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Year 2 Medicine > Neuropathology > Flashcards

Neuropathology Flashcards

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1
Q

Histology of Neural Tissues

  • Neurons:
    • Nuclei or ganglia (e.g. basal ganglia)
    • Columns or layers (e.g. cortex)
  • Glia:
  • Structural and metabolic functions
    • A… (metabolism)
    • O… (structure)
    • E… (lining of fluid compartments)
    • M… (monocyte-lineage population)
  • Meninges
  • Blood vessels
A
  • Neurons:
    • Nuclei or ganglia (e.g. basal ganglia)
    • Columns or layers (e.g. cortex)
  • Glia:
  • Structural and metabolic functions
    • Astrocytes (metabolism)
    • Oligodendrocytes (structure)
    • Ependyma (lining of fluid compartments)
    • Microglia (monocyte-lineage population)
  • Meninges
  • Blood vessels
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2
Q

Histology of Neural Tissues

  • Neurons:
    • Nuclei or … (e.g. basal ganglia)
    • … or layers (e.g. cortex)
  • Glia:
  • Structural and metabolic functions
    • Astrocytes (metabolism)
    • Oligodendrocytes (structure)
    • Ependyma (lining of fluid compartments)
    • Microglia (monocyte-lineage population)
  • M…
  • Blood …
A
  • Neurons:
    • Nuclei or ganglia (e.g. basal ganglia)
    • Columns or layers (e.g. cortex)
  • Glia:
  • Structural and metabolic functions
    • Astrocytes (metabolism)
    • Oligodendrocytes (structure)
    • Ependyma (lining of fluid compartments)
    • Microglia (monocyte-lineage population)
  • Meninges
  • Blood vessels
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3
Q

Histology of neural tissues:

A
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4
Q

Meninges

  • Meninges - covering layers
  • Provide … - interface between compartments
  • … mater - covers entire brain and spinal column
  • … - BV run within
  • … mater - directly on surface of brain
A
  • Meninges - covering layers
  • Provide protection - interface between compartments
  • Dura mater - covers entire brain and spinal column
  • Arachnoid - BV run within
  • Pia mater - directly on surface of brain
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5
Q

CEREBROSPINAL FLUID

  • Normal volume 150ml
  • Production by … plexus in the … ventricles (450ml per 24h)
  • Resorption by arachnoid … in the subarachnoid space
  • Metabolic importance
  • … of the CNS
  • Role in … regulation and defense
  • Cerebral … of blood flow
A
  • Normal volume 150ml
  • Production by choroid plexus in the lateral ventricles (450ml per 24h)
  • Resorption by arachnoid granulations in the subarachnoid space
  • Metabolic importance
  • Cushioning of the CNS
  • Role in immune regulation and defense
  • Cerebral autoregulation of blood flow
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6
Q

CEREBROSPINAL FLUID

  • Normal volume …ml
  • Production by choroid … in the lateral … (450ml per 24h)
  • Resorption by arachnoid … in the … space
  • … importance
  • Cushioning of the CNS
  • Role in immune regulation and defense
  • Cerebral autoregulation of blood flow
A
  • Normal volume 150ml
  • Production by choroid plexus in the lateral ventricles (450ml per 24h)
  • Resorption by arachnoid granulations in the subarachnoid space
  • Metabolic importance
  • Cushioning of the CNS
  • Role in immune regulation and defense
  • Cerebral autoregulation of blood flow
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7
Q

CSF CIRCULATION - VENTRICLES

A
  • Blue space- ventricles
  • Main compartment where CSF is located
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8
Q

CSF Circulation:

  • Brain is completely surrounded by CSF and has … within it filled with CSF
  • … … sinus - reabsorption back into venous system
  • Constant …
A
  • Brain is completely surrounded by CSF and has ventricles within it filled with CSF
  • Superior sagittal sinus - reabsorption back into venous system
  • Constant circulation
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9
Q

Hydrocephalus

  • … to CSF flow
  • Impaired resorption at arachnoid …
  • … of brain tissue (e.g. dementias) = ex vacuo
  • Very rarely …
A
  • Obstruction to CSF flow
  • Impaired resorption at arachnoid granulations
  • Shrinking of brain tissue (e.g. dementias) = ex vacuo
  • Very rarely overproduction
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10
Q

Types of hydrocephalus

A
  • Types:
  • Communicating
  • Non-communicating
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11
Q

Raised intracranial pressure

  • Mean CSF pressure above 200mm H20
  • Increased CSF volume (…)
  • How?
    • Intracranial … occupying lesion (neoplasm, haemorrhage, abscess)
    • Cerebral …
A
  • Mean CSF pressure above 200mm H20
  • Increased CSF volume (hydrocephalus)
  • How?
    • Intracranial space occupying lesion (neoplasm, haemorrhage, abscess)
    • Cerebral oedema
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12
Q

