Abstract
A basic understanding of nervous system pathology is integral to providing high-quality, safe, evidence-based care to patients with neurological diseases. This is particularly important in the field of critical care medicine. Although the manner in which disorders may affect the brain and spinal cord is quite varied (as are clinical and radiologic manifestations of disease), special structural features of the central nervous system give rise to unique patterns of vulnerability that produce reproducible morphologic patterns of neuropathology. Some types of pathological changes are unique to the nervous system such as demyelination and neurodegeneration, while others, such as trauma, neoplasms, and vascular diseases that occur elsewhere in the body, will have characteristic structural and functional effects on the brain and spinal cord. This chapter will cover basic reactions of the central nervous system to injury and then review some typical anatomic patterns of CNS disease.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Stiess M, Bradke F. Neuronal polarization: the cytoskeleton leads the way. Dev Neurobiol. 2011;71:430–44.
Perry A, Brat D. Neuropathology patterns and introduction. In: Perry A, Brat D, editors. Practical surgical neuropathology. Philadelphia: Elsevier; 2010. p. 1–14.
Sarnat HB, Nochlin D, Born DE. Neuronal nuclear antigen (NeuN): a marker of neuronal maturation in early human fetal nervous system. Brain Dev. 1998;20:88–94.
Vinters HV, Kleinschmidt-DeMasters BK. General pathology of the central nervous system. In: Love S, Louis DN, Ellison DW, editors. Greenfield’s neuropathology. 8th ed. London: Hodder Arnold; 2008. p. 1–62.
Gray DA, Woulfe J. Lipofuscin and aging: a matter of toxic waste. http://sageke.sciencemag.org/cgi/content/full/2005/5/re1. Published 2 Feb 2005.
Reichard RR, Smith C, Graham DI. The significance of beta-APP immunoreactivity in forensic practice. Neuropathol Appl Neurobiol. 2005;31:304–13.
Benfenati V, Ferroni S. Water transport between CNS compartments: functional and molecular interactions between aquaporins and ion channels. Neuroscience. 2010;168:926–40.
Graber DJ, Levy M, Kerr D, Wade WF. Neuromyelitis optica pathogenesis and aquaporin 4. J Neuroinflammation. 2008;5:1–22.
Wisniewski T, Goldman JE. Alpha B-crystallin is associated with intermediate filaments in astrocytoma cells. Neurochem Res. 1998;23:385–92.
Quinlan RA, Brenner M, Goldman JE, Messing A. GFAP and its role in Alexander disease. Exp Cell Res. 2007;313:2077–87.
Hickey WF, Kimura H. Perivascular microglial cells of the CNS are bone-marrow-derived and present antigen in vivo. Science. 1988;230:290–2.
Abbott NJ, Ronnback L, Hansson E. Astrocyte-endothelial interactions at the blood-brain barrier. Nat Rev Neurosci. 2006;7:41–53.
Abbott NJ, Patabendige AAK, Dolman DEM, et al. Structure and function of the blood-brain barrier. Neurobiol Dis. 2010;37:13–25.
Nag S, Manias JL, Stewart DJ. Pathology and new players in the pathogenesis of brain edema. Acta Neuropathol. 2009;118:197–217.
Del Bigio MR. Neuropathological changes caused by hydrocephalus. Acta Neuropathol. 1993;85:573–85.
Del Bigio MR. Cellular damage and prevention in childhood hydrocephalus. Brain Pathol. 2004;14:317–24.
Blumbergs P, Reilly P, Vink R. Trauma. In: Love S, Louis DN, Ellison DW, editors. Greenfield’s neuropathology. 8th ed. London: Hodder Arnold; 2008. p. 733–832.
Bruns JJ, Jagoda AS. Mild traumatic brain injury. Mt Sinai J Med. 2009;76:129–37.
Povlishock JT, Katz DI. Update of neuropathology and neurological recovery after traumatic brain injury. J Head Trauma Rehabil. 2005;2:76–94.
Povlishock JT, Becker DP, Cheng CL, Vaughan GW. Axonal change in minor head injury. J Neuropathol Exp Neurol. 1983;42:225–42.
Gavett BE, Stern RA, McKee AC. Chronic traumatic encephalopathy: a potential late effect of sport-related concussive and subconcussive head trauma. Clin Sports Med. 2011;30:179–88.
McKee AC, Gavett BE, Stern RA, et al. TDP-43 proteinopathy and motor neuron disease in chronic traumatic encephalopathy. J Neuropathol Exp Neurol. 2010;69:918–29.
Uryu K, Chen XH, Martinez D, et al. Multiple proteins implicated in neurodegenerative diseases accumulate in axons after brain trauma in humans. Exp Neurol. 2007;208:185–92.
