CNS Patho I Flashcards
Gimme 4 Major Clinical Presentations of CNS diseases
- suggest some causes too
- Note that things can give multiple presentations, not confined to 1
Raised ICP
- tumor, infection, vascular causes
Localizing Signs, SOL
- eg Sudden Hemiparesis
Progressive Neurodegeneration
- AD, PD;
Demyelinating Diseases
- White matter disease
Localizing Signs sub-presentations [2]
Acute, Sudden
- vascular, infraction
Subacute, Gradual
- tumours, infection
Raised ICP sub-presentations and causes
Can be
Diffuse
- infractions, vascular
- due to Oedema (infection, hemorrhage)
- Hydrocephalus;
Localized SOL
- by tumor, abscess infections
What is Hydrocephalus and descriptive causes
2 Types and definitions;
Hydrocephalus increase in CSF in CNS
- increased production
- decreased drainage
- obstruction/ flow problems
Communicating
- production, absorption, poor drainage
- poor absorption maybe problem w Arachnoid granulations - from SAS to Venous sinus
- but Ventricles and Subarachnoid space full communication;
Non-communicating
- Obstruction
- Meaning: ventricular system and Subarachnoid Space obstruction - maybe by SOL
Give causes of Communicating and Non communicating Hydrocephalus
and whats the Cx?
Communicating
- Arachnoid villi affected
- Possible SAH, Meningitis
Non-communicating - Obstructive
- SOL, Mass lesions, tumors, hematoma
- Meningitis, Scarring - blocks outflow of ventricles;
- Possible congenital malformations, Arnold Chiari
- – Chiari malformation (CM) is a structural defect in the cerebellum, characterized by a downward displacement
Cx: Raised ICP;
How could RICP be presented clinically?
- Cx [1]
N&V, Headache
- Papilledema! through fundoscopy
- sees optic disc SWELLING
Cx: Cerebral Herniation
Recall LP contraindicated in raised ICP due to risk of brain matter being compressed and pushed toward the spine; Coning;
- also optic disc CUPPING is due to glaucoma
Cerebral Herniation locations and Cx
[Think major meningeal folds in brain where it can sQuEEZE]
Falx Cerebri - Subfalcine herniation
- ACA compressed
Tentorium Cerebelli - Uncal/ Transtentorial; temporal lobe through TC;
- PCA compressed;
FORAMEN MAGNUM - CONING of cerebellar tonsils;
- this compresses lower brainstem and upper cervical cord;
- compression of BS, pons, medulla - respiratory depression - reticular formation for breathing;
- neck stiffness;
CVD 2 Fat processes;
Ischemic CVD
- thrombus, emboli, atherosclerosis (focal block)
- hypoperfusion (global VOLUME)
Hemorrhagic CVD
- AVM, rupture, aneurysm;
Describe stroke
CVA:
- CVD, vascular cause, acute onset, transient ischemia, brain necrosis
Stroke clinical symptoms
RICP - from hemorrhage (diffuse/localized RICP)
Localizing SIGNS- hemiparesis;
Severe headache - rupture of vessels
Stroke Risk Factors
CVS risk factor
- diabetes
- Hypertension, Hyperlipidemia
- Hypertension can cause ischemic stoke + hemorrhage stroke through rupture but less common;
- Hypercoagulability - thrombosis
- Coagulopathy - hemorrhage
Heart failure - Hypo perfusion
- AF
Congenital Vascular Malformation - hemorrhage
How would Global Hypoperfusion and Focal Cerebral Ischemia PRESENT AS
- think location and pathogenesis
Global Hypo-perfusion can cause Watershed infractions
- between ACA and MCA, cortical necrosis
- Watershed areas most vulnerable to hypoperfusion ischemia
FCI causes Infraction
- Pale Infraction
- Hemorrhagic infraction - Red infractions
FCI Pale vs Red infractions
- whats the distinction clinically
Pale infractions caused by
- Artery thrombosis, /vasculitis/
- Atherosclerosis;
Red infractions caused by
- Venous thrombosis
- Emboli, any emboli, tumor, fat
- emboli from AMI possible;
Clinically: Hemorrhagic infracts dont give Thrombolytics cos already bleeding;
Distinct morphologically presentations of Ischemic Infraction
- Gross and Histology
- think cells involved
- 2 days vs after 2 days;
Gross:
2 Days: Soft/Pale, indistinct Corticomedullary Junction
>2 Days: Friable, gelatinous
> 10 Days: Liquefactive necrosis;
NO FIBROSIS
Histology:
- oedema, neutrophils within 2 days
- after 2 days: Think Neuroglial!!!
- Macrophages, GLIOSIS , proliferation of Astrocytes, Microglia, Oligodendrocytes
- RED NEURONES - ischemic neuronal change; (MORE) eosinophilic - loss of Nissl bodies which should stain blue
Gliosis is a nonspecific reactive change of glial cells in response to damage to the central nervous system (CNS).
Haemorrhagic Stroke causes
- gimme examples, especially hypertension
Rupture
- Hypertension - think smaller arteries;
- – Small Blood vessels think Charcot–Bouchard aneurysms, associated w HT
- Malformations, structural abnormalities;
- AVM, Berry Aneurysms
- —- seen in younger Px;
- Cerebral Amyloid Angiopathy - amyloid deposition, weakening walls; - more older Px
- Coagulopathy;
