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Pathologic Basis of Disease

Pathologic Basis of Disease. Neuropathology - 1. Major cells of the CNS. Neurons Glial cells: -astrocytes -oligodendrocytes -ependymal cells -microglial cells. Supporting structures. Meninges: arachnoid cells Choroid plexus Blood vessels: blood-brain barrier.

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Pathologic Basis of Disease

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  1. Pathologic Basis of Disease Neuropathology - 1

  2. Major cells of the CNS • Neurons • Glial cells: -astrocytes -oligodendrocytes -ependymal cells -microglial cells

  3. Supporting structures • Meninges: arachnoid cells • Choroid plexus • Blood vessels: blood-brain barrier

  4. Organization of the CNS and disease • Not all cells in the CNS are ‘equal’: while some disease processes affect some groups of cells more than others (‘selective vulnerability’), other disease processes could affect other areas more. • Not all areas in the brain are equal: most areas in the brain have specific functions: a same disease process in two different areas of the brain, often give different symptoms. • Some disease processes are the same in the brain as elsewhere in the body, while others are unique to the brain (eg demyelinative disease, neurodegenerations)

  5. NEURON • Maturity: G0 phase • Great metabolic activity requiring a continuous supply of O2 and glucose

  6. Neuron cell death • Phagocytosis by macrophages: acute neuronal death, viral infections • Apoptosis • ‘simple atrophy’: loss of cell volume and ultimately cell death due to metabolic derangement (often in neurodegeneration).

  7. Protection of neurons from the bad outside world • Blood brain barrier: capillaries with endothelial cells with tight junctions (only active transport possible), astrocytic footplates • Brain CSF barrier: ependymal cells with tight junctions, and astrocytic footplates.

  8. WHY BBB & BCB • Controlled external milieu of neurons –needed for excitability of neurons • Protection against infections • Protection against autoimmune responses • Protection against cerebral oedema (skull is a closed box-no volume increase possible)

  9. CEREBRAL EDEMA • Abnormal accumulation of fluids with increase in cerebral tissue volume Normal Edema Grey matter 800mg/g 820mg/g White matter 680mg/g 760mg/g

  10. Topography of edema Localized edema Generalized edema

  11. Types of edema • Vasogenic edema: rupture of the blood-brain barrier • Cytotoxic edema: pump failure • Interstitial edema: passage through the ependymal lining of the ventricles

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