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202: Theme 1, Fundamental neuroscience and the brain > Neuropathology > Flashcards

Neuropathology Flashcards

(49 cards)

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1
Q

Role of CSF

A

Transport of metabolites

Cushions the brain and spinal cord

Immune regulation and defence

Auto regulation of blood flow to the brain

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2
Q

Circulation of CSF

A

[500ml a day circulates]

Lateral ventricle-[Foramen of Monro]—> Third ventricle
[Cerebral aqueduct]

Fourth ventricle–[Foramen of Luschka/ Magendie]–> Cisterna magna

Ascends over cerebellum and cerebral hemispher–[arachnoid granulation]–> Superior sagittal sinus

Ascends ventral subarachnoid space—> Over cerebral hemisphere—> arachnoid granulation…

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3
Q

Hydrocephalus Ex vacuo

A

Enlargement of ventricles and subarachnoid space due to shrinking of brain tissue.

Occurs in dementia

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4
Q

Raised intracranial pressure

  • Definition
  • Causes
A

CSF pressure above 200mm H2O

Causes:

  • Hydrocephalus
  • Intracranial space occupying lesion [neoplasm, bleed, abscess]
  • Cerebral oedema [e.g in hypoxia, injury, trauma]

Consequence= herniation

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5
Q

Herniations

- Different types

A

Subfalcine
- Cingulate gyrus dispace under the free edge of the falx cerebri

Central/ transtentorial
- Cerebral hemisphere tissue pushed through tentorium cerebelli

Tonsillar/ cerebellar

  • Cerebellar tissue pushed through foramen magnum
  • Can compress the medulla and cause breathing and cardiac impairments.
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6
Q

Duret haemorrhages

A

Small linear bleeds in the midbrain and upper pons.

- Caused by tonsillar herniation—> compression in medulla oblongata

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7
Q

Examples of space occupying lesions

A

Haemorrhages:

  • Extradural
  • Subdural
  • Subarachnoid
  • Intracerebral

Oedema + haemorrhage [from ischemic infarct]

Neoplasm
Abscess

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8
Q

Vascular brain injury causes [include vessels involved]

  • Extradural
  • Subdural
  • Subarachnoid
  • Intraparenchymal
A

Extradural bleed

  • Severe trauma with arterial laceration
  • Middle meningeal artery

Subdural

  • Trauma minor in atrophy
  • Caused by ruptured vein [bridging vein]
  • Seen in old age

Subarachnoid
- Rupture of saccular aneurysm in circle of willis

Intraparenchymal

  • Bleeding into the brain, from BV inside the brain.
  • Hypertension
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9
Q

Saccular aneurysm

A

Known as ‘berry aneurysm’
- Most common type of intracranial aneurysm

Can lead to subarachnoid haemorrhage if it ruptures

Vessels affected:

  • Anterior communicating [40%, most common]
  • Middle cerebral
  • Internal carotid
  • Tip of basilar
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10
Q

Cerebral oedema

- Causes

A

Vasogenic
- Increased vascular permeability

Cytotoxic
- Neuronal, glial/ endothelial cell damage

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11
Q

Global vs focal ischemia

A

Global- Includes wide range of brain tissue

  • Hypoxia [low O2 in blood]
  • Can still preserve brain if kept cold

Focal

  • Localised to brain tissue
  • Obstruction of blood flow
  • More dangerous
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12
Q

Hemorrhagic vs ischemic cerebral infarction

A

Haemorrhagic

  • Red blood cell in infarcted tissue
  • Caused by emboli
  • Petechial (small bleeds) lesions [ from bone marrow emboli]

Ischemic

  • Lack of blood flow= infarction
  • Caused by thrombosis
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13
Q

Histology of ischemic infarcts

A

ACUTE NEURONAL INJURY

Pyknosis [irreversible condensation of chromatin] in nucleus of neurones

Red neurones

Shrunken cell bodies

Loss of nucleoli

Eosinophilia [increased eosinophils] of cytoplasm

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14
Q

Glioma examples

A

Glioma- neoplasm of glial cells

Examples

  • Astrocytoma
  • Oligodendroglioma
  • Glioblastoma [very malignant]
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15
Q

Neoplasm of the brain example

A

[25% are metastatic]

Gliomas

Ganglion cell tumours- neural tumours

Meningiomas

Medulloblastoma [poorly differentiated]

Primary CNS lymphona

Peripheral nerve tumours

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16
Q

Peripheral nerve tumours example

A

Schwanoma - Schwann cells

Neurofibroma [nerve cell tumour]

MPNST [malignant peripheral sheath tumour]

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17
Q

Encephalitis

A

Inflammation of the brain

Viral causes:

  • Herpes simplex
  • CMV
  • HIV
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18
Q

Examples of parasitic infection of the brain

A

Toxoplasmosis

Cyscticerosis

-Localised infections

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19
Q

Spinocerebellar degenerative diseases

  • Definition
  • Symptoms
A

Accumulation of protein aggregates—> loss of cellular then CNS function

Symptoms:

  • Dementia
  • Personality changes
  • Language disturbance
  • Paralysis
  • Movement distrubance
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20
Q

Prion disease

Study These Flashcards
A

Progressive neurodegenerative condition

Example:
CJD [Creutzfeldt-Jakob]

21
Q

Consequences of head trauma

Study These Flashcards
A

Skull fracture

Contusion [bruise]
Laceration
Diffuse axonal injury [widespread lesion in white matter]

Vascular injury

22
Q

Coup and contrecoup head injury

Study These Flashcards
A

Coup- Injury of the brain occurs under the site of impact
- stationary head striking moving object.

