INTRODUCTION

to

NEUROPATHOLOGY

NEUROPATHY, Inflammatory
Guillain-Barr
***Preceded by influenzalike, or viral like, illness***
NO actual specific etiologic agent isolated,
autoimmune disease to myelin gangliosides most
likely
Inflammation of a peripheral nerve
DEMYELINATION
ASCENDING* paralysis (*LOWER extremities
before UPPER extremities)

***INCREASED PROTEIN IN CSF***

NEUROPATHY,
Toxic/Metabolic
Diabetes Mellitus

***(swollen axons)***

Vitamin Deficiencies (many Bs, E)

Heavy Metals, Pb, As, etc.
Organic Compounds

CHEMO

A diabetic ulcer is
JUST AS MUCH
related to
NEUROPATHY as
ISCHEMIA!!!

DEMYELINATION

***What kind of picture

would you see in a
hydrocephalus caused
by aqueductal
stenosis?***

INFECTIONS
Meningitis (generally* bacterial)

E. coli, Strep B (neonates)

H. influenzae (children)
Neisseria meningitidis (adults)
Strep. pneumoniae, Listeria (elderly)
***NUCHAL RIGIDITY***,PMNs in CSF, INCREASED
protein, ***REDUCED glucose only in BACTERIAL
meningitis, NOT viral***

Encephalitis (generally viral)

Arboviruses, HSV, CMV, V/Z, polio, rabies, HIV
Lymphs and macrophages in perivascular VirchowRobbins spaces

Meningoencephalitis

* viral, chemical, tumoral

ACUTE FOCAL SUPPURATIVE

CNS INFECTIONS

CEREBRAL ABSCESSES
Local (mastoiditis, ***sinusitis***)
Hematogenous (tooth extraction, sepsis)
Staph, Strep
Often fibrous capsule, liquid center

SUBDURAL EMPYEMA (IN SINUSITIS)

EXTRADURAL ABSCESS
(IN OSTEOMYELITIS)

CHRONIC BACTERIAL
Meningo-encephalits
TB, brain and meninges
SYPHILIS, gummas in brain,

***posterior column
degeneration, causing loss of
balance with eyes closed
(Romberg sign) and prostitute
pupils***
LYME DISEASE (Neuro-Borreliosis)

*** ***
PERIVASCULAR
GIANT CELLS in

***WHITE MATTER***
In HIV
ENCEPHALITIS

OTHERS

MALARIA
***TOXOPLASMOSIS (in HIV)***
AMEBIASIS
TRYPANOSOMES
RICKETTSIAE
ECHINOCOCCUS

***MS = AUTOIMMUNE***
Cause: ?
USA prevalence:

***F>>M,

1:1000

Ages: 30s, 40s***

Immune response primarily against CNS myelin (white

matter), MBP (Myelin Basic Protein)
Regional area of ***white matter oligodendrocyte
demyelination*** is called PLAQUE
Increased CSF gamma globulin, i.e., oligoclonal bands
Often presents classically with VISUAL problems

***SCOTOMATA***, ***and

paresthesias***CCPP?
EXACERBATIONS/REMISSIONS

CNS DEGENERATIVE DISEASES

CORTEX (dementias), ***DUH!***
BASAL GANGLIA and BRAIN
STEM (parkinsonian)
SPINOCEREBELLAR (ataxias)
MOTOR NEURONS (muscle
atrophy)

CNS DEGENERATIVE DISEASES

***CORTEX (dementias), why is
this redundant?***
ALZHEIMER DISEASE + TAUS
Frontotemporal
Pick Disease (also primarily frontal)

Progressive Supranuclear Palsy (PSP)

CorticoBasal Degeneration (CBD)
Vascular Dementias (MID)

ALZHEIMER DISEASE
Commonest cause of dementias (majority)
Sporadic, 5-10% familial

CORTICAL (grey matter) ATROPHY

NEURITIC PLAQUES*
(extraneuronal)

NEUROFIBRILLARY TANGLES
(intraneuronal)
AMYLOID!!! (i.e., BETA amyloid)

HUNTINGTON DISEASE
Classical

***familial***,

genetic disease
Progressive motor
loss and dementia
chorea, i.e.
writhing,
***jerky***
movements
Progressive, fatal
Atrophy of basal
ganglia, i.e., corpus
Cortical (basal ganglia) atrophy
striatum
Ventricular enlargement

CNS DEGENERATIVE DISEASES

SPINOCEREBELLAR
DEGENERATIONS (ATAXIAS)
Spinocerebellar ataxias
Friedrich Ataxia (AR, coordination,
gait, not cognitive)
Ataxia-Telangiectasia

Amyotrophic Lateral Sclerosis

Unknown etiology
***Progressive muscle atrophy atrophy and
weakness due to motor neuron loss (lower,
upper)***
5-10% familial
Lou Gehrig had it, so does Steven Hawking
CCPP: Hand weakness, hand muscle atrophy
rising ascending to diaphragm
Anterior horn cells reduced and gliotic

ACQUIRED TOXIC/METABOLIC
CNS DISEASES
***Vitamin B1 deficiency (Wernicke-Korsakoff)***

***Vitamin B12 defic. (vibratory sense, dorsal colums)***

Diabetes Increased/Decreased GLUCOSE
Hepatic Failure (NH4+)
CO (Cortex, hippocampus, Purkinje cells)
CH3-OH, Methanol (Retinal ganglion cells)
CH3-CH2-OH (acute/chronic, direct/nutritl)
Radiation (Brain MOST resistant to Rad. Rx.)
Chemo (Methotrexate + Radiation)

***W/K MAMILLARY BODIES

W/K MAMILLARY BODIES
W/K MAMILLARY BODIES***

128 Hz

***SCD =
DORSAL
COLUMN
DISEASE = HIGH
MCV???***

PARA-NEOPLASTIC SYNDROMES

SMALL
CELL,
LUNG
LYMPHOMAS
BREAST CA

Purkinje Cell
Degeneration
Encephalitis, Limbic
System
***Sensory Neuron
Degeneration, DRG, due
to auto-Abs, decreased
PAIN***
Eye Movement
Disorders