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Neuropathology Flashcards

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1
Q

List the three pathways that brain damage results from

A

Hypoxia/ischemia, excitatory amino acids, cerebral edema

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2
Q

Differentiate between focal and global decreased blood flow in brain ischemia

A

Focal: CVA (stroke) from cerebral artery occlusion
Global: cardiac arrest, severe systemic blood loss (shock)

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3
Q

What are the three areas of greatest vulnerability in the brain during global ischemia?

A

Purkinje cells of cerebellum, sommer sector of hippocampus, laminar necrosis

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4
Q

List four brain injury mechanisms

A

Trauma, tumors, ischemia, infections

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5
Q

What condition is described as abrupt or sustained ischemia causing loss of flow to small penetrating arteries emerging at right angles from large vessels in the cortex?

A

Laminar necrosis

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6
Q

Describe the mechanism by which excitatory amino acids cause cell injury

A

Excess glutamate binds to NMDA receptor which displaces magnesium and causes the calcium influx into post synaptic neurons, triggering neuronal firing and free radical cell injury

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7
Q

Describe cytotoxic edema

A

Swelling of neurons during hypo-osmotic states

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8
Q

Describe vasogenic edema

A

Blood brain barrier disruption with water collection between neurons

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9
Q

When would cytotoxic edema occur?

A

During severe ischemia

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10
Q

When would vasogenic edema occur?

A

During hemorrhage, meningitis, trauma

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11
Q

What are three main methods of increasing ICP?

A

Expansion of brain tissue, expansion of blood volume, expansion of CSF

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12
Q

Breakdown ICP into percentages between brain tissue, blood, and CSF

A

Brain tissue: 80%
blood: 10%
CSF: 10%

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13
Q

What is a normal ICP?

A

0 to 15 mmHg

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14
Q

What is the cerebral perfusion pressure equation?

A

CPP=MAP-(CVP or ICP) whichever is highest

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15
Q

What is Cushing’s reflex and what is it a sign of?

A

Hypertension, bradycardia, and widened pulse pressure

are a sign of increased ICP and decreased CPP

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16
Q

What is a transtentorial herniation?

A

Displacement of brain tissue through the tentorium

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17
Q

What are two types of transtentorial herniation?

A

Central syndrome and uncal syndrome

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18
Q

Describe signs of uncal syndrome

A

Progressive drowsiness/unconsciousness, ipsilateral dilated pupil, decerebrate posturing, flaccid paralysis, respiratory arrest

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19
Q

Differentiate between decorticate and decerebate posturing

A

Decorticate: Lesions of corticospinal tract causing flexion of arms wrists and fingers and plantarflexion of feet
Decerebrate: lesions of brainstem causing rigid extension of palms away from body, plantarflexion of feet

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20
Q

Describe an epidural hematoma

A

Arterial tear that causes acute bleeding between bone and dura causing unconsciousness then lucid period, then deterioration (usually from head injury/skull fracture)

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21
Q

Describe a subdural hematoma

A

Tear in vein that causes lower bleeding between dura and arachnoid. Symptoms include confusion, headache, and depressed consciousness within 24 hours to one week of injury

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22
Q

Describe a subarachnoid bleed

A

Causes acute abrupt onset of stiff neck and headache progressing to loss of consciousness, causes aneurysm into CSF

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23
Q

Contrast ischemic and hemorrhagic strokes

A

Ischemic (87%) due to obstructed bloodflow

Hemorrhagic (13%) due to bleeding into brain substance

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24
Q

List seven potential etiologies of ischemic stroke

A

Carotid plaque with emboli, carotid stenosis, a. fib, cardiogenic emboli, intracranial arteriosclerosis, aortic arch plaque, small vessel (penetrating artery) disease