Gorrie C, Oakes S, Duflou J, et al. Axonal injury in children after motor vehicle crashes: extent, distribution, and size of axonal swellings using beta-APP immunohistochemistry. J Neurotrauma. 2002;19:1171–82.
Sherriff FE, Bridges LR, Sivaloganathan S. Early detection of axonal injury after human head trauma using immunocytochemistry for beta-amyloid precursor protein. Acta Neuropathol. 1994;87:55–62.
Smith DH, Chen XH, Iwata A, et al. Amyloid beta accumulation in axons after traumatic brain injury in humans. J Neurosurg. 2003;98:1072–7.
Gennarelli TA. Animate models of human head injury. J Neurotrauma. 1994;11:357–68.
Decker DA, Perry A, Yachnis AT. Vascular and ischemic brain disorders. In: Perry A, Brat D, editors. Practical surgical neuropathology. Philadelphia: Elsevier; 2010. p. 527–50.
Auer RN, Dunn JF, Sutherland GR. Hypoxia and related conditions. In: Love S, Louis DN, Ellison DW, editors. Greenfield’s neuropathology. 8th ed. London: Hodder Arnold; 2008. p. 63–119.
Hazrati LN, Bergeron C, Butany J. Neuropathology of cerebrovascular diseases. Semin Diagn Pathol. 2009;26:103–15.
Vinters HV. Cerebrovascular disease—practical issues in surgical and autopsy pathology. Curr Top Pathol. 2001;95:51–99.
DeGirolami U, Seilhean D, Hauw JJ. Neuropathology of central nervous system arterial syndromes. Part I: the supratentorial circulation. J Neuropathol Exp Neurol. 2009;68:113–24.
Lammie GA. Hypertensive cerebral small vessel disease and stroke. Brain Pathol. 2002;12:358–70.
Schiff D, Lopes MB. Neuropathological correlates of reversible posterior leukoencephalopathy. Neurocrit Care. 2005;2:303–5.
Feske SK. Posterior reversible encephalopathy syndrome: a review. Semin Neurol. 2011;31:202–15.
Thal DR, Griffin WS, de Vos RA, Ghebremedhin E. Cerebral amyloid angiopathy and its relationship to Alzheimer’s disease. Acta Neuropathol. 2008;115:599–609.
Love S, Miners S, Palmer J, et al. Insights into the pathogenesis and pathogenicity of cerebral amyloid angiopathy. Front Biosci. 2009;1:4778–92.
Revesz T, Holton JL, Lashley T, et al. Genetics and molecular pathogenesis of sporadic and hereditary cerebral amyloid angiopathies. Acta Neuropathol. 2009;118:115–30.
Weller RO, Boche D, Nicoll JA. Microvasculature changes and cerebral amyloid angiopathy in Alzheimer’s disease and their potential impact on therapy. Acta Neuropathol. 2009;118:87–102.
Chabarit H, Joutel A, Dichgans M, et al. CADASIL. Lancet Neurol. 2009;8:643–53.
Joutel A, Dodick DD, Parisi JE, et al. De novo mutation in the Notch 3 gene causing CADASIL. Ann Neurol. 2000;47:388–91.
Rhoton Jr AL. Aneurysms. Neurosurgery. 2002;51(4 Suppl):S121–58.
Seibert B, Tummala RP, Chow R, et al. Intracranial aneurysms: review of current options and outcomes. Front Neurol. 2011;2:1–11.
Ducruet AF, Hickman ZL, Zacharia BE, et al. Intracranial infectious aneurysms: a comprehensive review. Neurosurg Rev. 2010;33:37–46.
Al-Shahi R, Bhattacharya JJ, Currie DG, et al. Prospective, population-based detection of intracranial vascular malformations in adults: the Scottish Intracranial Vascular Malformation Study (SIVMS). Stroke. 2003;34:1163–9.
Fleetwood IG, Steinberg GK. Arteriovenous malformations. Lancet. 2002;359:863–73.
Friedlander RM. Clinical practice. Arteriovenous malformations of the brain. N Engl J Med. 2007;356:2704–12.
Labauge P, Denier C, Bergametti F, Tounier-Lasserve E. Genetics of cavernous angiomas. Lancet Neurol. 2007;6:237–44.
Brat DJ, Perry A. Astrocytic and oligodendroglial tumors. In: Perry A, Brat DJ, editors. Practical surgical neuropathology—a diagnostic approach. Philadelphia: Churchill Livingstone/Elsevier; 2010. p. 63–102.
