CNS pathology Flashcards by Andy Lai

MC cause and type of head injury

Falls
Deacceleration injury

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What is raccoon eye and Battle sign? What do they indicate respectively?

Raccoon eye: periorbital ecchymosis ==> anterior cranial fossa fracture
Battle sign: retromastoid ecchymosis ==> petrous temopral bone fracture

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Glasgow Coma Scale (associated mortality)

= assessment of impaired consciousness level in response to defined stimuli to determinen severity of head injury

Eye opening response (4): spontaneous –> to speech –> to pain –> none

Verbal response (5): orientated –> confused –> inappropriate words –> incomprehensible sounds –> none

Motor response (6): obey commands –> localization to pain –> normal flexion to pain –> abnormal flexion to pain –> extension to pain –> none

> =14: minor severity (0.4%)
9~13: moderate severity (5%)
<=8: severe severity (45%)

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Types of skull fractures (4)

Linear fracture
Depressed fracture
Basilar fracture
Diastatic fracture

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Types of brain parenchymal injury

Contusion (coup or countercoup)
Laceration
Diffuse axonal injury

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Types of brain traumatic vascular injury (which is MC?) (What are the vessels involved?)

Epidural haematoma: middle meningeal artery
Subdural haematoma (MC): bridging vein between dura & arachnoid membrane
Cerebral / contusional haematoma: intracerebral vessels

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Difference in CT between epidual and subdural haematoma

lens-shaped, limited by suture lines
crescent-shaped, cross suture lines

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Involvement of which spinal level will lead to respiratory compromise in spinal injury?

C4 or above

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2 types of cerebral oedema and pathogenesis

vasogenic oedema: malignancy / infection –> BBB diruption & ↑ vascular permeability

cytotoxic oedema: generalised hypoxia / ischaemic insult –> neuronal / glial cell injury –> cellular swelling

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Cushing triad

sinus bradycardia, hypertension, irregular breathing

==> ↑ ICP

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Signs of ↑ ICP

papilledema
headache, projectile vomiting without nausea
Cushing triad

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4 types of herniation (herniated structure)

Subfalcine (cingulate gyrus)
Uncal (uncus)
Central (bilateral uncus)
Tonsilar (cerebellar tonsils)

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Results of uncal herniation

[CN3] ipsilateral pupil dilation
[cerebral peduncle] hemiplegia
[midbrain] coma

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Results of tonsillar herniation

[medulla] respiratory arrest, BP instability
[cerebellum] cerebellar signs

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Brain tumours predominantly found in children (3)

pilocytic astrocytoma
ependymoma
medulloblastoma

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Benign brain tumours (3)

pilocytic astrocytoma
meningioma
Schwannoma

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What are the brain tumours?

Glioma
1. Glioblastoma multiforme
2. Diffuse astrocytoma
3. Pilocytic astrocytoma
4. Oligodendroglioma
5. Ependymoma

Extra-axial tumours
1. Meningioma
2. Schwannoma
3. Pituitary adenoma

Other primary tumours
1. Medulloblastoma
2. Primary CNS lymphoma
3. CNS germinoma

Metastasis
1. Cerebral
2. Leptomeningeal

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MC brain tumour in adult (what is the origin)

Glioblastoma multiforme
(astrocytes)

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Common site and the respective gross pathology of glioblastoma

Corpus callosum (butterfly lesion)

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Pathology of glioblastoma multiforme (4)

necrosis, endothelial proliferation, markedly pleomorphic cells, contrast ring-enhancement in CT/MRI

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Median survival of glioblastoma multiforme with treatment

15 months

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MC spinal cord tumour

Ependymoma

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Site of medulloblastoma

vermis of cerebellum

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Common site of CNS germinoma

pineal gland

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MC sources of brain metastasis (3)

lungs, breasts (long latent period), colorectal

Brain tumour with diffuse infiltration, fibrillary matrix, and thus incurable by surgery

Diffuse astrocytoma

Brain tumour with cystic lesion, with mural nodule and spindle cells

Pilocytic astrocytoma

Brain tumour with calcifications, clear vacuolated cells (fry egg cell), branching vessels

Oligodendroglioma

Brain tumour with whorls, psammoma, calcifications

Meningioma

Brain tumour with rosettes

Medulloblastoma

What is lacunar infarct?

small infarcts (<15mm) at deep grey / white matter of the brain

Causes of global ischaemia of the brain (Which area is the most vulnerable?)

circulatory collapse, severe hypoglycaemia, epilepsy (Hippocampus)

Pathology of brain ischaemia

Gross: acute swelling +/- herniation --> liquefactive necrosis Microscopy: [early] red neurons, acute inflammation (neutrophils, oedema), shrinking & karyolysis of neurons [late] microglial cells with haemosiderin, liquefaction, glial fibres

MC site and MC cause of cerebral haemorrhage

basal ganglia hypertension

MC cause of lobar haemorrhage (which disease is it associated with?)

cerebral amyloid angiopathy Alzheimer's disease

Causes of Berry aneurysm

hypertension, connective tissue disease, structural defects

Sites of Berry aneurysm (4)

Anterior communicating artery (MC) MCA bifurcation Terminal ICA Basilar artery bifurcation

Risk factors for sporadic type of Alzheimer's disease

age multiple trauma DM apoE4

Genes for familial early-onset type of Alzheimer's disease

APP on chromosome 21 (related to Down's syndrome) PS1, PS2

MC site of pathology in Alzheimer's disease

hippocampus

Pathogenesis of Alzheimer's disease

1. abnormal cleavage of amyloid precusor protein (APP) --> polymerisation of Aβ42 peptides --> large aggregates (neuritic plaque) 2. hyperphosphorylation of tau protein --> tangle formation (neurofibrillary tangles)

Which protein is involved in the neuronal inclusions in a. Parkinson's disease? b. Fronto-temporal dementia (FTD)?

a. lewy bodies, tau b. TDP-43, tau

Which dementia presents with behaviour and language preceding memory loss?

fronto-temporal dementia (FTD)

Creutzfeldt-Jakob disease

Prion disease

Which disease is related to Gower's sign, calf pseudohypertrophy, cardiomyopathy? (heritance)

Duchenne / Becker muscular dystrophy (X-linked)

Floppy baby syndrome is the infantile presentation of which disease?

