PATH 693 - CNS (Reference Wheater's) 00:00:00

• Anterior Pituitary (pg 330) - PITUITARY is NOT part of CNS, but it's included because NEUROSURGEONS are responsible for taking it out ! arranged in nests ! Multiple cell types ! basophilic (darker cells) ! eosinophilic (lighter cells) ! Most common lesion = Pituitary ADENOMA (will look different and be all one cell type) !

! Posterior Pituitary (pg 332) ! Makes OXYTOCIN and VASSOPRESSIN (ADH) ! Herring bodies = round inclusions containing the hormone secretions ! Distended terminations of the axons where neurosecretory granules contact capillaries ! Cystic structures = remnants of embryologic medial pituitary lobe ! Can enlarge and become a cyst (which can be clinically symptomatic) Spinal cord ! CLEFT = ANTERIOR = motor nerve fibers (posterior = sensory) ! Large ANTERIOR spinal artery - main blood supply ! *Don't get confused with rami when it comes out b/c those are mixed nerves Medulla ! lining by 4th ventricle = ependymal cell lining ! Ependymal cells are epithelial cells ! Useful landmarks: ! Inferior Olive/Inferior Olivary (squiggle) - made up of neurons ! Take sections for autopsy ! Pyramids = main motor descending fiber tract (white matter tracts) ! Neurons (Gray Matter) = light pink (i.e., Cortex) ! White matter tracts = dark pink ! Dorsal nucleus of the Vagus = pigmented nuclei Pons ! can see the 4th ventricle ! Locus ceruleus = pigmented nuclei (take sections for autopsy) Midbrain ! Substantia nigra = pigmented nuclei ! cerebral aqueduct (lined by ependymal cells) ! Cerebral peduncles = main descending white matter tract Cerebellum ! vermis (midline) ! cause vermal atrophy* ! Alcohol ! Dylantin or Phenytoin (anti-epileptic drug) ! Heavy metal poisoning (mercury) ! Spinocerebellar ataxias

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Cortex (3 Layers) ! Molecular layer - pink layer ! Purkinje cells - big (neuron) cells, fairly easy to recognize ! Granular layer - on the inside (are also neurons, but they don't have big nucleoli like the ??paraminal? ?pyramidal?? neurons do) ! Bergmann Glia (astrocytes that proliferate when u have loss of purkinje cells) Deep nuclei (Fat Girls Eat Donuts) ! Dentate (most lateral) ! Fastigial ! Globus ! Emboliform Lipofuscin - golden yellow pigment in neurons as they age (non-specific aging change, common in dentate, NOT PATHOLOGIC) Hippocampus ! temporal horn of 4th ventricle - choroid plexus has fibrovascular cores makes them papillary --> can proliferate into a choroid plexus papilloma (looks almost like normal choroid plexus) ! Dentate fascia ! CA 1-4 ! CA1 = most impt for pathology out of the 4 ! susceptible to hypoxia/ischemia also includes purkinje cells and layers 3 & 5 of the cerebral cortex ! Enterorrhinal cortex - where the PLAQUES and TANGLES start in ALZHEIMER'S disease; look for early change in Alzheimer's ! Inferior temporal gyrus WHAT AREAS OF THE BRAIN ARE THE MOST SUSCEPTIBLE TO HYPOXIC INJURY? ! CA1 of Hippocampus ! Purkinje cells of ... ! Layers 3 & 5 of the cortex Parkinsons Disease: neurodegenerative disease that cause neuronal loss in the pigmented nuclear groups (to find the pathology, you need to be able to find the normal structure first) What is a dead neuron? ! Red nucleus (think RED = DEAD) - NOT PIGMENTED (TRICK QUESTION) ! Microscopic calcifications in the brain:

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! Corpora amylacia (aka Brain Sand) Microglia - see w/ damage to purkinje cells Be able to recognize the tissue type and structures ! Low power ! Med power ! High power

PITUITARY:

PIGMENTED NUCLEI OF THE BRAINSTEM: Midbrain Substantia nigra Pons Locus ceruleus Medulla oblongata Dorsal nucleus of the Vagus

HIPPOCAMPUS:

SPINAL CORD:

MAKE-UP LECTURE 01:40:47
BASAL GANGLIA: !

ventricular lining - single layer of ependymal cells (epithelial cells; next to

caudate nucleus ! Internal capsule - main descending white mater tract ! Putamen - looks histologically identical to caudate ! Globus pallidus = darker part ! Anterior commissure - landmark for nucleus basalis of Meynert (important in Alzheimer's disease --> degenerates) - main cholinargic output nucleus of the brain (therapy = cholinesterase inhibitors) ! Blood vessel - post-mortem bacterial overgrowth - bacteria can be gasforming and make create holes/cavities (post-mortem artifact that looks like swiss cheese --> gets mistaken for lacunar infarcts and smells horrible) • Thalamus: ! looks histologically identical to the globus pallidus, but it's not symmetrical (so you can tell them apart) ! ependymal lining ! lipofuscin - pigment in larger neurons • CORTEX: ! Leptomeninges = aracnoid + pia (contain blood vessels) ! 6 layers • White mater = darker pink ! ogliodendrocytes - make myelin ! Injury results in myelin loss ! astrocytes are hard to see in normal white matter (inconspicuous) ! Pathology makes them larger and reactive ! Sections from: ! Frontal Lobe ! Parietal Lobes ! Occipital Lobe ! Hard to tell difference b/t FRONTAL and PARIETAL lobes ! Thicker in older people due to fibrosis (common) ! OCCIPITAL LOBE: ! stria of genarie - easier to see on gross brains ! If someone asks you where in the cortex a section is from, the answer is usually the occipital lobe b/c of stria of genarie

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PATHOLOGIC SECTIONS: (01:50:43) Squash prep - good for cytologic detail & its a fast process

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whorls - characteristic of menigioma (a more common type of brain tumor) ! pseudo-inclusions in nuclei - invaginations of cytoplasm inside the nucleus ! Disadvantage = lose architecture and the relationship of lesion Do FS on all the neuro specimens Muscle Bx: never put a muscle Bx in formalin ! Holes = freeze artifact ! muscle cells (myofibrils) are round to polygonal ! Extend from origin to insertion of muscle ! nuclei (multi-nucleated) on the periphery of muscle fiber = normal muscle ! Pathologic processes = nuclei tend to move towards the center of the myofibril ! Myopathy - primary pathologic process of muscle ! Muscles are innervated by peripheral nerves ! Neuropathy (secondary pathologic process) causes atrophy of muscle fibers ! Atrophic muscle fibers = angulated in shape when denervated ! Case = neurogenic atrophy of skeletal muscle ! Groups of atrophic fibers = peripheral nerve disease ! Nuclei cluster together (don't mistake for inflammatory cells) = pyknotic nuclear clumps or nuclear bags ! Common reason for muscle Bx = inflammatory myopathies THINGS WE NEED TO KNOW: ! Do NOT FIX the muscle (keep it fresh) ! Squash preps and FS on neural tissues (save some tissue for permanent sections - fixed) ! Pigmented Nuclei ! Areas susceptible to Hypoxic injury: ! Purkinje cells (cerebellum) - *BE ABLE TO RECOGNIZE* ! Areas 3 & 5 of pyramidal layers of the cortex ! CA1 region of Hippocampus ! Lipofuscin

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