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Pathology (Guide) > Histopathology - Cerebral Pathology > Flashcards

Histopathology - Cerebral Pathology Flashcards

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1
Q

What is a stroke?

A

A clinical syndrome characterised by rapidly developing focal/global neurological deficit lasting > 24 hrs (of presumed vascular origin)

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2
Q

How long does a TIA last for?

A
  • <24hrs with complete resolution of Sx
  • Most = 1-5mins
    -1/3 lead to strokes after 5 years if untreated
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3
Q

What is the most common modifiable RF for all kinds of strokes?

A

HTN

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4
Q

What is ischaemia?

A

A lack of oxygen supply to tissue

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5
Q

What is an infarction?

A

An area of tissue death due to lack of oxygen

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6
Q

What is a the most common cause of brain infarction?

A

Cerebral atherosclerosis

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7
Q

What percentage of strokes are caused by infarctions?

A

70-80%

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8
Q

What are some causes of brain infarctions?

A
  • Embolism from intra/extra-cranial plaques
  • Cerebral atherosclerosis
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9
Q

What are an important future predictor of strokes?

A

TIAs

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10
Q

What is the epidemiology and clinical presentation of a stroke?

A

Epi:
- 100,000 new strokes/yr in UK

Sx:
- Sudden onset
- FAST
- Numbness
- Loss of vision
- Dysphagia

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11
Q

What vascular territories are commonly affected in strokes?

A
  • Anterior vs posterior territory
  • Most common = MCA
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12
Q

What are the investigations and management of a stroke?

A

Ix:
- CT/MRI (infarct vs haemorrhage)
- Ix for vascular risk (BP, FBC, ESR, U+E, Glucose, Lipids, ECG, Carotid doppler)

Mx:
- Aspirin +/- dipyridamole
- Thrombolytics (IF <3hr from event)
- +/- carotid endarterectomy
- Long term: Treat HTN, Lower Lipids, Anticoag

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13
Q

What are the causes/RFs for strokes + TIAs?

A
  • Smoking
  • DM
  • HTN
  • FHx
  • Prev. TIAs
  • OCP
  • PVD
  • Increased ethanol usage
  • Hyperviscosity (e.g. sickle cell, polycythaemia)
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14
Q

What is the epidemiology and clinical features of TIAs?

A

Epi:
- 0.4/1000 /yr
- 15% of 1st strokes preceded by TIAs

Sx:
- Sx last <24hrs
- Amaurosis fugax
- Carotid bruit

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15
Q

What vascular territories are commonly affected by TIAs?

A

Any
- Characteristically embolic atherogenic debris from carotid artery travels to ophthalmic branch of internal carotid

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16
Q

What are the investigations and management for TIAs?

A

Ix:
- Carotid US
- Ix for vascular risk (BP, FBC, ESR, U+E, Glucose, Lipids, CXR, Carotid doppler)

Mx:
- Aspirin + dipyridamole
- +/- carotid endarterectomy
- Long term: Treat HTN, Lower lipids, Anticoag

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17
Q

What are some stroke syndromes when caused at the ACA (anterior cerebral artery)?

A
  • Contralateral leg paresis
  • Sensory loss
  • Cognitive defects (e.g. apathy, confusion + poor judgement)
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18
Q

What are some stroke syndromes when caused at the MCA (Middle cerebral artery)?

A

Proximal occlusion:
- Contralateral weakness + sensory loss of face + arm
- Cortical sensory loss
- ?Contralateral homonymous hemianopia/quadrantanopia
- IF Dominant (left) hemisphere: asphasia
- IF non-dominat (right) hemisphere: neglect
- Eye deviation towards side of lesion + away from weak side

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19
Q

What are some stroke syndromes when caused at the PCA (posterior cerebral artery)?

A
  • Contralateral hemianiopia/quadrantanopia
  • Midbrain findings: CN III + IV aplsy/pupillary changes, hemiparesis
  • Thalamus findings: Sensory loss, amnesia, decreased level of consciousness
  • IF Bilateral: Cortical blindness/prosopagnosia
  • Hemiballismus
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20
Q

What are some stroke syndromes when caused by lacunar infarcts?

A
  1. Pure motor hemiparessi (posterior limb of internal capsule): contralateral arm, leg + face
  2. Pure sensory loss (ventral thalamic): hemisensory loss
  3. Ataxic hemiparesis (ventral pons or internal capsule): ipsilateral ataxia + leg paresis
  4. Dysarthria-clumsy hand syndrome (ventral pons/genu of internal capsule): dysarthria, facial weakness, dysphagia, mild hand weakness + clumsiness
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21
Q

What are lacunar infarcts?

