Crash course: Neuro Flashcards by Georgia Leggett

What are the 6 components of the brain?

4 lobes: Frontal, temporal, parietal, occipital
Cerebellum
Brainstem

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Frontal lobe

Thinking
Memory
Behaviour
Movement

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Temporal lobe

Hearing
Learning
Feelings

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Parietal lobe

Language
Touch

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Occipital lobe

Sight

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Cerebellum

Balance
Coordination

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Brainstem

Breathing
HR
Temperature

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What is a stroke?

focal neurological deficit of presumed vascular origin that lasts > 24h

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What is a TIA?

focal neurological deficit of presumed vascular origin that resolves within 24h

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What are the 2 types of stroke? What is the prevalence of each?

Ischaemic 80%

Haemorrhage 20%

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Give 4 causes of ischaemic stroke

ATHEROSCLEROSIS
Thromboembolic e.g. AF
Diabetes
Vasculitis

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Give 4 causes of haemorrhage stroke

HTN
AV malformation (<50s)
Cavernous angiomas (recurrent low pressure bleed)
Subarachnoid haemorrhage

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What is the single most important modifiable factor (and cause) for both haemorrhage an ischaemic strokes?

HTN

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What is the difference between ischaemia and infarction?

Ischaemia: lack of O2 supply to tissue

Infarction: death of tissue due to lack of O2 supply

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What are the 2 broad aetiologies haemorrhagic stroke?

Traumatic: extradural or subdural haemorrhage

Non traumatic: Intraparenchymal or SAH

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Where do Intraparenchymal haemorrhages usually occur? What causes them?

Basal ganglia

Vessel rupture due to HTN

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What is the main cause of subarachnoid haemorrhage? Where does this occur?

Ruptured berry aneurysms

Posterior communicating artery
or
Bifurcation of internal carotid

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What is the classic history of a patient with SAH?

Bilateral abdominal masses
FH of brain bleeds
(a/w Polycystic kidney disease)

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What can be seen on CT in SAH? (buzzword/ phrase)

Hyperattenuation around the Circle of Willis

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If NAD on CT head, what further investigation can be performed for SAH? What will be seen?

LP at 12h:
Xanthochromia + oxyhaemoglobin

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What causes extradural haemorrhage? What is the pathophysiology?

Fracture of pterion caused by trauma (e.g. RTA, punch to temples)

Rupture of middle meningeal artery

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What buzzword describes extradural haemorrhage on CT?

“lemon” shape

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What causes subdural haemorrhage? What is the pathophysiology?

Hx of minor head trauma

Rupture of bridging veins leading to collection of blood between dura + arachnoid mater

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Give 4 risk factors for subdural haemorrhage

Alcoholics
Anti-coagulations
Elderly
NAI

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What buzzword describes subdural haemorrhage on CT?

“Banana” shape Crescent shape

What is the single largest cause of death in <45s?

Traumatic brain injury

Give 4 red flags of TBI

Otorrhoea Rhinorrhoea “Straw-coloured” fluid (CSF) from nose or ears Battle’s sign

What are the 2 types of TBI?

Diffuse axonal injury Contusion (more common)

What is diffuse axonal injury?

shear tensile forces tearing axons apart in midline structures (Corpus callosum, rostral brainstem + septum pellucidum)

What is the commonest cause of traumatic coma?

Diffuse axonal injury

What is a contusion? What are the 2 types?

collision between brain + skull Coup: impact of brain on skull Countercoup: injury to opposite side of brain

What is the most common cell type in the brain? What is the most common tumour type in the brain?

Astrocytes Astrocytomas

What are primary brain tumours? What are 2 subtypes?

Originate within CNS Extra-axial: Cranium, soft tissue, meninges, nerves Intra-axial: glia, neurons, neuroendocrine cells

What are secondary brain tumours? (4)

Mets from other parts of body Commonest form of brain tumour Well demarcated, solitary nodules Poor prognosis

Which 3 cancers metastasise most commonly to the brain?

Lung Skin Breast

Give 3 genetic risk factors for brain tumours

FH brain tumours NF 1/2 Tuberous sclerosis

Give 2 features in PMH for brain tumours

Cancer Radiotherapy

Define staging and grading

S: how far the tumour has spread G: how differentiated the tumour cells are compared with native cells

What is the survival rate for the 4 grades of brain cancer?

Grade 1 → benign Grade 2 → >5y survival Grade 3 → 1-5y survival Grade 4 → <1y survival

Give 4 features of pilocytic astrocytoma

Indolent Most common brain tumour in kids 0-20y Good prognosis Grade 1

Give 2 features of diffuse gliomas

20-40y Grade 2-3

Give 3 features of gliomoblastoma multiforme

>50s Most common (aggressive) primary tumour in adults Grade 4

What features on microscopy indicate higher grade in brain tumours?

