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Y2 - CNS > Lecture 12 - Neuropathology > Flashcards

Lecture 12 - Neuropathology Flashcards

1
Q

What can maintained increased intracranial pressure cause?

A

Destruction of brain tissue
Displacement of midline structures
Brain shifts
Cerebral oedema

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2
Q

What are some compensatory mechanisms for regulating normal intracranially pressure?

A

Reduce venous blood volume
Reduce CSF volume
Brain atrophy

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3
Q

What is the normal intracranial pressure?

What pressure can coughing and straining lead to?

A

Normal = 0-10mmHg

Inc = max of 20mmHg

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4
Q

What can cause raised intracranial pressure?

A

Haematoma / Haeamorrhages
Tumours
Space occupying lesions
Cerebral oedema
Infections

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5
Q

How does a brain appear with cerebral oedema?

A

Loss of sulci
Widening of gyro

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6
Q

What is a subfalcine herniation?

A

The herniation of cingulate gyrus under the falx cerebri

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7
Q

What consequences can a subfalcine herniation cause on the brain?

A

Infarction of medial parts of frontal or parietal lobes or the corpus callosum

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8
Q

Why can a subfalcine herniation cause ischaemia of the corpus callosum?

A

Compression of the anterior cerebral artery

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9
Q

What is a Transtentorial herniation? (uncal herniation)

A

Herniation of medial part of the temporal lobe (uncus) into the tentorium cerebelli

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10
Q

What is a tonsillar herniation?

A

Cerebellar tonsils herniates through the Foramen magnum

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11
Q

Label slide 6 on herniations

A
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12
Q

In slide 7, what is the structure that is being compressed in this subfalcine herniation?

A

Lateral ventricle

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13
Q

What Cranial Nerve is most commonly damaged in an uncal herniation (trans-tentorial herniation)?

A

Occulomotor nerve (CN III)

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14
Q

What blood vessels can be occluded in a trans-tentorial herniation (uncal herniation)?

A

Posterior cerebral and superior cerebellar arteries causing ischaemia

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15
Q

What is a duret haemorrhage?

A

Secondary haemorrhage down into the brainstem from a transtentorial (uncal) haemorrhage

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16
Q

What is the consequence of tonsillar herniation (cerebellar tonsils)?

A

Pushed into Foramen magnum compressing brainstem

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17
Q

What are the 3 dural layers?

A

Dura mater
Arachnoid mater
Pia mater

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18
Q

Go to slide 11 and label the image

A
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19
Q

What blood vessel is normally ruptured leading to an extra dural haemorrhage?

A

Middle meningeal artery

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20
Q

What bone does the middle meningeal artery run behind?

A

Pterion

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21
Q

Where does blood accumulate in an Extradural haemorrhage?

A

Between the skull and the dura mater

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22
Q

How does the middle meningeal artery enter into the skull??

A

Foramen spinosum

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23
Q

What does the middle meningeal artery branch from?

A

Branches from maxillary artery

Which branches from external carotid artery

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24
Q

How does an extra dural haemorrhage present?

A

Lucid interval (hrs when fine) which then leads to drowsiness then neurological deficits

