[16] cns diseases

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



� 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





Meninges

Subarachnoidspace

Neutrophils and

Inflammatory cells



� 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



CASE 2. MENINGIOMA

Epithelial

cells inwhorls

Psammoma

bodies



� 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



� 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)





Blood vessels

Pleomorphic

Giant cells



� 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



� 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



CASE 4. ASTROCYTOMA

Fibrillary

background

Pleomorphic

Glial cells

[16] cns diseases

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