.[24]
- Perivascular pseudorosette = circular/flower-like arrangement of cells with blood vessel at the centre.[24]
- Homer-Wright rosette = (circular) rosette with a small (~100 micrometers ???) meshwork of fibers (neuropil) at the centre.[24]
- Medulloblastoma.
- Image: Medulloblastoma (ouhsc.edu).[25]
- PNET (can be thought of as a supratentorial medulloblastoma) .
- Neuroblastoma
- Medulloblastoma.
- Flexner-Wintersteiner rosette = rosette with empty centre (donut hole).[24]
- True ependymal rosette = surrounds a space.[24]
- Pineocytomatous/neurocytic rosette = irregular rosette with a large meshwork of fibers (neuropil) at the centre.[24]
- Similar to Homer-Wright rosette.
- Pineocytoma.
- Neurocytoma.
- RGNT - Rosette forming glioneuronal tumor of the IVth ventricle.
- Radial (cartwheel) profiles = neoplastic cells anchoring to stromal vessels, shorter processes than in ependymal pseudorosettes
- Multilayered rosettes
- Meningeothelial rosettes
- Meningioma - a rare pattern.[26]
Homer-Wright rosettes (WC).
Neurocytic rosettes (WC).
Perivascular pseudorosette (WC).
Multilayered rosettes (WC).
Ependymoblastous rosettes (WC/Marvin101).
True ependymal rosettes and pseudorosettes (WC).
Radial (cartwheel) profiles (WC).
Other important histological features
- Rosenthal fibres = worm-like or corkscrew-like (brightly) eosinophilic bodies; 10-40 micrometers.
- Key feature: variable thickness; helps separate from RBCs.
- Well-seen on trichrome stains.
Rosenthal fibres. (WP)
Rosenthal fibres - smear (WC/AFIP)
- Eosinophilic granular bodies = related to Rosenthal fibres; round cytoplasmic hyaline droplets in astrocytes.[27]
Eosinophilic granular bodies in pilocytic astrocytoma smear (WC/AFIP)
Eosinophilic granular body in a pleomorphic xanthoastrocytoma (WC/jensflorian)
- Pseudopalisading - picket fence-like alignment of cells; long axis of cells perpendicular to interface with other structures/cells.
- Pseudopalisading of tumour cells (around necrotic regions) is seen in glioblastoma.
Pseudopalisading necrosis in a glioblastoma (WC/jensflorian)
- Perivascular lymphocytic cuffing - Lymphocytes surrounding vessels.
- Seen in many inflammatory conditions including MS.
- Often seen in ganglioglioma and pleomorphic xanthoastrocytoma.
- Less common in some gemistocytic astrocytoma.
- No association with survival. [28]
Lymphocytic cuffing in ganglioglioma (WC/jensflorian)
Note:
- Good set of articles: Neuropathology for radiologists (ncbi.nlm.nih.gov).
Inclusion bodies
- Negri bodies.
- Cytoplasmic inclusions; classically in Purkinje cells of the cerebellum, pyramidal cells of Ammon's horn.
- Rabies.
Negri bodies. (WC/CDC)
- Owl eye inclusions.
- Basiopilic neuronal inclusions in enlarged cells, typically seen in CMV encephalitis
Owl eye inclusions
- Lewy bodies.
- Eosinophilic cytoplasmic inclusion - composed mostly of alpha-synuclein.[29]
Lewy body. (WC)
Table of inclusions
| Feature | Appearance | Associated disease | Comment | Image |
|---|---|---|---|---|
| Grumose bodies AKA granular bodies |
granular and eosinophilic ~50 micrometers | neurodegenerative disease, neuroaxonal dystrophies, aging | ?Comment | ?Image |
| Cowdry type 1 AKA Cowdry type A |
eosinophilic & round + halo | herpes simplex virus | can be confused with Lewy body, Marinesco body |
?Image |
| Lewy body | round cytoplasmic eosinophilic body +/- pale halo |
Parkinson disease, dementia with Lewy bodies | morphology dependent on location in brain; +ve for alpha-synuclein, alpha-B crystallin, ubiquitin |
, [1] |
| Lafora body | round | myoclonic epilepsy | look like corpora amylacea; location: dentate nucleus, liver, skeletal muscle, sweat glands | ?Image |
| Lipofuscin | yellow & granular | aging | olive, dendate | ?Image |
| Negri body | small eosinophic bodies | rabies | found in hippocampal neurons and Purkinje cells | |
| Hirano body | concentric calcification/rod-shaped bright eosinophilic; overlap edge of neuron | Alzheimer disease, Pick disease[30] | actin crystals, may look like capillaries; location: CA1 of hippocampus | [2][31] |
| Neurofibrillary tangles | flame-shaped cytoplasmic thingy ~30 micrometers |
aging, Alzheimer's disease | seen with silver stain | Schematic[31], [3][32] |
| Granulovacuolar degeneration | cytoplasmic vacuoles 4-5 micrometers | ageing, Alzheimer's disease, Pick's disease |
main found in Ammon horn[30] | [4][32] |
| Pick bodies | round, homogenous, intracytoplasmic, ~10 micrometers | Pick's disease | pyramidal neurons, dentate granule cells (hippocampus); +ve for tau, tubulin, ubiquitin |
[5] |
| Bunina body | size of Nissl granules, eosinophilic | amyotrophic lateral sclerosis (ALS) | EM: membrane-bound bodies; ubiquitin +ve | [6] |
Image collection: Inclusion bodies (photobucket.com).