Louis DN, Ohgaki H, Wiestler OD, Cavenee WK. WHO classification of tumours of the central nervous system. Lyon: International Agency for Research; 2007.
Brat DJ, Prayson RA, Ryken TC, Olsen JJ. Diagnosis of glioma: role of neuropathology. J Neurooncol. 2008;89:287–311.
Ohgaki H, Kleihues P. Genetic pathways to primary and secondary glioblastoma. Am J Pathol. 2007;170:1445–53.
Purow B, Schiff D. Advances in genetics of glioblastoma: are we reaching a critical mass? Nat Rev Neurol. 2009;5:419–26.
Nikiforova MN, Hamilton RL. Molecular diagnostics of gliomas. Arch Pathol Lab Med. 2011;135:558–68.
Riemenschneider MJ, Jeuken JW, Wesseling P, et al. Molecular diagnostics of gliomas: state of the art. Acta Neuropathol. 2010;120:567–84.
Phillips HS, Kharbanda S, Chen R, et al. Molecular subclasses of high-grade glioma predict prognosis, delineate a pattern of disease progression, and resemble stages in neurogenesis. Cancer Cell. 2006;9:157–73.
Colman H, Zhang L, Sulman EP, et al. A multigene predictor of outcome in glioblastoma. Neuro Oncol. 2010;12:49–57.
Dunbar E, Yachnis AT. Glioma diagnosis: immunohistochemistry and beyond. Adv Anat Pathol. 2010;17:187–201.
Aldape K, Burger PC, Perry A. Clinicopathologic aspects of 1p/19q loss and the diagnosis of oligodendroglioma. Arch Pathol Lab Med. 2007;131:242–51.
Gianinni C, Burger PC, Berkey BA, et al. Anaplastic oligodendroglial tumors: refining the correlation among histopathology, 1p 19q deletion and clinical outcome in Intergroup Radiation Therapy Oncology Group Trial 9402. Brain Pathol. 2008;18:360–9.
Jenkins RB, Blair H, Ballman KV, et al. A t(1;19)(q10;p10)mediates the combined deletions of 1p and 19q and predicts a better prognosis of patients with oligodendroglioma. Cancer Res. 2006;66:9852–61.
Yan H, Parsons DW, Jin G, et al. IDH1 and IDH2 mutations in gliomas. N Engl J Med. 2009;360:765–73.
Houillier C, Wang X, Kaloshi G, et al. IDH1 or IDH2 mutations predict longer survival and response to temozolomide in low-grade gliomas. Neurology. 2010;75:1560–6.
Capper D, Weibert S, Balss J, et al. Characterization of R132H mutation-specific IDH1 antibody binding in brain tumors. Brain Pathol. 2010;20:245–54.
Perry A. Meningiomas. In: Perry A, Brat DJ, editors. Practical surgical neuropathology—a diagnostic approach. Philadelphia: Churchill Livingstone/Elsevier; 2010. p. 185–217.
Lohmann CM, Brat DJ. A conceptual shift in the grading of meningiomas. Adv Anat Pathol. 2007;7:153–7.
Perry A, Scheithauer BW, Stafford SL, et al. “Malignancy” in meningiomas: a clinicopathological study of 116 patients with grading implications. Cancer. 1999;85:2046–56.
Scheithauer BW, Woodruff JM, Spinner RJ. Peripheral nerve sheath tumors. In: Perry A, Brat DJ, editors. Practical surgical neuropathology—a diagnostic approach. Philadelphia: Churchill Livingstone/Elsevier; 2010. p. 235–85.
Yachnis AT, Perry A. Embryonal (primitive) tumors of the central nervous system. In: Perry A, Brat D, editors. Practical surgical neuropathology. Philadelphia: Elsevier; 2010. p. 165–84.
Parsons DW, Li M, Zhang X, et al. The genetic landscape of the childhood cancer medulloblastoma. Science. 2011;331:435–9.
Dunham C. Pediatric brain tumors: a histologic and genetic update on commonly encountered entities. Semin Diagn Pathol. 2010;27:147–59.
Frohman EM, Racke MK, Raine CS. Multiple sclerosis—the plaque and its pathogenesis. N Engl J Med. 2006;354:942–55.
Love S. Demyelinating diseases. J Clin Pathol. 2006;59:1151–9.
Schmidt RE. White matter and myelin disorders. In: Perry A, Brat DJ, editors. Practical surgical neuropathology—a diagnostic approach. Philadelphia: Churchill Livingstone/Elsevier; 2010. p. 485–513.
Trapp BD, Peterson J, Ransahoff RM, et al. Axonal transaction in the lesions of multiple sclerosis. N Engl J Med. 1998;338:278–85.
