Diseases of the Nervous System Diseases of the Nervous System Central nervous system Central nervous system Brain is a prisoner Brain is a prisoner Basic cellular elements Basic cellular elements Neurons, location means everything Neurons, location means everything Neuronal reaction to injury, very limited Neuronal reaction to injury, very limited Axonal growth Axonal growth No regeneration of lost cells No regeneration of lost cells Accumulation of junk within the cells can be harmful. Accumulation of junk within the cells can be harmful. Glial component, supportive Glial component, supportive Microglia, the police force of the CNS Microglia, the police force of the CNS Astrocytes, structural like fibroblasts elsewhere Astrocytes, structural like fibroblasts elsewhere Gemistocytes are reactive astrocytes Gemistocytes are reactive astrocytes Oligodendrocytes, make myelin (the insulation) Oligodendrocytes, make myelin (the insulation) Meninges Meninges Cerebral Edema Cerebral Edema Injury to brain Injury to brain Tumor Tumor Rubor…… Rubor…… Swelling can’t go Swelling can’t go anywhere anywhere Compression of vital Compression of vital structures structures Herniation Herniation Sublax Sublax Transtentorial Transtentorial Cerebellar tonsils Cerebellar tonsils Brainstem Hemorrhages Brainstem Hemorrhages CSF Flow CSF Flow Made in the ventricles Made in the ventricles Flows down aqueduct Flows down aqueduct Into 4 Into 4 th th ventricle ventricle Out into the Out into the subarachnoid space subarachnoid space Up to the arachnoid Up to the arachnoid granulations granulations Back into the blood Back into the blood Obstructions in Obstructions in movement will lead to movement will lead to hydrocehpalus hydrocehpalus
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Diseases of the Nervous SystemDiseases of the Nervous System
Central nervous systemCentral nervous systemBrain is a prisonerBrain is a prisonerBasic cellular elementsBasic cellular elements
Neurons, location means everythingNeurons, location means everythingNeuronal reaction to injury, very limitedNeuronal reaction to injury, very limited
Axonal growthAxonal growthNo regeneration of lost cellsNo regeneration of lost cellsAccumulation of junk within the cells can be harmful.Accumulation of junk within the cells can be harmful.
Glial component, supportiveGlial component, supportiveMicroglia, the police force of the CNSMicroglia, the police force of the CNSAstrocytes, structural like fibroblasts elsewhereAstrocytes, structural like fibroblasts elsewhere
Gemistocytes are reactive astrocytesGemistocytes are reactive astrocytesOligodendrocytes, make myelin (the insulation)Oligodendrocytes, make myelin (the insulation)
MeningesMeninges
Cerebral EdemaCerebral Edema
Injury to brainInjury to brainTumorTumorRubor……Rubor……
Swelling can’t go Swelling can’t go anywhereanywhereCompression of vital Compression of vital structuresstructuresHerniationHerniation
Made in the ventriclesMade in the ventriclesFlows down aqueductFlows down aqueductInto 4Into 4thth ventricleventricleOut into the Out into the subarachnoid spacesubarachnoid spaceUp to the arachnoid Up to the arachnoid granulationsgranulationsBack into the bloodBack into the bloodObstructions in Obstructions in movement will lead to movement will lead to hydrocehpalushydrocehpalus
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HydrocephalusHydrocephalus
Obstruction to flow of CSFObstruction to flow of CSFOver production of CSFOver production of CSFInability of arachnoid Inability of arachnoid granulations to restore granulations to restore water of CSF back into water of CSF back into circulationcirculation
HydrocephalusHydrocephalusNoncommunicating: Can’t get out of ventriclesNoncommunicating: Can’t get out of ventriclesCommunicating: CSF can’t get to arachnoid granulationsCommunicating: CSF can’t get to arachnoid granulations
TraumaTrauma
Birth traumaBirth traumaHemorrhageHemorrhagePermanent lossPermanent loss
Subdural HemorrhageSubdural HemorrhageRotational injury tears little veinsRotational injury tears little veinsSlow venous bleedingSlow venous bleeding
Epidural HemorrhageEpidural Hemorrhage
Trauma with skull fxTrauma with skull fxMiddle meningeal a.Middle meningeal a.Hemorrhage Hemorrhage compresses braincompresses brain
Subarachnoid Subarachnoid HemorrhageHemorrhage
Not as commonly due Not as commonly due to trauma, but maybe.to trauma, but maybe.Arterial bleedingArterial bleedingTypically from Circle of Typically from Circle of WillisWillisBlood in subarachnoid Blood in subarachnoid spacespace
Infection of brain Infection of brain substancesubstanceHerpes Herpes -->>Absent temporal Absent temporal lobeslobesSporadicSporadicImmunsuppressedImmunsuppressedHIVHIV
