Neuro histopath Flashcards by Justyna Gromala

Name 4 main stroke syndromes

ACA
MCA
PCA
lacunar

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What are the RFs for stroke and which is the main one

ATHEROSCLEROSIS (esp. cerebral atherosclerosis is the commonest cause, can also be embolism form intra/extracranial plaques)

smoking
HTN
DM
high cholesterol
excessive alcohol

past TIA
OCP
hyperviscosity e.g. PV or SCD
FH
PVD (?)

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What are the similarities and differences between stroke and TIA

similar: rapid onset focal neurological sx

differences: stroke >24h, TIA <24h (usually lasting 1-5 minutes)

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What is the risk of having a stroke following a TIA?

1/3 of people following TIA go on to have a stroke after 5 years if left untreated.

15% of first strokes are preceded by TIA

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What is the incidence of strokes in the UK?

100 000 new strokes every year in the UK

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What is the incidence of TIA in the UK

4/1000 in a year

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What is the commonest territory to be affected by stroke?

MCA

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What is the immediate management in stroke?

if ischaemic:
aspirin +/- dipyridamole (antiplatelet medication)

thrombolytics if <3h from event

+/- carotid endartectomy

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What is the long term management in stroke/TIA?

treat HTN
lower lipids
anticoagulation

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What is the immediate management in TIA?

aspirin +/- dipyridamole

+/- carotid endartectomy

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What are the investigations for stroke/TIA?

stroke: CT/MRI

TIA: carotid USS

both: BP, FBC, ESR, U&E, glucose, lipids, CXR, ECG, carotid doppler

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What features are seen in ACA syndrome

contralateral leg paresis
contralateral sensory loss in leg
urinary incontinence
cognitive deficits (apathy, confusion, poor judgement)

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What features are seen in MCA syndrome?

proximal occlusion:
- contralateral weakness and sensory loss of face and arm
- contralateral hemisensory loss
- may have contralateral homonymous hemianopia or quadrantanopia
- if dominant (usually left hemisphere): aphasia
- if non-dominant (usually right) hemisphere: neglect
- eye deviation towards the side of the lesion and away from the weak side

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What is the problematic result in cerebral oedema?

raised ICP

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What is cerebral oedema?

excess accumulation of fluid in the brain parenchyma

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Name mechanisms of CNS damage

oedema
hydrocephalus
raised ICP
stroke (haemorrhage and infarction)
Traumatic brain injury

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What causes communicating and non-communicating hydrocephalus?

non-communicating is due to obstruction of flow of CSF (most commonly the aqueduct is affected)

communicating: problems with reabsorption of CSF into venous sinuses

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What are causes of raised ICP?

SOL (tumour, abscess)
oedema

or both

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What is normal ICP

7-15 mmHg (in a supine adult)

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What conditions does the diagnosis of a stroke include and exclude?

Includes:
- cerebral infarcion
- primary intracerebral haemorrhage
- most cases of SAH
- intraventricular haemorrhage

excludes:
- subdural haemorrhage
- epidural haemorrhage
- intracerebral haemorrhage
- infarction caused by infection or a tumour

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What is an important predictor of a future stroke?

TIA

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Is there permanent injury to the brain following a TIA?

no (usually)

unlike in a stroke

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What are AVMs? where can they occur?

arteriovenous malformations

can occur anywhere in the CNS

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When and how to AVMs present?

present with haemorrhage, seizures, headache and focal neurological deficits

high pressure can cause massive bleeding

present between the 2nd and 5th decade of life

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Mx of AVMs

surgery embolisation radiosurgery

Cavernous angioma

well defined malformative lesion composed of closely packed vessles with no parenchyma interposed between vascular spaces.

When do cavernous angiomas become symptomatic?

after age 50

Mx of cavernous angiomas

surgery

How do cavernous angiomas present

headache seizures focal deficits haemorrhage you get low pressure recurrent bleeds

Rare causes of non-traumatic cranial haemorrhages

AVMs cavernous angiomas capillary telangiectasias connective tissue d/o e.g. Ehler Danlos syndrome

What is a key difference between AVMs and cavernous angiomas

AVM: high pressure - massive bleeds Cavernous angioma: low pressure - low pressure recurrent bleeds

How common are berry aneurysms?