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25
What is a transient ischemic attack?
Brain angina without infarction, usually results in 24 hours with no permanent damage
26
What is a thrombotic CVA and what are the signs?
Occlusion of brain tissue from clot formation usually affecting the cortex Causes aphasia, visual field defects, monocular blindness
27
What is a lacunar infarction? What are the signs?
Occlusion of deep penetrating arteries in the non-cortical brain causing motor hemiplegia, sensory hemiplegia, dysarthria, and clumsy hand syndrome
28
What is a cardiogenic CVA?
A clot/thrombus (usually from left heart) that migrates to brain and lodges in cerebral artery
29
What are predisposing conditions to cardiogenic CVA?
A fib, recent AMI, endocarditis, ventricular aneurysm
30
Which three bacteria are responsible for majority of meningitis cases?
Strep pneumo, N meningitidis, H flu
31
What are risk factors for meningitis?
Recent URI, otitis media, sinusitis, sepsis, head trauma
32
What components of the CNS are affected by meningitis?
Pia, arachnoid, and subarachnoid space (involves brain and spinal cord)
33
What are symptoms of meningitis?
Fever, headache, stiff neck, photophobia, nausea/vomiting, altered mental status
34
What are three types of neuroglial tumors and which is the most common?
Infiltrating astrocytoma (most common), oligodendoglioma, ependyoma
35
What are signs and symptoms of brain tumors?
Seizures, headaches, focal neurological deficits (depends on location)
36
What is a meningioma?
A well-circumscribed, benign, slow-growing tumor outside the brain substance
37
What is myasthenia gravis?
Antibody mediated loss of functional acetylcholine receptors in neuromuscular junction
38
What are three mechanisms myasthenia gravis operates by?
Complement-mediated injury of postsynaptic membrane, receptor-specific antibodies with degradation, blockage of acetylcholine receptors by antibodies
39
List clinical signs of myasthenia gravis
Diminished motor function, muscle weakness/fatigue, difficulty swallowing/chewing, diplopia, ptosis
40
Contrast tetraplegia (quadriplegia) from paraplegia
Tetraplegia: loss of motor/sensory after damage to neural structure in cervical cord (arms, legs, trunk, pelvis affected) Paraplegia: loss of motor/sensory after damage of thoracic, lumbar or sacral cord (legs, trunk, pelvis impaired)
41
Describe central cord syndrome
Injury within central gray and white matter (usually of cervical cord) affecting motor function of upper extremities (spastic paresis)
42
Describe anterior cord syndrome
Damage to anterior 2/3 of cord from infarction of anterior spinal artery affecting motor in lower extremities and trunk; loss of pain/temperature sensation; preservation of vibration, position, and touch
43
Why are vibration, position, and touch sensations preserved, while pain and temperature sensations are not in anterior cord syndrome?
Vibration, position, and touch are in the dorsal column while pain and temperature sensations are in anterior column
44
What is Brown-Sequard syndrome?
Injury to half of spinal cord while opposite side remains intact causing loss of motor, vibration, position, and touch on ipsilateral side; loss of pain and temperature on contralateral side
45
Why are pain and temperature on contralateral side affected in Brown-Sequard syndrome?
Pain and temperature sensations cross over to the opposite side in the spinal cord while other senses (motor, vibration, position, touch) crossover in brainstem
46
Which sections of the spine are most commonly affected by radiculopathy?
Cervical and lumbar
47
Describe the pathology of intervertebral disc disease
Annulus fibrosis ruptures, nucleus pulposus impinges nerve root
48
Which roots give rise to sciatica?
L4 through S3
49
Which root values supply the Buttocks?
S3-S5, with some input from S1-2
50
What movements intensify sciatic nerve pain?
Coughing, straining, stooping, standing
51
List four examples of upper motor neuron disorders
MS, stroke, spinal cord injury, ALS (LMN disorder too)
52
What do MS, stroke, spinal cord injury, and ALS all have in common?
They are disorders of the upper motor neuron
53
List three places ALS causes progressive death of motor neurons
Anterior horn of cord (LMNs), motor nuclei of brainstem, UMNs of cerebral cortex
54
Which type of motor neurons are affected in ALS?
Upper and lower motor neurons
55
What effect on muscles does death of LMNs have?
Muscle atrophy
56
What are clinical symptoms of ALS?
Weakness, spasticity, stiffness, impaired fine motor skills, fasciculations, difficulty chewing/swallowing, and moving shoulder muscles
57
What is multiple sclerosis?
Demyelination with inflammation of myelin in central nervous system (PNS is spared)
58
What is the normal age of onset for MS?
20 to 40
59
What does demyelination in MS result in?
Conduction disorders and decreased velocity, sclerotic plaque development
60
List four places sclerotic plaques develop from myelin breakdown in MS
Optic nerve, periventricular white matter, cerebellum, spinal cord
61
What are clinical signs of MS?
Visual field defects, speech and swallowing defects, gait and coordination defects, weakness, fatigue, paresthesia with loss of vibratory sense, vertigo, sexual dysfunction
62
List two ways to diagnose MS
Elevated IgG levels in serum, protein and lymphocytes elevated in CSF from lumbar puncture

Pathophysiology (3 decks)

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