A
  • Deep hemispheric white matter
  • Involving deep penetrating arteries of MCA, circle of Willis, basilar, + vertebral arteries
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22
Q

What percentage of strokes are caused by haemorrhagic causes?

A

20%

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23
Q

What are the non-traumatic haemorrhages?

A
  • Intraparenchymal haemorrhage
  • Subarachnoid haemorrhage
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24
Q

What are some features of an intraparenchymal haemorrhage, including its most common site?

A
  • 50% due to HTN
  • Abrupt onset
  • Can cause Cahrcot-bouchard microaneurysms (likely to rupture)
  • Common site: Basal Ganglia
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25
What is the most common cause of haemorrhagic strokes?
HTN
26
What are some features of subarachnoid haemorrhages, including some buzzwords?
- 85% from ruptured berry aneurysms - Most at internal carotid bifurcation (+ posterior communicating artery) - F>M, <50yrs - Thunderclap headache, vomiting + LoC - Increased risk in APKD, Ehler's Danlos + Aortic coarctation - BUZZWORDS: HYPERATTENUATION AROUND CIRCLE OF WILLIS
27
What are some rare non-traumatic haemorrhagic causes of stroke?
- AV malformations (young people <50yrs) - Cavernous angiomas (recurrent low pressure bleeds) - Capillary telengiactasias - Connective tissue disorders (e.g. Ehlers-Danlos)
28
What are some traumatic haemorrhages?
- Extradural haemorrhge - Subdural haemorrhage - Traumatic parenchymal injury
29
What are some features of an extradural haemorrhage?
- Skull fracture from truama (usually at pterion) - Most common site = MIDDLE MENINGEAL ARTERY - Rapid arterial bleed, lucid interval then LoC - Buzzword = Lemon shape
30
What are some features of a subdural haemorrhage?
- Previous history of minor head trauma - Damaged bridging verins with slow venous bleed - Often elderly/alcoholic/on anticoagulation - A/w gradual headache, fluctuating consciousness + behavioural changes - Buzzword: Banana/crescent shape
31
What are the different types of traumatic parenchymal injury?
- Traumatic brain injury - Concussion - Contusions - Diffuse axonal injury - Skull fractures
32
What is a concussion?
Transient LoC + paralysis, recovery in hours/days
33
What is a contusion?
Collision between brain + skull - Coup = where impact occurs - Contracoup = opposite region of impact
34
What are some features of a diffuse axonal injury?
- Occurs at moment of injury due to shear tensile forces breaking axons apart - Commonest cause of coma - Midline strictures like Corpus Callosum, rostral brainstem + septum peelucidum affected - Causes vegetative state + post-traumatic dementia
35
What should be looked out for when skull fractures occur (in terms of brain injury)?
- Otorrhea/rhinorrhoea - Buzzword = STRAW-COLOURED FLUID = CSF + Battle's sign
36
What is a Battle's sign
Haemorrhage on mastoid process
37
What is the single largest cause of death in under 45s?
Traumatic brain injury
38
What are some causes of raised ICP?
- Oedema - Space occupying lesion (e.g. tumour/abscess)
39
What can raised ICP lead to?
Brain herniation
40
What are the three main types of brain herniation and their features?
Subfalcine: - Hernation of singular corex beneath flax (midline fold of dura) Transtentorial/uncal: - Herniation of medial temporal lobe under tentorium (horizontal dura mater between parietal lobes + cerebellum) Tonsillar herniation: - Hernation of cerebellum through foramen magnum - Compresses brainstem leading to cardiorespiratory arrest + death (risk if doing LP with raised ICP)
41
What is oedema and its types?
Excess accumulation fo fluid in brain parenchyma - Vasogenic = disruption of blood brain barrier permeability - Cytotoxin = secondary to cellular injury (e.g. ischaemc or hypoxic)
42
What is hydrocephalus?
An increase in CSF + enlargement fo ventricular system
43
What are three types of hydrocephalus and the differences between them?
Communicating: - Obstruction in outflow of CSF - E.g. in neonates, lateral ventricles obstruct cerebral aqueduct causing build-up of CSF in lateral ventricles leading to enlarging brain + ventricles Non-communicating: - Reduced absorption of CSF into sinus veins - E.g. in meningitis the meninges can become fibrous which reduces absorption Normal pressure: - Gait disturbances - Urinary incontinence - Confusion
44
What is the normal flow of CSF?