Spinal muscular atrophy

Histology is only useful in which two endocrine cancers to determine malignancy?

papillary thyroid carcinoma, neuroblastoma

1st and 2nd MC pituitary adenoma

Prolactinoma, Null cell adenoma

Size limit in pituitary adenoma to differentiate between macroadenoma and microadenoma

1cm

Pathology of pituitary adenoma (4)

- foci of haemorrhage - cellular monomorphism - lack of reticulin network - may infiltrate adjacent bone, dura

Aetiology of goitre (4)

- TSH (e.g. iodine deficiency) - Graves' disease - Thyroiditis - Neoplasm

Post-thyroidectomy monitoring (3)

- Neck USG - TSH & thyroglobulin

Pathogenesis of Hashimoto's thyroiditis (2)

anti-TSH-R Ab CD8+ T cells mediate killing

Genetic association with Hashimoto's thyroiditis

HLA-DR3, DR5

Pathology of Hashimoto's thyroiditis (3)

- atrophic thyroid follicles - infiltration of lymphocytes & plasma cells - abundant Hurthle cells

Genetic association of Graves' disease

HLA-DR3

Pathology of Graves' disease (2+2)

[thyroid] diffuse hyperplasia of thyroid epithelium, T-cell infiltration [orbital tissue / skin] T-cell infiltration, ↑ ECM components

MC thyroid carcinoma

Papillary thyroid carcinoma

Which thyroid carcinoma orginates from para-follicular C cells?

Medullary thyroid carcinoma

Which thyroid carcinoma spread via blood only?

Follicular thyroid carcinoma

Genes for papillary thyroid carcinoma (3)

BRAF, RET, RAS

Gene for follicular thyroid carcinoma

PAX8/PPARγ1 fusion

Gene for anaplastic thyroid carcinoma

TP53

Gene for medullary thyroid carcinoma

RET [MENII]

Which thyroid carcinoma has very poor prognosis?

anaplastic thyroid carcinoma

Pathology of papillary thyroid carcinoma (6)

- multi-focal, non-encapsulated - Nuclear size and shape: nuclear enlargement, elongation, overlapping - Chromatin: Ophan Annie nucleus - Nuclear membrane: irregular contour, nuclear groove, nuclear pseudoinclusion - Architecture: papillary / follicular - Others: Psammoma bodies

Pathology of follicular thyroid carcinoma

focal, encapsulated (cannot be distinguished from follicular adenoma without signs of invasion)

Pathology of anaplastic thyroid carcinoma

small blue round cells

Pathology of medullary thyroid carcinoma

amyloid deposits

Triple assessment for thyroid gland

TFT, USG, FNAC

Framework for follow-up of thyroid nodule

Bethesda system

Sources of metastatic thyroid cancer (2)

RCC, breast

MC endocrine disorder in adult

Hyperparathyroidism

Familial syndrome associating with parathyroid hyperplasia

MEN1, MEN2a

Genes (2) associated with hyperparathyroidism

PRAD1, MEN1

What is pseudohypoparathyroidism?

(AD) PTH resistance

Pathology of adrenal cortex in exogenous cushing syndrome

adrenal atrophy sparing zona glomerulosa

Pathology of adrenal cortex in Cushing disease

bilateral adrenal hyperplasia, yellow thick cortex

Which is the "10% tumour"? Explain (4)

Phaeochromocytoma. 10% bilateral, extra-adrenal, malignant, secrete adrenaline/ dopamine

Familial syndrome related to phaeochromocytoma

MENII, von Hippel-Lindau syndrome, NF1

Pathology of phaeochromocytoma (2)

Zellballen pattern, rich vascularity

What is the only criteria of malignancy for phaeochromocytoma?

Distant metastasis

Pathology of neuroblastoma

SBRCT

MEN1 syndrome (gene, 3 associated tumours)

MEN1, parathyoid, pancreas, pituitary

MEN2A syndrome (gene, 3 associated tumours)

RET, MTC, adrenal medulla, parathyroid

MEN2B syndrome (gene, 3 associated tumours)

RET, medullary thyroid carcinoma, adrenal medulla, extra-endocrine

MC SOL in head injury

Subdural haematoma

Autopsy findings in ↑ ICP (6)

flattened gyri, narrowed sulci midline shift obliterated ventricles herniation, commpression of brainstem cerebral ischaemia cerebral oedema

Types of intracranial haemorrhage

Epidural haematoma Subdural haematoma Subarachnoid haemorrhage Cerebral haemorrhage

Which intracranial haemorrhage is assoicated with lucid interval (~1 hour)?

Epidural haemorrhage

What is leukoaraiosis? Which disease does it imply? How does it present on imaging?

demyelination of white matter, esp. in the periventricular region Binswanger disease (subcortical ischaemic vascular dementia) periventricular radiolucency

What is neuritic plaque and neurofibrillary tangles? How to stain them (2)?

Extracellular amyloid core, surrounded by neurites (irregular twisted axons) Intracellular tau-containing filaments IHC or silver stain

CNS pathology Flashcards

(92 cards)