Consequences of raised intracranial pressure - Herniation

  • Sub… (cingulate)
  • …/transtentorial
  • …/cerebellar
    • …/Cerebellar herniation may cause compression of the medulla with impairment of vital respiratory and cardiac functions
A
  • Subfalcial (cingulate)
  • Central/transtentorial
  • Tonsillar/cerebellar
    • Tonsillar/Cerebellar herniation may cause compression of the medulla with impairment of vital respiratory and cardiac functions
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13
Q

Tonsillar/Cerebellar herniation may cause compression of the … with impairment of vital respiratory and cardiac functions

A
  • Tonsillar/Cerebellar herniation may cause compression of the medulla with impairment of vital respiratory and cardiac functions
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14
Q

A brain …, or cerebral …, occurs when brain tissue, blood, and cerebrospinal fluid (CSF) shifts from their normal position inside the skull.

A

A brain herniation, or cerebral herniation, occurs when brain tissue, blood, and cerebrospinal fluid (CSF) shifts from their normal position inside the skull.

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15
Q

Tonsillar herniation at autopsy

  • Coning herniation and compression of the … …
  • Duret haemorrhages
A
  • Coning herniation and compression of the medulla oblongata
  • Duret haemorrhages
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16
Q

What type of herniation?

A

TONSILLAR HERNIATION

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17
Q

Space occupying lesion

  • …/epidural haemorrhage
  • … haemorrhage
  • … haemorrhage
  • Intracerebral haemorrhage
  • Ischaemic infarct with subsequent oedema or haemorrhage
  • Neoplasm
  • Abscess
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A
  • Extradural/epidural haemorrhage
  • Subdural haemorrhage
  • Subarachnoid haemorrhage
  • Intracerebral haemorrhage
  • Ischaemic infarct with subsequent oedema or haemorrhage
  • Neoplasm
  • Abscess
18
Q

Space occupying lesion

  • Extradural/… haemorrhage
  • Subdural haemorrhage
  • Subarachnoid haemorrhage
  • … haemorrhage
  • … infarct with subsequent oedema or haemorrhage
  • Neo…
  • Ab…
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A
  • Extradural/epidural haemorrhage
  • Subdural haemorrhage
  • Subarachnoid haemorrhage
  • Intracerebral haemorrhage
  • Ischaemic infarct with subsequent oedema or haemorrhage
  • Neoplasm
  • Abscess
19
Q

Head Trauma

  • Skull fracture
  • Parenchymal injury:
    • … (bruising) concussion is a clinical term/syndrome
    • … (penetration or tearing)
    • Diffuse … injury
  • Coup and …
    • Important - clue to how injury has occurred
  • After trauma, 2 areas of contusion in brain (one at front, one at back)
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A
  • Skull fracture
  • Parenchymal injury:
    • Contusion (bruising) concussion is a clinical term/syndrome
    • Laceration (penetration or tearing)
    • Diffuse axonal injury
  • Coup and contrecoup
    • Important - clue to how injury has occurred
  • After trauma, 2 areas of contusion in brain (one at front, one at back)
20
Q

… Only occur if brain moving hits a stationary object

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A

Contrecoup Only occur if brain moving hits a stationary object

21
Q

… injury is associated with a moving object impacting a stationary head

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A

Coup injury is associated with a moving object impacting a stationary head

22
Q

Coup vs Contrecoup

  • COUP
    • Head hits … object (wall) first - contusion at front (coup) then…
  • CONTRECOUP
    • Brain … within skull - rebound - brain rebounds back within skull to other side (… to force)
    • Second injury caused (contrecoup injury)
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A
  • COUP
    • Head hits stationary object (wall) first - contusion at front (coup) then…
  • CONTRECOUP
    • Brain moves within skull - rebound - brain rebounds back within skull to other side (opposite to force)
    • Second injury caused (contrecoup injury)
23
Q