- Produced by choroid plexus - Flows through interventricular forament into 3rd ventricle - Flows via cerebral aqueduct into 4th ventricle - Goes to sub-arachnoid space - Goes to spinal cord + brain - Reabsorption via superior sagittal sinus into venous system
45
Where do primary brain tumours originate?
CNS
46
What are the two types of primary brain tumours and where do they originate/the type of tumour?
Extra-axial: - Cranium - Soft tissue - Meninges - Nerves - BENIGN Intra-axial: - Glial - Neurones - Neuroendocrine cells - MALIGNANT
47
What are secondary brain tumours?
Metastatic lesions from other parts of the body
48
What are some features of secondary brain tumours?
- Commonest form of adult brain tumours - Most common sources = lung, breast, malignant melanoma - Located at grey-white matter junction - Well demarcated, solitary or multiple with surrounding oedema - VERY POOR PROGNOSIS
49
What are some RFs for brain tumours?
- Previous tumours - Radiotherapy to head + neck - Neurofibromatosis 1+2 - Tuberous sclerosis - FHx of brain cancer
50
What are some signs + Sx of brain tumours?
Raised intracranial pressure: - Headache - Vomiting - Change in mental state Supratentorial: - Focal neurological deficit - Seizures - Personality changes Infratentorial: - Ataxia - Long tract signs = spasticity, hyperreflexia - Cranial nerve palsies
51
What are some neuroimaging techniques?
- MRI - CT - Functional MRI - MR-spectroscopy - PET-SCAN
52
What is the management of a brain tumour?
- Surgical resection - Radiotherapy +/- chemotherapy
53
What is the WHO classification of CNS tumours?
Tumour type: Cell of origin/lineation of differentiation: - Astrocytes = astrocytomas - Oligodendrocytes = oligodendrocytomas (FRIED EGG APPEARANCE) - Ependyma = Ependyoma (VENTRICULAR TUMOUR, HYDROCEPHALUS) - Meningothelial cells = meningioma Tumour grade: predicted natural clinical behaviour (e.g. survival time) - Grade 1 = benign (well differentiated) - Grade 2 = 5yrs + survival - Grade 3 = 1-5yrs survival - Grade 4 = <1yr survival (poorly differentiated) Molecular profiling - Genetics - Molecular markers
54
What are the three different types of astrocytic brain tumours?
- Pilocytic astrocytoma (G1) - Diffuse glioma (G2-3) - Glioblastoma multiforme (G4 = BAD)
55
What age group does a pilocytic astrocytoma arise, what are its histological features, associated mutations and buzz words?
Age: - 0-20 yrs Histology: - Piloid HAIRY CELLS - Rosenthal fibres - Slow mitotic divisions Mutation: - BRAF in 70% Buzzwords: - INDOLENT - CHILDHOOD
56
What age group does a diffuse glioma arise, what are its histological features and associated mutations?
Age: - 20-40yrs Histology: - Low-moderate cellularity - Low mitotic activity - No vascular proliferation Mutation: - IDH A/W longer surivival + better response to chemo + radiotherapy
57
What age group does a glioblastoma multiforme arise, what are its histological features, associated mutations and buzz words?
Age: - 50+ yrs - Median survival = 8mths - MOST COMMON, AGGRESSIVE PRIMARY TUMOUR IN ADULTS Histology: - High cellularity - High mitotic activity - Microvascular proliferation - Necrosis Mutation: - IDH wildtype Buzzwords: - AGGRESSIVE - POOR PROGNOSIS
58
What age group does a meningioma arise, what are its histological features, location and buzz words?
Age: - Increased incidence with age Histology: - PSAMMOMA BODIES (calcifications) - Mitotic activity determines grading Location: - Meninges - Arachnoid cells Buzzwords: - NF2
59
What age group does a medulloblastoma arise, where is it found and its buzz words?
Age: - 2nd most common brain tumour in children after astrocytoma Location: - Cerebellum Buzzwords: - Squint
60
Where are ependyomas found?
- Posterior fossa - Tuberous sclerosis
61
Where are craniopharyngiomas and pituitary tumours found?
- Pituitary sella
62
What are some familial syndromes associated with CNS tumours, and their features?
Von Hippel- Lindau - Hemangioblastoma of cerebellum, brainstem + spinal cord - Retina - Renal cysts - Phaeochromocytoma Tuberous sclerosis: - Giant cell astrocytoma - Cortical tuber - Supependymal nodules + calcifcations on CT NF1: - Optic glioma - Neurofibroma - Astrocytoma NF2: - Vestibular schwannoma - Meningioma - Ependymoma - Astrocytoma Multiple endocrine neoplasia type 1 (MEN1): - Pituitary adenoma

Pathology (Guide) (84 decks)

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