Contrecoup

  • Injury occurs in the opposite site of where head was hit.
  • e.g moving head hitting a stationary object
23
Q

Hydrocephalus

  • Causes
  • Clinical differences
Study These Flashcards
A

Obstruction of CSF flow

Impaired arachnoid granulation absorption

Dementia- shrinking of brain tissue

Over production of CSF [rare]

Clinical classification

  • Communicating [or obstructive]
  • Non-communicating
24
Q

Concussion

Study These Flashcards
A

Clinical term used to describe symptoms associated head trauma

25
Spinal cord injury
C4 injury and above - May paralyse the diaphragm [C3-5 innervation] C4 injury below - Quadriplegia Thoracic spine injury - Paraplegia
26
Berry aneurysm risk factors - Lifestyle - Acquired conditions - Genetic
Lifestyle - Hypetension - Obesity - Smoking - Excessive alcohol Acquired conditions - Head trauma - Infections Genetics: - Marfan's syndrome - Autosomal dominant polycystic kidney disease - Ehlers-Danlos syndrome - Inherited hemorrhagic telangiectasia
27
Extradural bleed
Haemorrhage between the periosteum and periosteal dura mater. Causes: - ARTERIAL laceration from severe head trauma - Most likely of middle meningeal artery
28
Treatment of berry aneurysm
If ruptured - Decrease intracranial pressure [i.e craniotomy] - Restoration of respiration Prevention of rupture - Surgical clipping [craniotomy required] - Endovascular coiling [endovascular approach, radiology]
29
Subdural haemorrhage
Haemorrhage between the meningeal dura layer and arachnoid layer. Causes: - Ruptured bridging vein - Head trauma minor in atrophy - Shaken baby syndrome Risk factors: - Old age [more brittle veins and larger subdural space] - Infants [ larger subdural space] - Blood thinners - Dementia - Long-term alcohol use
30
Subarachnoid bleed
Hematoma between the subarachnoid matter and pia mater [subarachnoid space] Cause: - Rupture of saccular aneurysm in the Circle of Willis
31
Intraparenchymal bleed - Mechanism - Causes [9]
Haemorrhage into the neural parenchyma - Caused by rupture of small vessels within the brain - Can be accompanied with oedema Causes: - Hypertension - Sickle cell disease - Arteriovenous malformation - Amyloid deposits - Intracranial neoplasm - Coagulopathy - Infection - Vasculitis - Trauma
32
Cauda equina syndrome - Definition - Symptoms [7] - Causes [6]
Set of symptoms due to damage/compression of spinal cord below the cauda equina [end of spinal cord] Symptoms: - Severe back pain - Saddle anesthesia - Bladder and bowel dysfunction----> decreased tone of the urinary and anal sphincters. - Urinary retention---> Detrusor weaknesses - Weakness of the muscles of the lower legs (often paraplegia) - Sexual dysfunction - Absent anal reflex Cause: - Disc herniation in the lower region of the back. - Spinal stenosis - Neoplasm - Epidural abscess - Epidural hematoma - Trauma
33
Spine tumours
Primary - Tumour originated in spinal tissue Secondary - Metastatic - Originated from cancers, common to spread to bone - Breast, thyroid, prostate, lung [bronchi], myeloma Can compress spinal cord or spinal nerves
34
Spinal abscess
Caused by infection - Can be caused by IV drug use - Can destroy spinal disc Bacterial - S. aureus - TB - Meningitis Fungal
35
Causative agent of meningitis in the elderly [4]
Streptococcus pneumoniae Meningococcus Listeria monocytogenes
36
Causative agent of meningitis in newborns
Escherichia coli | Group B streptococci
37
Causative agent of meningitis in children
Streptococcus pneumoniae Meningococcus Haemophilus
38
Viral causative agents of meningitis
HIV HSV VZV CMV Enterovirus
39
Fungal causative agents of meningitis
Candida Crytococcus neoformans Histoplasma
40
Parasitic causative agents of meningitis
Angiostrongylus Schistosoma, Toxocariasis Schistosoma Cysticerosis
41
Signs and symptoms of meningitis
Stiff neck Vomiting Confusion Photophobia Butterfly rash- does not blanche under pressure.
42
Investigations for meningitis
Lumbar puncture [except when intracranial pressure is high, due to tonsillar herniation risk] - Cloudy CSF - Increased protein levels [viral] - Increased WBC count [bacterial] - Decreased glucose levels CT/MRI done before lumbar puncture to check ICP.
43
Meningitis risk factors
IV drug use Cerebral shunt Cochlear implant Young children- developmental abnormalities Skull trauma, allowing nasal cavity bacteria to enter CSF space
44
Non-infections causative agents of meningitis [5]
Drug interactions: - Antibiotics - Immunoglobulins - NSAIDs Sarcoidosis Malignant/metastatic Lupus erythematosus Vasculitis
45
Bacterial causative agents of meningitis for adults
Meningococcus [N.meningitides] | Step. pneumoniae
46
Causative agents for meningitis in the immunosuppressed
Meningococcus Step. pneumoniae Listeria monocytogenes virus, TB, fungi
47
Risk factors for spinal S.aureus abscess [5]
Skin abcess Septicaemia/ bacteraemia Back injury/ trauma Lumbar puncture Surgery
48
Intraparenchymal haemorrhage risk factors [6]
Age, >60 Hypertension System coagulopathies Vuscular malformations Vasculitis Cerebral amyloid angiopathy
49
Complications of subarachnoid haemorrhage
Acute: - Vasospasm= focal/global ischaemia Late: - Hydrocephalus due to scarring and CSF obstruction.

202: Theme 1, Fundamental neuroscience and the brain (27 decks)

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