Lecture 21 Pathology for CNS 2

Question 1

Give examples of cerebrovascular diseases?

Answer 1

Strokes, TIA and intercerebral haemorrhage

Question 2

How much for the brain weigh?

Answer 2

1-2% of body weight

Question 3

How much O2% does the body use?

Answer 3

20%

Question 4

When blood flow is reduced to brain, tissue survival depends on?

Answer 4

Collateral circulation, duration of ischaemia and magnitude/rapidity of flow reduction

Question 5

Global hypoperfusion (blood flow reduce to whole brain) causes?

Answer 5

Hypotentsion or cardiac arrest -> generalised neuronal dysfunction

Question 6

How many patients/year have stroke?

Answer 6

130,000

Question 7

What are the risk factors for strokes?

Answer 7

Diabetes M, hypertension, hyperlididaemia, heart disease or previous TIA

Question 8

Define TIA

Answer 8

Transient ischaemic attack is temp loss of function that resolves itself within 24 hours

Question 9

Risk of having full stroke after TIA?

Answer 9

1 in 10 chance of having full stroke within 4 weeks if left untreated

Question 10

Treatments for TIA?

Answer 10

Aspirin/clopidogrel as antiplatelets. Control BP and lower cholesterol

Question 11

Define aphasia?

Answer 11

Loss of speech

Question 12

Define hemianopia?

Answer 12

Loss of vision

Question 13

What causes an intracerebral haemorrhage?

Answer 13

Hypertension ‘capsular haemorrhage’. Arterial origin.

Question 14

What causes a subarachnoid haemorrhage?

Answer 14

Spontaneous. 80% rupture of saccular aneurysms

Question 15

What causes subdural haemorrhage?

Answer 15

Minor trauma (elderly). Anticoagulants. Bleeding from bridging veins between cortex & venous sinuses

Question 16

What causes extradural haemorrhage?

Answer 16

Middle meningeal artery, post head injury

Question 17

What are the symptoms of a intracranial haemorrhage?

Answer 17

Headache, rapid or gradual loss of consciousness

Question 18

What are the symptoms of a subarachnoid haemorrhage?

Answer 18

Thunderclap headache. Spontaneous -> catastrophic

Question 19

What are the symptoms of a subdural haemorrhage?

Answer 19

Fluctuant conscious level, minor trauma.

Question 20

What are the symptosms of a extradural haemorrhage?

Answer 20

Head injury with #skull. Slowly decreasing conscious level.

Question 21

What is dementia?

Answer 21

Irreversible clinical synddromewith widespread impairment of mental function

Question 22

Who is at risk of dementia?

Answer 22

> 65yo. 80,000 people in uk

Question 23

Side effects of dementia?

Answer 23

Memory loss, speed of thought, language, understanding, disinterested, difficulties in controlling emotions.

Question 24

What can mimic dementia?

Answer 24

Depression or delirium

Question 25

What are the types of dementia?

Answer 25

Alzheimer's disease (70%), Vascular dementia (15%) and dementia with lewy bodies (15%). RARE cause (syphilis)

Question 26

What assessments are done for dementia?

Answer 26

Ensure thyroid function is normal, CT scan, Check vit B12 (alcoholism)

Question 27

What is alzheimer's disease due to?

Answer 27

AB amyloid accumulation. Tau - neurofibrillary tangles and plaques, loss of neurones and synapses.

Question 28

What does alzhimers lead to?

Answer 28

defects in visual-spatial skills (gets lost), memory loss, decreasing cognition and ansognosia (lack of awareness)

Question 29

What is alzhimers treated with?

Answer 29

cholinesterase inhibitors

Question 30

What is epilepsy?

Answer 30

Recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain -> seizures.

Question 31

What can cause epilepsy?

Answer 31

Space occupying lesions, stroke, alcohol withdrawal.

Question 32

How can epilepsy be managed?

Answer 32

Sodium valproate, carbamazepine, phenytoin, lamotragine

Question 33

What bacteria can cause meningitis?

Answer 33

Neisseria meningitides, pneumocococcus, meningococcus

Question 34

Meningitis can be what?

Answer 34

Bacterial, viral or fungal

Question 35

What are the symptoms of brain abscesses?

Answer 35

Headaches, seizures and temperaures

Question 36

Radiologically what is found with a brain abscess?

Answer 36

Ring enhancing lesion

Question 37

How are brain abscesses spread?

Answer 37

Via blood (embolus from bacterial endocarditis,IV drug users at risk) or directly (from infected ear)

Question 38

What is parkinson's disease?

Answer 38

Movement disorder, sporadic or familial. 1 in 1000

Question 39

What is the postural instability of parkinson's disease due to?

Answer 39

Progressive degeneration of the dopaminergic nigrostriatal system.

Question 40

What are the clinical features of parkinson's disease?

Answer 40

Bradykinesis, rigidity, resting tremor, posterural instability

Question 41

Define bradykinesis?

Answer 41

Slowed ability to start and continue movements & impaired ability to adjust the body's postition

Question 42

What is the treatment for parkinson's disease?

Answer 42

L-dopa e.g modopar to replace the lost dopamine. (Start when necessary & lowest poss dose) OR anticholinergic drugs

Question 43

What drug can induce parkinson's and how can it be helped?

Answer 43

Haloperidol and can be helped me procyclidine

Question 44

Side effects of tumours?

Answer 44

Headaches, seizures, cognitive behaviour change, vomiting, altered consciousness

Question 45

Where can the primary tumours be that cause brain tumours?

Answer 45

Breast, small cell lung cancer

Question 46

What are the four types of brain tumours?

Answer 46

Meningiomas, astrocytomas, glioblastomas and pituitary tumours

Question 47

Notes on meningiomas?

Answer 47

Slow growing, don't often infiltrate brain, surgically removed.

Question 48

Notes on astrocytomas?

Answer 48

Range from WHO grade 1-IV. ^ malignant potential. Grade 4 fatal

Question 49

Notes on glioblastoma?

Answer 49

Ring enhancing lesion in frontal lobe

Question 50

Define transphenoidally

Answer 50

Surgery where instruments are inserted into part of the brain through nose