1% of gen pop affected

presentation of SAH

sudden onset severe headache vomiting LOC

What is the commonest site for a berry aneurysm

80% internal carotid artery bifurcation 20% occur within the vertebro-basilar circulation

Focal vs global cerebral ischaemia

focal: defined vascular territory global: systemic circulation fails

Focal vs global cerebral ischaemia

focal: defined vascular territory global: systemic circulation fails

What is the single largest cause of death in people under 45?

trauma

pervalence of truamatic head injury

9 in 100 000

What are the types of head trauma

non-missile (acceleration/deceleration; rotation) missile RTA, falls and assaults focal or diffuse

What is diffuse axonal injury

occurs at the moment of injury shear and tear forces affecting axons commonest cause of coma (when no bleed) midline structures are particularily affected e.g. corpus callosum, rostral brainstem and septum pellucidum

MCA - full words

middle cerebral artery

Sx of PCA syndrome

- contalateral hemianopia/quadrantanopia with macular sparing - thalamic findings: contralateral sensory loss, amnesia, decreased level of conciousness - midbrain findings (CN III and IV palsy/pupillary changes, hemiparesis) - if bilateral: cortical blindness and prospagnosia (inability to recognise faces)

lacunar infarcts

non-cortical infarcts characterised by the absence of cortical signs (no aphasia, hemianopsia, agnosia, apraxia) most commonly due to chronic HTN-ive vasculopathy

What is the main RF for lacunar infarcts

HTN

skull fractures - types

cranial vault fractures basilar skull fractures

Signs seen in skull fractures

Liquorrhoea Battle sign Raccoon eyes otorrhoea signs of TBI lacerations haematoma contusions palpable deformities mobile bone fragments -> risk of infection!!

What is battle sign

bruising over the mastoid process

What are contusions?

brain in collision with the skull

coup and countercoup meaning

coup = where the impact occurs countercoup = opposite region of the impact

straw coloured fluid buzzword

indicates leakage of CSF -> skull fracture

Which areas of the brain are affected by contusions?

lateral surfaces of the hemispheres inferior surfaces of frontal and temporal lobes

What is the commonest cause of intraparenchymal haemorrhage?

50% due to HTN

What site is most commonly affected by intraparenchymal haemorrhages

basal ganglia

What is a concussion

minor traumatic brain injury transient LoC and paralysis - recovery within hours or days typically associated with no changes on standard neuroimaging (CT/MRI)

What are the types of brain haemorrhages

non-traumatic - SAH - intraparenhchymal haemorrhage - rare (AVMs, capillary telangiectasia, cavernous angiomas, Ehler Danlos syndrome) traumatic - subdural haemorrhage - extradural haemorrhage - traumatic parenchymal injury (skull #, concussion, contusion, diffuse axonal injury)

imaging buzzword for SAH

hyperattenuation around circle of willis

What conditions are associated with SAH

APKD Ehler danlos aortic coarctation

hyperattenuation around circle of willis - buzzword for..?

SAH

lemon shape on neuroimaging buzzword for....?

Extradural haemorrhage

presentation of EDH

rapid arterial bleed (most commonly affecting MMA) lucid interval then LoC

banana shape on neuroimaging buzzwird

subdural haemorrhage

who is commonly affected by subdural haemorrhages?

elderly alcoholics poeple on anticoagulation

buzzwords for subdural haemorrhage

banana shape on neuroimaging fluctuating consciousness gradual headache behavioral change

What vessels are damaged in SDH? is it a slow or rapid bleed>

damaged bridging veins with slow venous bleed

CAUSES OF NON-COMMUNICATING HYDROCEPHALUS?

meningitis -> meninges can become fibrous and this reduces absorption

how does CSF flow from lateral to 3rd ventricle?

interventricular foramen

Neuro histopath Flashcards

(66 cards)