CNS Pathology

Melani H. Sionzon, MD, DPSP

Review: Principal cells of the CNS
Neurons Glial Cells
± Astrocytes ± Olidodendroglia ± ependyma

Microglia Meningothelial cells

Features Unique to CNS
Enclosed in a rigid bony compartment Autoregulation of cerebral blood flow Dependent on glucose and high O2 supply CSF fills ventricles and spaces Lack a lymphatic circulation Cell have limited regenrative ability Immunologically secluded BBB and blood CSF barrier separates the brain from the rest of the body

Intracranial compartments
Epidural space Subdural space Subarachnoid space Cerebral parenchymal compartment Intravntricular spaces

Pathologic Reactions
³Selective vulnerability´ Pathologic reactions of neurons
± ± ± ± ± ± ± Acute injury Degeneration Axonal reaction Formation of neuronal inclusions Vacuolization of cytoplasm and neurophil Aggregation of abnormal proteins Neuronophagia

Pathologic Reactions
Astrocytes - Gliosis ± glial scar Microglia - glial nodules
± Phagocytosis of dying neurons (neuronophagia)

Cerebral Edema
Vasogenic edema
± blood brain barrier dysfunction, fluid accumulates between neurons and glial cells

Cytotoxic edema
± fluid accumulates inside the cells (ischemia, hypoxia)

Interstitial edema
± results from increase CSF (dysfunction of brain CSF barrier) ± Complication of hydrocephalus

Gross Appearance of the brain in vasogenic edema Common autopsy findings
± Flattened broad gyri ± Narrowed slit-like sulci slit± Compressed lateral ventricles ± Brain is heavier than normal, soft; fluid seeps from cut surfaces ± Signs of herniation may be seen

Herniations
Cingulate herniation/ Subfalcine
± Cingulate gyrus compressed underneath the falx cerebri ± Caused by unilateral hemispheric mass

Transtentorial herniation/ Uncinate
± Uncus gyri herniate in the cerebellar tentorium

Tonsillar herniation
± Cerebellar tonsils are compressed in the foramen magnum ± Life threatening

Developmental Disorders
Cranial Dysraphism
± Anencephaly ± encephalocele

Spinal Dysraphism
± ± ± ± Spina bifida occulta Meningocele Meningimyelocele Rachischisis

Physical Injuries
Contusions (bruising)
± ³Coup lesions´ and ³contre coup´ contusion ± Rapid accelaration/ deceleration

Laceration (tearing) Diffuse Axonal Injury Traumatic vascular injury Penetrating wounds

Spinal Cord Injuries
Hyperextension injury
± Cervical spinal ± Sudden posterior displacement of the head ± Rupture of anterior spinal ligament

Hyperflexion injury
± Impact force driving the head down and forward ± Anterior contusion of the cervical spine

Intracranial Bleeding
Epidural hematoma Subdural hematoma Subarachnoid hematoma Intracerebral hemorrhage Intraventricular hemorrhage ³hydrocephalus internus´