Cerebral Pathology

Question 1

What is an infarction? What % of strokes are due to infarction? What is the main cause for it?

Answer 1

Tissue death due to lack of O2, 70-80%
Cerebral atherosclerosis (others include embolism from intr/extra cranial plaques)

Question 2

Risk factors for strokes/ TIAs (8)

Answer 2

Same as for formation of atheroma: smoking, DM, OCP, past TIA, FH, alcohol excess, hyperviscosity e.g. polycythaemia, sickle cell anaemia

Question 3

Signs & symptoms of stroke (4)

Answer 3

Sudden onset
FAST - face dropping, Arms, Speech, (time to call)
numbness, loss of vision, dysphagia (depends on territory))

Question 4

Vascular territories commonly affecte in stroke (2)

Answer 4

Anterior vs post territry, commonest = MCA

Question 5

Investigations for stroke (4)

Answer 5

CT/ MRI = find out if haemorrhagic or infarct

IX for vascular risk - BP, FBC, ESR, CxR. ECG, carotid doppler

Question 6

Management of stroke (4)

Answer 6

Aspirin +/- dipyridamole (PDE inhibitor that breaks down cAMP > preventing plt aggregation)
Thrombolytics if

Question 7

Signs & symptoms of TIA (2)

Answer 7

Last

Question 8

Vascular territories affected

Answer 8

Any - usually embolic atherogenic debris from the carotid artery travels to the opthalmic branch of internal carotid

Question 9

Investigations for TIA

Answer 9

Carotid US

Ix for vascular risk - BP, FBC, ESR, glu, lipids, CXR, ECG, carotid doppler

Question 10

Management for TIA

Answer 10

Exactly the same as for stroke, except dont give thrombolytics
Aspirin +/- dipyridamole
+/- carotid endarterectomy
Long term - treat HTN, reduce lipis, anticoag

Question 11

Non traumatic types of haemorrhages (2)

Answer 11

Intraparenchymal

SAH

Question 12

Characteristics of Intraparenchymal haemorrhages (3)

Answer 12

50% due to HTN
abrupt onset, can cause CHARCOT-BOUCHARD microaneurysms (likely to rupture)
Common site - basal ganglia

Question 13

Characteristics of SAH - main cause, gender, symptoms (5)

Answer 13

85% from ruptured berry aneurysms - most at internal carotid bifurcation
F>M usually

Question 14

SAH associations (6)

Answer 14

PKD
Pts with aortic coarctation
Ehler’s Danlos
Vascular abnormalities - AV malformations, capillary telengactasia, venous & cavernous angiomas

Question 15

Traumatic types of haemorrhage (3)

Answer 15

Extradural haemorrhage
Subdural haemorrhage
Traumatic parenchymal injury

Question 16

Extradural haemorrhage characteristics (3)

Answer 16

Skull fracture > ruptured middle meningeal artery > rapid arterial bleed - lucid interval then LOC

Question 17

Subdural haemorrhage characteristics (4)

Answer 17

Prev history of minor trauma > damaged bridging veins with slow venous bleed.
Elderly/ alcoholic
associated with brain atrophy, fluctuating consciousness

Question 18

Traumatic parenchymal injuries: concussion, diffuse axonal injury, contusion. Characteristics

Answer 18

Concussion - Transient LoC + paralysis, recovery in hours/ days
Diffuse axonal injury - vegetative state post traumatic dementia
Contusions - brain contacts the skull +/- fracture
Coup - where impact occur - contracoup is opposite to region of impact

Question 19

Increased ICP causes (3)

Answer 19

Oedema
SOL
Both > herniation

Question 20

Systemic symptoms of bacterial meningitis (4)

Answer 20

Marked systemic symptoms:

rash, drowsy, fever, septic shock, coma

Question 21

Systemic symptoms of viral meningitis (2)

Answer 21

Mild systemic symtoms:

not unwell, rash unusual

Question 22

Meningism features (4)

Answer 22

Headache
photophobia
stiff neck
Kernig’s sign +ve

Question 23

CSF characteristics with a viral infection: appearance, predominant cell, glucose (40-90), protein (15-45), bacteria

Answer 23

Clear usually
Lymphocytes
Normal > 40
normal or slightly elevated but

Question 24

CSF characteristics with a TB infection: appearance, predominant cell, glucose (40-90), protein (15-45), bacteria

Answer 24

FIBRIN web
Lymphocytes
Reduced

Question 25

CSF characteristics with a pyogenic infection: appearance, predominant cell, glucose (40-90), protein (15-45), bacteria

Answer 25

Turbid Neutrophils reduced 250 bacteria seen in smear and culture

Question 26

Causative bacterial pathogens of cerebral infection in neonates (3)

Answer 26

GBS E. Coli Listeria

Question 27

Causative viral pathogens of cerebral infection in neonates (4)

Answer 27

Echovirus Coxsackie's virus Mumps virus HIV

Question 28

Causative bacterial pathogens of cerebral infection in 1 month to 6 yrs (1)

Answer 28

Strep. Pneumonia (haemophilus influenza)

Question 29

Causative bacterial pathogens of cerebral infection in young adults + adoloscents (2)

Answer 29

Strep. Pneumoniae | Neisseria Meningitidus

Question 30

Causative bacterial pathogens of cerebral infection in Elderly (2)

Answer 30

Strep. Pneumoniae | Gram -ve bacilli e.g. E. Coli

Question 31

Causes of viral encephalitis (2)

Answer 31

HSV 1 | Rabies

Question 32

Symptoms of viral encephalitis (4)

Answer 32

Drowsiness, seizures behavioural change headache, fever

Question 33

Brain tumours are most commonly primary or secondary?

Answer 33

Secondary mets; most commonly from lung, breast, malignant melanoma

Question 34

Characteristics of brain tumours (3)

Answer 34

Well demarcated solitary/ multiple with surrounding oedema

Question 35

Primary tumours originating in the brain, spinal cord or meninges commonly metastasize outside CNS. T or F?

Answer 35

F

Question 36

Commonest group of primary brain tumours?

Answer 36

Astrocytomas

Question 37

``` Buzz words to identify brain tumours: NF2 Ventricular tumour, hydrocephalus Indolent, childhood Soft, gelatinous, calcified ```

Answer 37

Meningoma ependymoma Pilocytic astrocytoma Oligodendroma