Vascular injury- ….. rupturing

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A

Vascular injury- BV rupturing

24
Q

Vascular injury

  • … - severe trauma with arterial laceration (middle meningeal artery)
  • … - trauma may be minor in atrophy (bridging veins)
  • Subarachnoid - rupture of saccular (berry) aneurysm (Circle of willis)
  • Intracerebral - ….tension
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A
  • Extradural - severe trauma with arterial laceration (middle meningeal artery)
  • Subdural - trauma may be minor in atrophy (bridging veins)
  • Subarachnoid - rupture of saccular (berry) aneurysm (Circle of willis)
  • Intracerebral - hypertension
25
_Vascular injury_ * Extradural - severe trauma with arterial laceration (... meningeal artery) * Subdural - trauma may be minor in atrophy (... veins) * ... - rupture of saccular (berry) aneurysm (Circle of willis) * ... - hypertension
* Extradural - severe trauma with arterial laceration (middle meningeal artery) * Subdural - trauma may be minor in atrophy (bridging veins) * Subarachnoid - rupture of saccular (berry) aneurysm (Circle of willis) * Intracerebral - hypertension
26
_EXTRADURAL - SUBDURAL_ * An extradural haematoma is a collection of blood in the 'potential' space between the skull and the outer protective lining that covers the brain (the ... ...). * A subdural hematoma (SDH) is a type of bleeding in which a collection of blood—usually associated with a ... brain injury—gathers between the inner layer of the ... mater and the ... mater of the meninges surrounding the brain.
* An extradural haematoma is a collection of blood in the 'potential' space between the skull and the outer protective lining that covers the brain (the dura mater). * A subdural hematoma (SDH) is a type of bleeding in which a collection of blood—usually associated with a traumatic brain injury—gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain.
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_SUBARACHNOID HAEMORRHAGE_ * Arachnoid layer is relatively ... - not easily visualised * Most easily recognised at base of brain * Confined to base of the brain * ... aneurysm - vascular abnormalities often seen in circle of willis * ... = subarachnoid haemorrhage
* Arachnoid layer is relatively thin - not easily visualised * Most easily recognised at base of brain * Confined to base of the brain * Berry aneurysm - vascular abnormalities often seen in circle of willis * Rupture = subarachnoid haemorrhage
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_INTRACEREBRAL HAEMORRHAGE_ * ... brain matter itself * ... associated
* Within brain matter itself * Hypertension associated
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_Cerebral oedema_ * ... of brain matter * ... - increased vascular permeability * ... - neuronal, glial or endothelial cell damage
* Swelling of brain matter * Vasogenic - increased vascular permeability * Cytotoxic - neuronal, glial or endothelial cell damage
30
_Cerebral infarction/Stroke_ * 15% of cardiac output into brain * ...% of O2 demand in brain * Stroke = ... onset of neurological symptoms * Hypoxia vs ischaemia (global vs focal) * ... are the most O2 sensitive cells * ... infarction in emboli (petechial lesions e.g. BM) * ... infarction in thrombosis * Tolerate hypoxia better than ischaemia - lack of blood flow - damages neuronal tissue more than lack of oxygen
* 15% of cardiac output into brain * 20% of O2 demand in brain * Stroke = sudden onset of neurological symptoms * Hypoxia vs ischaemia (global vs focal) * Neurons are the most O2 sensitive cells * Haemorrhagic infarction in emboli (petechial lesions e.g. BM) * Ischaemic infarction in thrombosis * Tolerate hypoxia better than ischaemia - lack of blood flow - damages neuronal tissue more than lack of oxygen
31
_Cerebral infarction/Stroke_ * ...% of cardiac output into brain * 20% of O2 demand in brain * Stroke = sudden onset of neurological symptoms * Hypoxia vs ischaemia (global vs focal) * Neurons are the most O2 sensitive cells * Haemorrhagic infarction in emboli (petechial lesions e.g. BM) * Ischaemic infarction in ... * Tolerate ... better than ... - lack of blood flow - damages neuronal tissue more than lack of oxygen
* 15% of cardiac output into brain * 20% of O2 demand in brain * Stroke = sudden onset of neurological symptoms * Hypoxia vs ischaemia (global vs focal) * Neurons are the most O2 sensitive cells * Haemorrhagic infarction in emboli (petechial lesions e.g. BM) * Ischaemic infarction in thrombosis * **Tolerate hypoxia better than ischaemia - lack of blood flow - damages neuronal tissue more than lack of oxygen**
32
_Ischaemic infarct histology_ * ... neuronal injury * '... neurons' * Pyknosis of nucleus * ... of the cell body * Loss of ... * Intense ... of cytoplasm * Owing to irreversible hypoxic/ischaemic insult