Immunohistochemistry
Main article: Immunohistochemistry
General
- S-100.
- Sensitive... but non-specific, e.g. also stains melanoma.
Glial
- GFAP (glial fibrillary acidic protein) - should stain perikaryon.
Glial tumours
Standard work-up:
- GFAP.
- MAP2C. [33]
- Ki-67 (MIB-1).
Useful additional markers:
- IDH1(R132H) in Astrocytic/Oligodendroglial tumors. [34]
- ATRX in mixed gliomas. [35]
- EMA in Ependymal tumors. [36]
- OLIG-2 usually -ve in Ependymomas. [37][38]
Neuronal
- Synaptophysin.
- Chromogranin.
Carcinoma vs. glial tumours
- AE1/AE3 often +ve in glial tumours (e.g. astrocytomas, oligodendrogliomas); CAM5.2 is usu. -ve in glial tumours.[39]
Others
- APP (amyloid precursor protein) - detects axonal swellings.
- NF (neurofilament) - detects axonal swellings.
Brain tumours
Main article: Neuropathology tumours
Tumours are a big part of neuropathology. The most common brain tumour (in adults) is a metastasis. The most common primary tumours originating in the brain (in adults) are gliomas. More than 50% of these are classified as glioblastoma which has a horrible prognosis.
Non-tumour
Cerebral hemorrhage
- See: Intracranial hematoma for intracranial bleeds
Includes discussion of:
Duret hematoma
- AKA Duret hemorrhage.
General
- Bleed in the upper brainstem (midbrain and pons).
- Thought to be due to transtentorial herniation secondary to supratentorial mass effect (e.g. supratentorial tumour, intracranial hemorrhage).[40]
- Often fatal.[41]
Gross
- Extravasated blood in midbrain and pons - usu. ventral (anterior) and paramedian (adjacent to the midline).[40]
Image:
Microscopic
Features:
- RBC extravasation.
- +/-Hemosiderin-laden macrophages.
- +/-Ischemic neurons.
Alcohol & CNS
Clinical
- Wernicke's encephalopathy
- Mnemonic WACO:
- Wernicke's.
- Ataxia.
- Confusion, confabulation -- Korsakoff.
- Ocular Sx (CN IV palsy).
- Cause: thiamine deficiency.
- Mnemonic WACO:
Pathology
Features:[43]
- Morel's laminar sclerosis = spongy degeneration and gliosis of the cerebral cortex[44] usu. prominent in the third layer of the cortex (outer pyramidal layer) and especially in the lateral-frontal cortex.[45]
- Central pontine myelinolysis (CPM).[46]
- Just what it sound like - myelin loss in the central pons.
- Classically associated with rapid correction of hyponatremia.[47]
- Mammillary body shrinkage.[48]
- Anterior cerebellar vermis atrophy; weak finding - as also age-related.[49]
- Vermis atrophy is also seen in schizophrenia.[50]
Marchiafava-Bignami Disease
- Rare.
- Demyelination of the corpus callosum.[45]
Wernicke's encephalopathy
General:
- Due to thiamine deficiency.
- Malnourishment often accompanies alcoholism.
Features:[51]
- Neurons of mammillary bodies preserved - key.
- Loss of myelin.
- Hemorrhage.
- Edema.
- Reactive blood vessels.
Note:
- The thalamus and inferior olives show neuronal loss.[51]
Common non-specific findings
- Intracranial haemorrhage - due to trauma.
Meningitis
General
- Definition: inflammation of the meninges (pia mater, arachnoid membranes, dura mater).
Classic clinical presentation:
- Neck stiffness.
- Fever.
- +/-Headache.
- +/-Decreased level of consciousness.
CSF findings:
| Type | Glucose | Protein | Cells | Cytopathology |
|---|---|---|---|---|
| Bacterial, acute | low | high | neutrophils |  |
| Viral | normal | slight elevation | lymphocytes | Cytophathology |
Etiology
- Infectious.