Increased cellularity Increased mitotic figures Microvascular proliferation

What is the location and buzzword associated with Meningioma?

Meninges/ arachnoid cells Psammoma bodies

What is the location and buzzword associated with medulloblastoma? (embryonal)

Cerebellum Children, balance problems, Squint

What is the location and buzzword associated with ependyoma?

Posterior fossa Tuberous sclerosis

What is the location and buzzword associated with craniopharyngioma?

Pituitary sella Inferior bitemporal hemianopia

What is the location and buzzword associated with pituitary tumour?

Pituitary sella Superior bitemporal hemianopia

What is the management for primary brain tumours?

Surgical resection Radiotherapy NOT chemo (most don't penetrate BBB)

What is dementia?

global impairment of cognitive function + personality without impairment of consciousness. (beyond normal ageing)

List the 5A's of dementia

Amnesia Apraxia Aphasia Agnosia Anomia

List the 4 types of dementia in order of decreasing prevalence

Alzheimers Vascular Lewy body Frontotemporal

Give the 2 main theories of Alzheimer's aetiology

Accumulation of β-amyloid plaques: interferes with neuronal communication Hyperphosphorylation of Tau proteins → formation of neurofibrillary tangles

Which lobes are most commonly affected first in Alzheimer's?

Medial temporal lobes + hippocampus

What tool is used to stage Alzheimers?

BRAAK staging

What is seen on MRI in Alzheimer's?

Global atrophy

Give 2 associations of vascular dementia

Mini strokes Step-wise deterioration

Give 3 associations of Lewy body dementia

Fluctuating course Little people/ animals running around Parkinsonian Sx

Give 4 buzzwords associated with Frontotemporal dementia

Personality change Disinhibition Overeating Emotional blunting

Give 3 patient characteristics commonly seen in frontotemporal dementia

Younger: 40-60 Strong +ve FH (autosomal dominant) Dx of Huntingtons disease

What is seen on microscopy in frontotemporal dementia?

Pick bodies

What is Parkinson's disease?

Depletion of dopaminergic neurons projecting from basal ganglia to the substantia nigra

What is the pathophysiology of Parkinson's?

Alpha synuclein mutation + misfolding to form Lewy bodies Accumulation of Lewy bodies in nigrostriatal pathway

What causes loss of smell in Parkinson's?

Accumulation of lewy bodies in olfactory bulb

What is seen on microscopy in Parkinson's?

Lewy bodies Melanin deposition

What are the 5 Parkinson's plus syndromes?

Vascular Parkinson's Drug-induced Parkinson's Multiple system Atrophy (MSA) Progressive supranuclear palsy (PSP) Corticobasal dysfunction

What characterises drug-induced Parkinson's?

Bilateral motor deficit + PD

What characterises multiple system atrophy?

Autonomic dysfunction + PD

What characterises progressive supranuclear palsy?

Vertical gaze dysfunction + PD

Describe CSF production and circulation

CSF produced by ependymal cells of choroid plexus (mainly in lateral ventricles) From lateral ventricles, goes through interventricular foramina to 3rd ventricle Flows down cerebral aqueduct to 4th ventricle Enters subarachnoid space (via medial + lateral apertures) Drains back into superior sagittal sinus via arachnoid granulations

What is communicating hydrocephalus?

Increased production or decreased absorption of CSF

What is non-communicating hydrocephalus?

intraventricular obstruction of CSF flow

What triad characterises normal pressure hydrocephalus ?

Gait disturbance Urinary incontinence Confusion

What is seen on MRI in hydrocephalus?

Massive ventricles

What are the 3 types of brain herniation?

Subfalcine: cingulate gyrus pushed under falx cerebri Uncal/ transtentorial: medial temporal lobe pushed under tentorium cerebelli Tonsilar: cerebellar tonsils pushed through foramen magnum.

Which type of herniation does not involve the cerebral cortex?

Tonsilar herniation (cerebellum through foramen magnum)

What are the consequences of tonsilar herniation?

Cardiorespiratory failure + death

What percentage of patients who experience a TIA will have a significant infarct within 5 years?

33%

What is the most common cause of non-traumatic intraparenchymal haemorrhages?

HTN

Give 2 signs of skull fracture

Battle sign: haemorrhage over mastoid process, post traumatic basilar skull fracture Panda eyes: base of skull fracture in anterior cranial fossa