Pathology (chapter 8 & 2)

nervous system and specialized imaging techniques part 2/2

stroke syndrome

denotes the sudden and dramatic development of focal neurologic deficit

what is most commonly involved in a stroke

internal carotids

stroke varies from _____________ to ______________

dense hemiplegia and coma to only a trivial neurologic disorder

specific neurologic defect depends on the:

affected arteries

transient ischemic attacks (TIAs)

focal neurologic deficits that completely resolve within 24 hours

TIAs result from:

from emboli originating from the surface of an anteriosclerotic ulcerated plaque (embolic stroke) or from stenosis of an extracerebral artery

almost 2/4 of strokes are preceded by ______ ?

Transient ischemic attacks (TIAs)

what is the 5 year cumulative risk of stroke in patients with TIAs

50%

most common location of surgically treatable arteriosclerotic disease causing TIAs is:

the region of the carotid bifurcation in the neck

intraparenchymal hemorrhage

hemorrhagic stroke

4 causes of intraparenchymal hemorrhage

head trauma, hypertensive vascular disease, congenital berry aneurysm rupture, and arteriovenous malformation

oval or circular collections that displace the surrounding bran and can cause significant mass effect

result of hypertensive hemorrhages

subarachnoid hemorrhage

another form of hemorrhagic stroke

primary cause of subarachnoid hemorrhage

ruptured berry aneurysm

neurologic deficit due to lack of circulation

stroke

embolic stroke originating from arteriorsclerotic ulcerated plaque

transient ischemic attack

blood beneath arachnoid layer of meninges

subarachnoid hemorrhage

the most common demyelinating disorder of the CNS

multiple sclerosis

what does multiple sclerosis primarily involve

the spinal cord, optic nerves, and central white matter of the brain

shows as recurrent attacks of focal neurologic deficits

multiple sclerosis

what is the peak age/gender incidence for multiple sclerosis

20 to 40 years and strong predominance in women

clinical course is characterized by multiple relapses and remissions

multiple sclerosis

what is the modality of choice for multiple sclerosis

MRI

MRI characteristics of scattered plaques of demyelination that demonstrate as multiple areas of increased signal intensity on T2 weighted images

multiple sclerosis

what is epilepsy

a condition in which brain impulses are temporarily disturbed

what presents as a spectrum of symptoms, ranging from loss of consciousness for a few seconds to violent seizures

epilepsy and convulsive disorders

most cases of epilepsy are ______

idiopathic

what are the two primary forms of epilepsy

petite mal or grand mal

mildest form of epilepsy most commonly seen in children and disappears in young adulthood

petite mal

brief episodes of loss of consciousness, which may be associated with mild muscular twitching

petite mal epilepsy

generalized convulsions associated with the patient falling to the floor, hypersalivating (foaming at the mouth) and losing control of urine/feces

grand mal epilepsy

seizure disorder shows:

calcified hippocampus

what is one of the causes of seizure disorder seen on an MRI

hippocampus sclerosis

normal aging

enlargement of the ventricular system and sulci

what is normal aging caused by

gradual loss of neurons

alzheimer’s disease

a diffuse form of progressive cerebral atrophy that develops at an earlier age than the senile period

which imaging modality demonstrates nonspecific findings of cerebral atrophy, including symmetrically enlarged ventricles with prominence of the cortical sulci in alzheimer’s

CT and MRI

huntingtons disease

an inherited condition that predominantly involves men

choreiform movements

involuntary movements that are rapid, jerky, and continuous

when/how does huntington’s disease present

presents in the early to middle adult years with dementia and typical choreiform movements

what is the pathologic hallmark of huntington’s disease

atrophy of the caudate nucleus and putamen

produces appearance of focal dilation of frontal horns and a loss of their normal concave shape on CT images

huntington’s disease

what appearance does huntington’s disease give on CT images

appearance of focal dilation of the frontal horns and loss of their normal concave shape

what is parkinson’s disease

a progressive, degenerative disease

parkinson’s disease AKA:

shaking palsy

what is parkinson’s disease characterized by (4 things)

stooped posture, stiffness and slowness of movement, fixed facial expression, involuntary rhythmic tremor that disappears with voluntary movement

when does parkinson’s show up

in middle or later in life

this disease is very gradually progressive and exhibits a prolonged course

parkinson’s disease

cerebellar atrophy

isolated atrophy of the cerebellum

cerebellar atrophy may represent

an inherited disorder, degenerative disease, or toxic effect of long use of drugs

ALS

amyotrophic lateral sclerosis

amyotrophic lateral sclerosis is AKA

Lou Gehrig’s disease

what type of disease is ALS

an idiopathic disease

what is ALS characterized by

widespread selective atrophy and loss of motor nerve cells

what does ALS result in

extensive paralysis

how can ALS cause death

usually from respiratory weakness or aspiration pneumonia

atrophy of caudate nucleus and putamen

huntingtons disease

degeneration of basal ganglia

parkinson’s disease

upper and lower motor neurons

amyotrophic lateral sclerosis

cerebral atrophy, enlarged ventricular system, and demyelination

normal aging

hydrocephalus

dilation of the ventricular system that is usually associated with increased intracranial pressure

2 types of hydrocephalus

noncommunicating (obstructive) and communicating

which type of hydrocephalus: CSF flow blocked somewhere in its normal path

noncommunicating hydrocephalus

which type of hydrocephalus: CSF flows into extraventricular subarachnoid space

communicating hydrocephalus

what helps on images to identify the type/location of obstruction in hydrocephalus?

pattern of ventricular enlargement and other characteristics

what is sinusitis caused by

viral upper respiratory infection

what does sinusitis do?

obstructs drainage and causes localized pain, tenderness, and fever

how does sinusitis appear radiographically

as a soft tissue density lining the walls of the involed sinuses

what is most commonly affected with sinusitis

the maxillary

sinusitis for maxillary is best represented on what projection

waters

what is an air fluid level in a sinusitis considered

a manifestation of acute inflammatory disease

what is the most common demyelinating disorder of the CNS?

multiple sclerosis

which is caused by venous bleeding as a complication of head trauma

subdural hematoma

petite mal is the mildest form of

epilepsy

Define the imaging features most commonly used by radiologists to indicate pathophysiology changes

location, size, density, ,structure, shape, demarcation, perfusion, and integration

The tissue density and structure describe

the abnormal appearance in comparison with what is expected as normal

perfusion

its degree of vascularity

image production for CT

uses rotating beams and detectors to measure attenuation, reconstructs cross sectional images

image production for fusion imaging

combines images from different modalities to provide anatomic and functional information

image production for MRI

magnetic fields and radiofrequency

image production for mammo

low dose xrays to image breast tissue

nuclear medicine

uses radiopharmaceuticals that emit gamma rays to reflect organ function and physiology

PET (positron emission tomography)

detects gamma rays to show metabolic activity

Single photon emission computed tomography (SPECT)

uses gamma emitting radiopharmaceuticals and rotating detectors to create 3D images

ultrasound

uses high frequency sound waves