[16] cns diseases
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8/7/2019 [16] CNS Diseases
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� 10 month old�
History:� 1 week PTA:
� cough and fever� Given counter medication slight relief �
Irritability few days later� Increased sleeping time� Loss of appetite
� Few hrs PTA:� Difficulty to arouse� Jerky movements of extremities
CASE 1. ACUTE MENINGITIS
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� Physical Exam�
Harsh breath sounds� Neck rigidity � Lab findings:
� CSF: cloudy fluid with numerous neutrophils� Culture: (+) H. influenzae
� Gross:� Brain stem and cerebellum: Covered with a thick
layer of cream white exudates� Microscopic:
� Numerous neutrophils in subarachnoid space andaround blood vessels
CASE 1. ACUTE MENINGITIS
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CASE 1. ACUTE MENINGITIS
Meninges
Subarachnoidspace
Neutrophils and
Inflammatory cells
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� 45 year old female�
History � On and off tolerable facial pain for 3 years with
nasal congestion and rhinorrhea� anosmia for 2 weeks
� Endoscopy � Bulging mass in the ethmoid area
� Microscopic:� Mixture of spindle cells and epithelial cells
arranged in whorls (or small nodules)� Few psammoma bodies at the center of the
whorls
CASE 2. MENINGIOMA
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CASE 2. MENINGIOMA
Epithelial
cells inwhorls
Psammoma
bodies
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� 52 year old male� CC: seizure attack
� Course:� Several seizure attacks for a month� Comatose� Hooked to a ventilator
� CT scan� Large contrast enhancing tumor along the
right cerebral hemisphere
CASE 3. GLIOBLASTOMA
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� Gross:� Solid firm whte and soft yellow areas infiltrating
normal brain tissue� Microscopic:
� Pleomorphic glial cells� Occasional large bizarre giant tumor cells� Proliferation of endothelial cells in blood vessels� Malignant tumor cells crowded along the edges of
necrotic areas (Pseudopalisading necrosis)
CASE 3. GLIOBLASTOMA
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CASE 3. GLIOBLASTOMA
Blood vessels
Pleomorphic
Giant cells
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� 40 year old male� CC: On and off headaches of increasing severity
for the past few months� With weakness in the right upper extremities
� CT scan and MR I:� Mass involving the left temporal love
� Gross:� Poorly defined gray tumor infiltrating the
brain substance
� Soft gelatinous area in cut sections
CASE 4. ASTROCYTOMA
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� Microscopic:� Mild to moderate increase in the number of glial
cell nuclei� Variable nuclear pleomorphism� Intervening network of fine, GFAP positive
astrocytic cell processes� Fibrillary background
CASE 4. ASTROCYTOMA
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CASE 4. ASTROCYTOMA
Fibrillary
background
Pleomorphic
Glial cells