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25
What causes a subdural haemorrhage? What layers does the blood accumulate between?
The shearing of bridging veins (venous blood) on the way to the dural venous sinuses (likely the superior Sagittal sinus) Between the dura mater and arachnoid mater
26
What causes acute subdural Haematoma?
Trauma leading to rapid blood accumulation
27
Who often have chronic subdural Haematoma and why?
Elderly and chronic alcoholics Brain atrophy leading to increased tension on the bridging veins
28
How do subdural Haematomas present?
Assaults Falls RTCs Minor head injuries (elderly) Have to be careful of anticoagulant therapy or liver cirrhosis.
29
How do subdural haemorrhages appear on CT head?
Banana shape (Branching Banana)
30
What is the cause of a subarachnoid haemorrhage?
Shearing of meningeal blood vessels Usually caused by basal skull fractures and contusions
31
What is a contusion?
Brain bruises
32
What are some spontaneous causes of a subarachnoid haemorrhage?
Ruptured berry aneurysm Amyloid angiography Vertebral artery. Dissection Arteriovenous malformation
33
Where does blood accumulate in a subarachnoid haemorrhage?
In the subarachnoid space where CSF is Blood forced into subarachnoid space
34
What are the symptoms of a subarachnoid haemorrhage?
Sudden onset headache (worst ever/thunderclap headache) Rapid neurological deterioration Sudden collapse
35
What part of circulation do subarachnoid haemorrhages occur in due to a berry aneurysm?
Anterior circulation of circle of Willis
36
What conditions increase the risk of forming berry aneurysms in the circle of Willis?
Erhrlos Danlos syndrome (connective tissue) Polycystic kidney disease
37
What is a stroke?
Sudden event producing a disturbance of CNS function due to vascular disease
38
What are the 2 categories of stroke?
Ischaemic stroke Haemorrhagic stroke
39
What are the 2 types of ischaemic stroke?
Thrombotic occlusion Embolic occlusion
40
What are the 2 types of haemorrhagic stroke?
Intracerebral haemorrhage Subarachnoid haemorrhage
41
What are the risk factors for stroke?
Hyperlipidaemia Hypertension Diabetes Mellitus
42
What is an ischaemic stroke?
Obstruction of blood supply leads to ischaemia
43
Why are the basal ganglia, thalamus and deep white mater at increased risk of ischaemic stroke?
Has no collateral supply of blood
44
What is an example of a watershed area of the brain?
Border of the middle cerebral artery supply and anterior cerebral arertry supply Can get wedge shaped necrosis here
45
Label the blood supply to the brain on slide 19
46
What are some causes of Embolic stroke?
Cardiac murmur thrombi (AF) Atherosclerosis (DVT through patent Foramen ovale) Septic Embolic (infective endocarditis)
47
What blood vessel is most commonly affected by emboli leading to a stroke? Why?
Middle cerebral artery Where ICA comes in and branches to circle of Willis
48
What are some thrombotic causes of stroke?
Carotid bifurcation Origin of MCA Basilar artery Lacunae infarcts
49
What is gliosis?
Fibrosis in the brain
50
What is seen on histology in cerebal ischaemia?
Neutrophils start to migrate since inflammation Gliosis
51
What is spontaneous intracererbral haemorrhage (stroke) commonly caused by?
Hypertension Cerbreral amyloid angiography Arteriovenous and cavernous malformations Tumours
52
What effects does hypertension have on the body?
Systemic effects - brain,heart, vessels and kidneys Arteriosclerosis (artery walls thicken): Arteries to: Basal ganglia and thalamus White matter Brainstem
53
What does cerebal amyloid angiopathy cause?
Lobar haemorrhages involving the cerebral coritccecs and tiny microhaemorrhages
54
In cerebral amyloid angiopathy, what vessels do amyloid deposits end up in?
Meningeal and coritcal vessels
55
What are Arteriovenous malformations?
Subarachnoid vessels to brain causing wormlike tangles
56
What part of the brain are affectd in cavernous malformations?
Cerebellum and pons
57
What are some examples of Primary CNS tumours?
Gliomas (stroma) Parenchymal Meningeal Neuronal Poorly differentiated
58
What are some symptoms of CNS tumours?
Seizures Headaches Focal neurological deficits Raised ICP (nausea and vomiting)
59
What is the most common type of glioma?
Astrocytoma
60
What is more aggressive? Astrocytoma or glioblastoma multiforme?
Glioblastoma multiforme.
61
What is an ependymoma a cancer of?
Tumor of ventricular system often spreading to CSF
62
What infection is lymphoma associated with?
EBV
63
What is a meningioma?
Benign tumour derived from arachnoid meningiothelilal cells Can compress important structures
64
What are the 4 methods by which infections can spread to the CNS?
Direct local spread (air sinuses, osteomyelitis from fractures, middle ear infections, infected teeth) Haematogenous (retrograde venous spread through anstomoses and venous sinuses of skull) Iatrogenic (lumbar puncture) Peripheral nerves (Herpes zoster, viruses)