* Acute neuronal injury * 'red neurons' * Pyknosis of nucleus * Shrinkage of the cell body * Loss of nucleoli * Intense eosinophilia of cytoplasm * Owing to irreversible hypoxic/ischaemic insult
33
What is this showing?
ischaemic infarct
34
What is this showing?
* Old ischaemic infarct * Huge loss of tissue * Healing artifact - scarring
35
_Neoplasms_ * Primary or metastatic? * Approximately 75% ... (hence 25% ...) * 20%of malignant childhood tumours are located in the ... * Gliomas (astrocytoma, oligodendroglioma, glioblastoma) * ...iomas * Poorly differentiated neoplasms (medulloblastoma) * Primary CNS ... * Meta... (lung, breast, skin/melanoma, kidney, GI tract) * ... nerve tumours (schwannoma, neurofibroma, MPNST)
* Primary or metastatic? * **Approximately 75% primary (hence 25% metastatic)** * 20%of malignant childhood tumours are located in the **CNS** * Gliomas (astrocytoma, oligodendroglioma, glioblastoma) * Meningiomas * Poorly differentiated neoplasms (medulloblastoma) * Primary CNS lymphoma * Metastasis (lung, breast, skin/melanoma, kidney, GI tract) * Peripheral nerve tumours (schwannoma, neurofibroma, MPNST)
36
_Neoplasms_ * Primary or metastatic? * Approximately ...% primary (hence ...% metastatic) * 20%of malignant ... tumours are located in the CNS * ... (astrocytoma, oligodendroglioma, glioblastoma) * Meningiomas * ... differentiated neoplasms (medulloblastoma) * Primary CNS lymphoma * Metastasis (lung, breast, skin/melanoma, kidney, GI tract) * Peripheral ... tumours (schwannoma, neurofibroma, MPNST)
* Primary or metastatic? * Approximately 75% primary (hence 25% metastatic) * 20%of malignant childhood tumours are located in the CNS * Gliomas (astrocytoma, oligodendroglioma, glioblastoma) * Meningiomas * Poorly differentiated neoplasms (medulloblastoma) * Primary CNS lymphoma * Metastasis (lung, breast, skin/melanoma, kidney, GI tract) * Peripheral nerve tumours (schwannoma, neurofibroma, MPNST)
37
* Top left - early ... (...) increase in area, increase in areas of brain by tumour * Top right - ... - fast growing-haemorrhagic and necrotic * Bottom left - ... * Bottom right - ... - histologically
* **Top left - early glioblastoma (oligodendroglioma) increase in area, increase in areas of brain by tumour** * **Top right - glioblastoma - fast growing-haemorrhagic and necrotic** * **Bottom left - meningioma** * **Bottom right - meningioma - histologically**
38
_Infections - Neuropathology_ * Meningitis - ... of ... * Bacterial (acute or chronic) * ... * ... * RMSV, neurosyphilis, lyme disease, malaria * ... - usually bacterial * Encephalitis - viral (HSV, CMV, HIV, JC polyoma virus) * Localised - toxoplasmosis, cysticercosis
* Meningitis - inflammation of meninges * Bacterial (acute or chronic) * Viral * Fungal * RMSV, neurosyphilis, lyme disease, malaria * Abscess - usually bacterial * Encephalitis - viral (HSV, CMV, HIV, JC polyoma virus) * Localised - toxoplasmosis, cysticercosis
39
_Infections - Neuropathology_ * Meningitis - inflammation of meninges * ... (acute or chronic) * Viral * Fungal * RMSV, neurosyphilis, ... disease, malaria * Abscess - usually ... * E... - viral (HSV, CMV, HIV, JC polyoma virus) * Localised - toxoplasmosis, cysticercosis
* Meningitis - inflammation of meninges * Bacterial (acute or chronic) * Viral * Fungal * RMSV, neurosyphilis, lyme disease, malaria * Abscess - usually bacterial * Encephalitis - viral (HSV, CMV, HIV, JC polyoma virus) * Localised - toxoplasmosis, cysticercosis
40
What is this image showing?
41
Toxoplasmosis
Toxoplasmosis is a common infection that you can catch from the poo of infected cats, or infected meat.
42
_PROGRESSIVE / DEGENERATIVE CONDITIONS_ * ... diseases (Alzheimer d., Parkinson d.,) * ... degenerative diseases * Accumulation of protein aggregates leading to loss of cellular and subsequent loss of CNS functions: Dementia, behavioural and personality changes, language disturbance, movement and coordination disturbance, paralysis. * ... diseases (multiple sclerosis) * ... diseases (Creutzfeldt-Jakob disease) * ... metabolic diseases (Neuronal storage diseases) * Toxic & ... metabolic diseases (Vit B1 & B12 def., CO toxicity, alcohol toxicity, radiation toxicity)
* Neurodegenerative diseases (Alzheimer d., Parkinson d.,) * Spinocerebellar degenerative diseases * Accumulation of protein aggregates leading to loss of cellular and subsequent loss of CNS functions: Dementia, behavioural and personality changes, language disturbance, movement and coordination disturbance, paralysis. * Demyelinating diseases (multiple sclerosis) * Prion diseases (Creutzfeldt-Jakob disease) * Genetic metabolic diseases (Neuronal storage diseases) * Toxic & acquired metabolic diseases (Vit B1 & B12 def., CO toxicity, alcohol toxicity, radiation toxicity)

Year 2 Medicine (162 decks)

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