- Bacterial.
- Viral.
- Parasitic
- Autoimmune.
- Toxic.
- Aseptic - see Mollaret's meningitis.
Bacterial meningitis - most probably cause by age:[52]
| Age | Organism |
|---|---|
| Neonate | Escherichia coli, Group B Streptococcus |
| Infants, children | Streptococcus pneumoniae |
| Adolescents, young adults | Neisseria meningitidis |
| Elderly | Streptococcus pneumoniae, Listeria monocytogenes |
Gross
Features:
- +/-Clouded appearance of the meninges.
- +/-Pus.
- +/-Petechiae.
- +/-Cerebral edema.
Image
Streptococcus Meningitis. (WC/Dr. Edwin P. Ewing, Jr.)
Hemophilus influenza Meningitis. (WC/CDC)
Pneumococcus Meningitis. (WC/Dr. Yale Rosen)
Bacterial Meningitis MRI (WC/MBq)
Microscopic
Features:
- Inflammation of the meninges:
- +/-Neutrophils.
- +/-Lymphocytes.
- +/-Plasma cells.
- +/-Microorganisms (infectious meningitis):
- Bacteria.
- Fungi, e.g. aspergillosis (may be intravascular).
Main DDx:
Image
Bacterial meningitis. (WC/Marvin101)
Cerebral abscess
General
- May mimic malignancy clinically.
Microscopic
Features:
- Sheets of neutrophils surrounded by fibrosing brain.
- Fibrosing brain: pale (lighter pink than normal brain tissue), dense.
Images:
Neurodegenerative diseases
Main article: Neurodegenerative diseases
This is a hueueuge topic. It is covered in its own article and includes a general discussion of dementia.
Epilepsy
Main article: Epilepsy
Cerebrovascular accident
- Abbreviated CVA.
- AKA stroke.
Main article: Cerebrovascular accident
Hypoxic-ischemic encephalopathy
- Abbreviated HIE.
Main article: Hypoxic-ischemic encephalopathy
Multiple sclerosis
- Abbreviated MS.
Main article: Multiple sclerosis
Cerebral amyloid angiopathy
General
- Abbreviated CAA.
- Disease of the old.
- Strong association with lobar haemorrhage (bleeds of the cerebellar cortex and cerebral cortex).[54]
Etiology:
- Amyloid deposition in the basal lamina of smooth muscle (in the cerebellar cortex and cerebral cortex).
Gross
- Bleeds typically superficial (cortex and subcortical white matter) and in the frontal lobe or parietal lobe.[55]
Microscopic
Features:
- Amorphous, acellular eosinophilic material within walls of small arteries.
- This is a high power diagnosis with congo red staining.
Notes:
- Amyloidosis is seen in all individuals with Alzheimer's disease; the amount of amyloid is what differs -- in CAA it is lots and lots.
- The white matter is typically spared by CAA.[56]
Images
CAA - congo red - very high mag. (WC)
CAA - congo red - low mag. (WC)
CAA - beta-amyloid - high mag. (WC)
Stains
IHC
- Abeta-amyloid (AKA beta-amyloid).
Central pontine myelinolysis
- Abbreviated CPM.
- AKA pontine myelinolysis.
General
- Classically in the pons, ergo "pontine" is in the name.
- Classically midline, ergo "central" is in the name.
- May occur elsewhere -- known as extrapontine myelinolysis.
Etiology:
- Rapid correction of hyponatremia.[57]
- Tacrolimus post-liver transplant.[58]
- Associated with alcoholism and malnourishment.
Clinical:[59]
- Decreased level of consciousness - most common.
- Quadriplegia.
- Poor prognosis.
Microscopic
Features:[60]
- Myelin loss.
- No inflammation.
- Relative preservation of neurons.
Images:
Vascular malformations
Main article: Vascular malformations
Types:[61]
- Arteriovenous malformation.
- Most important clinically - highest risk of bleeding.
- Varix.
- One large (dilated) vein.
- Venous angioma.
- Many small veins.
- Cavernous malformation.
- Vessels are back-to-back (no intervening parenchyma).
Also see: Sturge-Weber syndrome.
Cysts
General
- All are "benign", but some may be fatal due to spatial constraints.
List of cysts
- Colloid cyst.
- Columnar epithelium.
- Arachnoid cyst - considered precursor of meningioma.
- Psammoma bodies.
- Clumps of cells.
- Whorled pattern.
- Dermoid cyst.
- Skin + adnexal structures.
- ... think of ovarian dermoid.
- Epidermoid cyst.
- Choroid plexus cyst.
- Neuroenteric cyst.