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HIV EncephalopathyHIV Encephalopathy
MeningitisMeningitisNeuronalNeuronalBoth cognitive motorBoth cognitive motorDiffuse cortical atrophyDiffuse cortical atrophyMicroglia at site of dead Microglia at site of dead neuronsneuronsGP120 protein is directly GP120 protein is directly toxictoxic
Tertiary SyphilisTertiary Syphilis
Years after initial infectionYears after initial infectionObliterativeObliterative end end arteritisarteritisMeningitisMeningitisBrain properBrain properTabesTabes dorsalisdorsalis
PrionPrion DiseaseDisease
No nucleic acidNo nucleic acidSporadic or geneticSporadic or geneticAccumulation of Accumulation of abnormally folded abnormally folded proteinproteinVariety of Variety of conformations of the conformations of the diseased proteindiseased proteinSpongioformSpongioformencephalopathyencephalopathyKuruKuru
PrionPrion DiseaseDisease
Degenerative DiseasesDegenerative Diseases
Not just aging changesNot just aging changesNeuronal DeathNeuronal DeathGray matterGray matter
White matter changes are secondaryWhite matter changes are secondarySelective or generalized lossSelective or generalized lossAtrophy (local or global)Atrophy (local or global)Histological featuresHistological features
NeurofibrillaryNeurofibrillary tanglestanglesIntracellular or Intracellular or intranuclearintranuclear inclusionsinclusions
55--15 years15 yearsEventually loss of Eventually loss of languagelanguageHigher functionsHigher functionsParkinson’s in a fewParkinson’s in a fewPneumonia is often cause Pneumonia is often cause of deathof death
Hemorrhages in Hemorrhages in mamillarymamillary bodiesbodiesConfusionConfusionParalysis of Paralysis of extraoccularextraoccular musclesmusclesAtaxiaAtaxia
Korsakoff’sKorsakoff’sInabilbityInabilbity to form new memoriesto form new memoriesConfabulationConfabulation
B12 DeficiencyB12 Deficiency
Inability to maintain myelinInability to maintain myelinPosterior column degenerationPosterior column degeneration
EthanolEthanol
Acutely, neural depressantAcutely, neural depressantInhibitions go firstInhibitions go firstLoss of depth perceptionLoss of depth perception
ChronicChronicDegeneration of granular cell layer of cerebellumDegeneration of granular cell layer of cerebellumLoss of Purkinje cellsLoss of Purkinje cellsBergman’s Bergman’s gliosisgliosis
Abnormal migration of neurons during developmentAbnormal migration of neurons during development
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CNS TumorsCNS Tumors
Primary vs. Primary vs. metastaticmetastaticBenign vs. malignantBenign vs. malignantFocal vs. diffuseFocal vs. diffuseAbove or below Above or below tentorumtentorumNot too common in adultsNot too common in adultsAbout 20% of childhood malignanciesAbout 20% of childhood malignanciesLocation is criticalLocation is criticalCell typeCell type
None are of neuronal originNone are of neuronal originAstocytomaAstocytoma, most, mostOligodendrocytomaOligodendrocytomaMicrogliomatosisMicrogliomatosisEpendymomaEpendymoma
AstrocytomaAstrocytoma
AstrocyticAstrocytic originoriginAbove Above tentorumtentorum most times most times in adultsin adults
Multiple gradesMultiple gradesCompresses surrounding Compresses surrounding tissuetissueHemorrhage and necrosisHemorrhage and necrosisWith higher grade With higher grade malignant tumors, malignant tumors,
Arise from Arise from meningesmeningesBenign in a biological Benign in a biological sensesenseConsider where it isConsider where it isFibroblast lookingFibroblast lookingCells in whirls and Cells in whirls and clustersclustersPsammomaPsammoma bodiesbodies
MeningiomaMeningioma
PsammomaPsammoma bodiesbodiesLittle calcificationsLittle calcificationsMicroscopicMicroscopicWithin the tumorWithin the tumorCan spot on XCan spot on X--rayrayConcentric layers Concentric layers -->>
Peripheral NervesPeripheral Nerves
Axon vs. Axon vs. SchwannSchwann cellscellsMotorMotorSensorySensory
Inflammatory, autoimmuneInflammatory, autoimmuneToxicToxicTraumaTraumaVascular, especially diabetesVascular, especially diabetesTumorsTumors
DemylinizationDemylinizationAscending paralysisAscending paralysisPhrenicPhrenic nerve involvement is life threateningnerve involvement is life threatening
Cranial nerves tooCranial nerves tooV & VIIIV & VIII
NeurofibromatosisNeurofibromatosis
Two typesTwo typesNo capsuleNo capsuleType 1Type 1
GeneticGeneticAll over the bodyAll over the bodyGliomaGlioma of optic n. (rare)of optic n. (rare)MeningiomaMeningiomaCafCaféé--auau--laitlait spotsspotsPigmented nodules of irisPigmented nodules of iris