65
What can infections of the CNS affect?
Meninges Accumulation of aggregates of acute inflammation like abcesses Brain parenchyma (functional tissue)
66
What is meningitis?
Inflammation of the leptomeninges (arachnoid mater + Pia mater)
67
What are teh different types of meningitis?
Acute pyogenic (bacterial) Aseptic (viral) Chronic Carcinomatosis (lots of tumour deposits in meninges)
68
What symptoms can someone have with meningitis?
May be septic (Neisseria meningitidis) Headache Photophobia Stiff neck Altered consciousness Focal neurological impairment
69
What are some investigations done for meningitis?
CT scans Lumbar puncture (will have neutrophils and other inflammatory mediators in)
70
What are some complications of meningitis?
Cerebral oedema Cerebral infarction Cerebral abscess Empyema Epilepsy Meningoencephalitis Septicaemia
71
What is the most common cause of bacterial acute pyogenic meningitis in infants?
Escherichia coli
72
What is the most common cause of bacterial acute pyogenic meningitis in young adults (5-30)?
Neisseria meningitidis
73
What is the most common cause of bacterial acute pyogenic meningitis in adults (30+)?
Streptococcus pneumoniae
74
What is the most common cause of bacterial chronic meningitis?
Mycobacterium tuberculosis
75
What is a cerebal abscess?
Acute inflammation and bacterial build up in cerebrum
76
What is encephalitis?? What type of eof organism most commmonly causes it?
Infection of the brain parenchyma Viral > bacterial
77
What white blood cell will be elevated most commonly with encephalitis?
Lymphocytes since normally viral
78
What white blood cell will be elevated most commonly with encephalitis?
Lymphocytes since normally viral
79
What white blood cell will be elevated most commonly with encephalitis?
Lymphocytes since normally viral
80
What virus typically cases encephalitis of the temporal lobe?
Herpes Zoster virus
81
What virus typically cases encephalitis of the spinal cord?
Polio
82
What virus typically cases encephalitis of the brainstem?
Rabies
83
What virus commonly causes encephalitis in foetuses and those who are immunocomprimised?
Cytomegalovirus
84
What are prion disease?
Diseases that lead to abnormal cellular protein accumulations
85
How t prion diseases cause damage?
Neurone cell death Synapse loss Spongiform microvacuolations Lack of inflammation
86
What are some examples of prion diseases?
Creutzfeldt-Jakobs disease (CJD) Scrapie’s (sheep) Bovine spongiform encephalopathy BSE (Mad cow disease)
87
What is the pathophysiology of prion disease like Creutzfeldt-Jakobs disease?
Normally protiens in alpha helices structure When mutation or infection by prion occurs they undergo conformational change to B pleated sheets B pleated sheets much more resistant to proteolysis so build up causing damage Also affect nearby proteins to change to B pleated sheet structure
88
What are some symptoms of Creutzfelt-JaKobs disease?
Subtle changes in memory Cerebal polar ataxia Global dementia Behavioural issues
89
What is the basis for neurodegenerative diseases?
Loss of neurones due to accumulation of protein aggregates
90
What are some changes with neurodegenerative disease if they affect the hippocampus and cerebral cortices?
Cognitive changes Alteration in memory,behaviours and language
91
What lobes does Alzheimer’s disease affect?
Frontal, temporal and parietal
92
What are the proteins that build up causing Alzheimer’s?
Alpha beta plaques Neurofibrillary tangles (tau)
93
What is the pathophysiology of Alzhemiers disease?
Transmembrane protein cleared to amyloid Amyloid broken down to Alpha Beta (AB) monomers AB monomers -> AB aggregates -> AB fibrils -> AB plaques build up Tau can aggregates out of cells forming neurofibrillary tangles due to being hyperphosphorylated and being unable to bind to microtubules
94
What are the signs and symptoms of Alzheimer’s?
Impaired intellectual function Impaired memory Altered mood and behaviour Disorientated
95
What gives you an increased risk of Alzheimer’s and why?
Down syndrome Trisomy of Chromosome 21 The amyloid precursor protein found on chromosome 21
96
What causes Parkinson’s?
Loss of dopaminergic neurones from the substantia migrate
97
How does Parkinson’s disease present?
Hypokinesia Rigidity Brady Kinesia Instability Tremor
98
What part of the brain is affected in Huntingtons disease?
Basal ganglia
99
What type of inheritance is Huntingtons disease? What causes it?
Autosomal dominatn CAG trinucleotide repeats These accumulate leading to cell injury, death and gliosis
100
How does Huntingtons present?
Hyperkinesia (involuntary jerky movements)

Y2 - CNS (21 decks)

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