- Foregut cyst with connection to dura.[62]
- Gastrointestinal tract epithelium.
- Usually seen with vertebral anomalies.
- Foregut cyst with connection to dura.[62]
- Epithelial cyst.
- Others.
Colloid cyst
General
Classic presentation:[63]
- Headache - may be relieved by lying down.
- Can cause sudden natural death.[64]
Gross
- Fluid filled cyst - classically in the third ventricle.
Images
Colloid cyst at autopsy. (Shaktawat et al.[65])
www:
Microscopic
Features:[66]
- Simple epithelium with ciliated cells and goblet cells.
Images
Colloid cyst. (WC)
![[1]](http://firstaidteam.com/usmlerximages/v/USMLERxLewy+bodies.gif.html){kind=link}
![[2]](http://faculty.washington.edu/alexbert/MEDEX/Fall/adhirano.jpg){kind=link}
![[3]](http://faculty.washington.edu/alexbert/MEDEX/Fall/adtangle.jpg){kind=link}
![[4]](http://faculty.washington.edu/alexbert/MEDEX/Fall/adgvd.jpg){kind=link}
![[5]](http://s212.photobucket.com/albums/cc74/cat_at_uw/Osler%20-%20Neuropath/?action=view¤t=Picks60x.jpg&mediafilter=images){kind=link}
![[6]](http://pathol.umin.ac.jp/gakubu/exam/2006jpg/19.jpg){kind=link}
www:
Paediatric pathology
Kernicterus
General
- Due to hyperbilirubinemia.[67]
Gross
Note:
- May not be specific.[67]
Image:
Microscopic
Features - similar to HIE:[68]
- +/-Red neurons.
- +/-Gliosis.
Joubert syndrome
- Malformation of the cerebellar vermis.[71]
Epidemiology
- Autosomal recessive - mutation in a number of genes including NPHP1, AHI1, and CEP290.[71]
Weird stuff
Acute disseminated encephalomyelitis
- Abbreviated ADEM.
Main article: Acute disseminated encephalomyelitis
Neuromyelitis optica
- Abbreviated NMO.
General
- Rare autoimmune disease - once considered a variant of multiple sclerosis.
- Autoantibodies directed at aquaporin-4.[72]
Diagnosis:
- NMO-IgG.
Clinical - preferentially:
- Eye (optic neuritis).
- Spinal cord (myelitis).
Microscopic
Features:
- Inflammation - lymphocytes, macrophages.
- Reactive astrocytes.
Images:
IHC
- Mixed lymphocyte population with CD3 > CD20.
- Aquaporin-4 loss.
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
- Commonly abbreviated CADASIL.
Main article: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
Progressive multifocal leukoencephalopathy
- Abbreviated PML.
Main article: Progressive multifocal leukoencephalopathy
See also
References
- ↑ MUN. Feb 3, 2009.
- ↑ Yeung, J.C.; Leonard, Blair J. N. (2005). The Toronto Notes 2005 - Review for the MCCQE and Comprehensive Medical Reference (2005 ed.). The Toronto Notes Inc. for Medical Students Inc.. pp. NS7. ISBN 978-0968592854.
- ↑ R. Kiehl. 8 November 2010.
- ↑ URL: http://neuropathology-web.org/chapter2/chapter2aHIE.html. Accessed on: 10 December 2014.
- ↑ URL: http://moon.ouhsc.edu/kfung/iacp-olp/apaq-text/N1-MS-01-16-Ans.htm and http://moon.ouhsc.edu/kfung/iacp-olp/apaq-text/n1-ms-01.htm. Accessed on: 31 October 2010.
- ↑ URL: http://www.neuropathologyweb.org/chapter1/chapter1aNeurons.html. Accessed on: 22 December 2010.
- ↑ Holland GR (1996). "Experimental trigeminal nerve injury". Crit. Rev. Oral Biol. Med. 7 (3): 237–58. PMID 8909880.
- ↑ Piercecchi-Marti MD, Pélissier-Alicot AL, Leonetti G, Tervé JP, Cianfarani F, Pellissier JF (December 2004). "Pellagra: a rare disease observed in a victim of mental and physical abuse". Am J Forensic Med Pathol 25 (4): 342–4. PMID 15577526.
- ↑ URL: http://frontalcortex.com/?page=oll&topic=24&qid=602. Accessed on: 3 November 2010.
- ↑ Finnie JW, Manavis J, Blumbergs PC, Kuchel TR (November 2000). "Axonal and neuronal amyloid precursor protein immunoreactivity in the brains of guinea pigs given tunicamycin". Vet. Pathol. 37 (6): 677–80. PMID 11105962. http://vet.sagepub.com/content/37/6/677.full.
- ↑ MUN. 15 November 2010.
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