8679901 central-nervous-system-pathology
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CNS CNS PathologyPathology
Melani H. Sionzon, MD, DPSPMelani H. Sionzon, MD, DPSP
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Review: Principal cells of the Review: Principal cells of the CNSCNS
NeuronsNeurons
Glial CellsGlial Cells– AstrocytesAstrocytes– OlidodendrogliaOlidodendroglia– ependymaependyma
MicrogliaMicroglia
Meningothelial cellsMeningothelial cells
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Features Unique to CNSFeatures Unique to CNS
Enclosed in a rigid bony compartmentEnclosed in a rigid bony compartmentAutoregulation of cerebral blood flowAutoregulation of cerebral blood flowDependent on glucose and high O2 supplyDependent on glucose and high O2 supplyCSF fills ventricles and spacesCSF fills ventricles and spacesLack a lymphatic circulationLack a lymphatic circulationCell have limited regenrative abilityCell have limited regenrative abilityImmunologically secludedImmunologically secludedBBB and blood CSF barrier separates the brain BBB and blood CSF barrier separates the brain from the rest of the body from the rest of the body
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Intracranial compartmentsIntracranial compartments
Epidural spaceEpidural space
Subdural spaceSubdural space
Subarachnoid spaceSubarachnoid space
Cerebral parenchymal compartmentCerebral parenchymal compartment
Intravntricular spacesIntravntricular spaces
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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
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Pathologic ReactionsPathologic Reactions
Astrocytes - Gliosis – glial scarAstrocytes - Gliosis – glial scar
Microglia - glial nodulesMicroglia - glial nodules– Phagocytosis of dying neurons Phagocytosis of dying neurons
(neuronophagia)(neuronophagia)
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Cerebral EdemaCerebral Edema
Vasogenic edema Vasogenic edema – blood brain barrier dysfunction, fluid accumulates blood brain barrier dysfunction, fluid accumulates
between neurons and glial cellsbetween neurons and glial cells
Cytotoxic edema Cytotoxic edema – fluid accumulates inside the cells (ischemia, hypoxia)fluid accumulates inside the cells (ischemia, hypoxia)
Interstitial edema Interstitial edema – results from increase CSF (dysfunction of brain CSF results from increase CSF (dysfunction of brain CSF
barrier)barrier)– Complication of hydrocephalusComplication of hydrocephalus
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Gross Appearance of the brain in vasogenic Gross Appearance of the brain in vasogenic edemaedema
Common autopsy Common autopsy findingsfindings– Flattened broad gyriFlattened broad gyri– Narrowed slit-like sulciNarrowed slit-like sulci– Compressed lateral Compressed lateral
ventriclesventricles– Brain is heavier than Brain is heavier than
normal, soft; fluid seeps normal, soft; fluid seeps from cut surfacesfrom cut surfaces
– Signs of herniation may Signs of herniation may be seenbe seen
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HerniationsHerniations
Cingulate herniation/ SubfalcineCingulate herniation/ Subfalcine– Cingulate gyrus compressed underneath the falx Cingulate 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 foramen Cerebellar tonsils are compressed in the foramen
magnummagnum– Life threateningLife threatening
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Developmental DisordersDevelopmental Disorders
Cranial DysraphismCranial Dysraphism– AnencephalyAnencephaly– encephaloceleencephalocele
Spinal DysraphismSpinal Dysraphism– Spina bifida occultaSpina bifida occulta– MeningoceleMeningocele– MeningimyeloceleMeningimyelocele– Rachischisis Rachischisis
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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
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Spinal Cord InjuriesSpinal Cord Injuries
Hyperextension injuryHyperextension injury– Cervical spinalCervical spinal– Sudden posterior displacement of the head Sudden posterior displacement of the head – Rupture of anterior spinal ligamentRupture of anterior spinal ligament
Hyperflexion injuryHyperflexion injury– Impact force driving the head down and Impact force driving the head down and
forwardforward– Anterior contusion of the cervical spineAnterior contusion of the cervical spine
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Intracranial BleedingIntracranial Bleeding
Epidural hematomaEpidural hematoma
Subdural hematomaSubdural hematoma
Subarachnoid hematomaSubarachnoid hematoma
Intracerebral hemorrhageIntracerebral hemorrhage
Intraventricular hemorrhage Intraventricular hemorrhage “hydrocephalus internus”“hydrocephalus internus”
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