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SBCP Pathology > CNS: Revision > Flashcards

CNS: Revision Flashcards

1
Q

What are the neuroglia?

A

Non-neuronal and non excitable support cells

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2
Q

3 kinds of the macroglial cells?

A

Oligodendrocytes (wrap around axons and form myelin sheathes)

Astrocytes (metabolic buffers, detoxifiers, insulation, repair and scarring)

Empendymal cells (CSF production)

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3
Q

What are the microglia of the CNS?

A

Fixed macrophage system within the CNS

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4
Q

What is on outside of brain, grey or white matter?

A

Grey matter

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5
Q

Name the layers of the meninges

A 
Dura mater
Arachnoid mater
Subarachnoid space
Arachnoid mater
Pia mater
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6
Q

Regulatory centres in the brainstem? (7)

A 
Vomiting
Swallowing
Respiratory
Urinary bladder control
Pneumotaxic
Cardiac acceleration
Cardiac slowing
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7
Q

What produces CSF?

A

Choroid plexus of the lateral third and fourth ventricles

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8
Q

Where does CSF travel to

A

Exits ventricular system through the foramina of Luschka and Magendie, into the subarachnoid space.

From here, descends into spine or ascends to bath the brain

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9
Q

What drains the CSF?

A

Superior sagittal sinus

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10
Q

Normal volume of CSF?

A

120ml, changed 3-5 times a day

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11
Q

What is the most common form of acute hydrocephalus?

A

Obstructive hydrocephalus, where there is obstruction to flow of CSF

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12
Q

What may cause obstructive hydrocephalus? (4)

A

Previous meningitis

Tumours of the posterior fossa or the brainstem (blocks the fourth ventricle)

Tumours of the third ventricle eg colloid cysts, are a well known cause and can lead to sudden death

Congenital causes eg CHirari malformation

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13
Q

What is a Chiari malformation?

A

Defect in the posterior fossa or cerebellum causes blockage of CSF flow at the foramen magnum

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14
Q

What is hydrocephalus ex Vacuo?

A

A COMPENSATORY increase in CSF seen in certain dementia. There is ventricular enlargement due to loss of brain parenchyma.

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15
Q

Gross changes to the brain with hydrocephaly?

A

Dilation of the ventricles

Corresponding decrease in white matter

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16
Q

Normal intracranial contents attributing to pressure?

A

Brain- 70%
CSF 15%
Blood 15 %

17
Q

Causes of raised ICP (4)

A

Mass effect:

  • Tumours
  • Abscess
  • Infarction
  • Haemorrhage
18
Q

Clinical features of raised ICP (8)

A

Dizziness
Headache
Vomiting

Confusion
Focal neurological signs (paralysis, hemianopia, dysphasia)

Papilloedema
Seizure
Decreased consciousness

19
Q

Four stages of raised ICP

A
  1. SPATIAL COMPENSATION by reduction in blood flow or brain
  2. ICP rises as COMPENSATION IS EXHAUSTED: Systemic arterial pressure may correspondingly increase
  3. ICP rises rapidly as cerebral perfusion decreases
  4. CEREBRAL VASOMOTOR PARALYSIS where ICP=SAP and cuts off blood supply
20
Q

What is the 4th stage of rasied ICP?

A

Cerebral vasomotor paralysis as ICP=SAP and cuts off blood supply

21
Q

If the lesion causes ICP to raise at a high rate, how does this affect mortality compared to slower rate?

A

No set pressure where death occurs

Higher rate will exhaust compensatory mechanisms quicker

22
Q

How does a raised ICP affect the brain grossly? (4)

A

Flattening of gyral pattern

Compression of ventricle on same side as lesion

Lateral shift of midline structures if the lesion is unilateral

Internal hernation

23
Q

What is a subfalcine herniation?

A

When cingulate gyrus herniates under Falx Cerebri

24
Q

What is an uncal hernation? What nerve is compressed?

A

Brain herniates through the tentorial incisura

Compresses CNIII

Posterior artery compression

Haemorrhage in midbrain and pons

25
Q

What artery is compressed in uncal herniation?

A

Posterior cerbral

26
Q

What is a tonsillar herniation?

A

Cerebellar tonsils herniate down the foramen magnum leading to brainstem compression

27
Q

What is vasogenic oedema?

A

A type of cerebral oedema where the integrity of the normal BBB is disrupted.

Can be local (eg due to abcess, tumour, infarct) or generalised (sepsis)

28
Q

What is cytotoxic oedema?

A

A type of cerebral oedema where the is an increase in INTRACELLULAR fluid secondary to hypoxia or ischaemia

29
Q

What is interstitial oedema?

A

A type of cerebral oedema that is due to increased water content within the peri-ventricular tissues

Occurs in acute hydrocephalus

30
Q

Treatment for cerebral oedema

A

Steroids for inflammation or tumour

Surgery for haemorrhage

SBCP Pathology (24 decks)

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