Moore GR. Current concepts in the neuropathology and pathogenesis of multiple sclerosis. Can J Neurol Sci. 2010;37:S5–15.
Jarius S, Wildemann B. AQP4 antibodies in neuromyelitis optica: diagnostic and pathogenetic relevance. Nat Rev Neurol. 2010;6:383–92.
Marignier R, Giraudon P, Vukusic S, et al. Anti-aquaporin-4 antibodies in Devic’s neuromyelitis optica: therapeutic implications. Ther Adv Neurol Disord. 2010;3:311–21.
White MK, Khalili K. Pathogenesis of progressive multifocal leukoencephalopathy—revisited. J Infect Dis. 2011;203:578–86.
Johnson T, Nath A. Immune reconstitution inflammatory syndrome and the central nervous system. Curr Opin Neurol. 2011;24:284–90.
Hellwig K, Gold R. Progressive multifocal leukoencephalopathy and natalizumab. J Neurol. 2011;258(11):1920–8.
Kleinschmidt-DeMasters BK, Tyler KL. Infections and inflammatory disorders. In: Perry A, Brat DJ, editors. Practical surgical neuropathology—a diagnostic approach. Philadelphia: Churchill Livingstone/Elsevier; 2010. p. 455–84.
Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial meningitis in the United States, 1998–2007. N Engl J Med. 2011;21:2016–25.
Edberg M, Furebring M, Sjölin J, Enblad P. Neurointensive care of patients with severe community-acquired meningitis. Acta Anaesthesiol Scand. 2011;55:732–9.
Honda H, Warren DK. Central nervous system infections: meningitis and brain abscess. Infect Dis Clin North Am. 2009;23:609–23.
Walker M, Zunt JR. Parasitic central nervous system infections in the immunocompromised host. Clin Infect Dis. 2005;40:1005–15.
Love S, Wiley CA. Viral infections. In: Graham DI, Lantos PL, editors. Greenfield’s neuropathology. 8th ed. London: Hodder Arnold; 2008. p. 1105–15.
Del Valle L, Pina-Oviedo S. HIV disorders of the brain: pathology and pathogenesis. Front Biosci. 2006;11:718–32.
Norrby E. Prions and protein folding diseases. J Intern Med. 2011;270:1–14.
Harris J, Chimelli L, Kril J, Ray D. Nutritional deficiencies, metabolic disorders, and toxins affecting the nervous system. In: Graham DI, Lantos PL, editors. Greenfield’s neuropathology. 8th ed. London: Hodder Arnold; 2008. p. 675–731.
Harper C. The neuropathology of alcohol-related brain damage. Alcohol Alcohol. 2009;44:136–40.
Rahman M, Friedman WA. Hyponatremia in neurosurgical patients: clinical guidelines development. Neurosurgery. 2009;65:925–35.
Lowe J, Mirra SS, Hyman BT, Dickson DW. Ageing and dementia. In: Graham DI, Lantos PL, editors. Greenfield’s neuropathology. 8th ed. London: Hodder Arnold; 2008. p. 1105–15.
Berg L, McKeel DW, Miller P, et al. Clinicopathologic studies in cognitively healthy aging and Alzheimer disease. Relation of histologic markers to severity, age, sex, and apolipoprotein E genotype. Arch Neurol. 1998;55:326–35.
Sonnen JA, Larson EB, Crane PK, et al. Pathological correlates of dementia in a longitudinal, population-based sample of aging. Ann Neurol. 2007;62:406–13.
Jellinger KA, Attems J. Prevalence and impact of cerebrovascular pathology in Alzheimer disease and parkinsonism. Acta Neurol Scand. 2006;114:38–46.
Mirra SS. The CERAD neuropathology protocol and consensus recommendations for the postmortem diagnosis of Alzheimer disease: a commentary. Neurobiol Aging. 1997;18:S91–4.
Braak H, Braak E. Neuropathological staging of Alzheimer-related changes. Acta Neuropathol. 1991;82:239–59.
Leverenz J, McKeith I. Dementia with Lewy bodies. Med Clin North Am. 2002;86:519–35.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag London
About this chapter
Cite this chapter
Yachnis, A.T. (2013). Introduction to Basic Neuropathology. In: Layon, A., Gabrielli, A., Friedman, W. (eds) Textbook of Neurointensive Care. Springer, London. https://doi.org/10.1007/978-1-4471-5226-2_6
Download citation
DOI: https://doi.org/10.1007/978-1-4471-5226-2_6
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-5225-5
Online ISBN: 978-1-4471-5226-2
eBook Packages: MedicineMedicine (R0)