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Clinical Neuroscience > Pathology > Flashcards

Pathology Flashcards

1
Q

What is normal intra cranial pressure?

A

0-10mmHg

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2
Q

Value of raised intracranial pressure

A

20mmHg

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3
Q

What is subfalcine herniation?

A

Herniation of cingulate gyrus under falx cerebri

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4
Q

What is a transtentorial herniation?

A

Herniation of medial temporal lobe (uncus) through tentorial notch (uncal herniation)

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5
Q

What is a tonsilliar herniation?

A

Herniation of cerebellar tonsils through foramen magnum (coning)

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6
Q

What is at risk in a uncal/transtenorial herniation?

A

Oculomotor nerve
Posterior cerebral artery
Superior cerebellar arteries

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7
Q

What is a duret haemorrhage?

A

Secondary haemorrhage into brainstem due to downwards displacement of brain

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8
Q

What is an extra dural haemorrhage between?

A

Inner table to periosteum + dura mater

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9
Q

What vessel is damaged in an extra dural haemorrhage?

A

Middle meningeal artery

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10
Q

What is a sub dural haemorrhage between?

A

Dura mater + arachnoid mater

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11
Q

What vessel is damaged in subdural haemorrhage?

A

Bridging veins

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12
Q

Categories of subdural haemorrhage + causes

A
  • acute: trauma > rapid accumulation of blood
  • chronic: elderly + chronic alcoholics (atrophy of brain)
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13
Q

Categories of subarachnoid haemorrhages + causes

A
  • traumatic: basal skull fractures + contusions
  • spontaneous: ruptured berry aneurysm, amyloid angioplasty, vertebral artery dissection, arteriovenous malformation
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14
Q

What are contusions?

A

Brain bruising

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15
Q

What is the most common cause of subarachnoid haemorrhage?

A

Ruptured berry aneurysm

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16
Q

What is the most common location of berry aneurysm?

A

Anterior cerebral artery

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17
Q

Who are subarachnoid haemorrhages more common in?

A
  • Connective tissue disorders e.g. ehlers danlos syndrome
  • polycystic kidney disease
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18
Q

Risk factor for a stroke

A

Hyperlipidaemia
Hypertension
Diabetes mellitus

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19
Q

Two categories of strokes

A

Ischaemic (cerebral infarct) (most common)
Haemorrhagic

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20
Q

What can ischaemic strokes be caused by?

A

Thrombotic occulsion
Embolic occulsion (most common)

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21
Q

What type of necrosis do you get in the brain?

A

Coagulative necrosis (wedge shaped)

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22
Q

What vessel is most affected in stroke caused by embolic occulsion?

A

Middle cerebral artery
Direct extension of ICA

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23
Q

What is the most common type of stroke?

A

Embolic occlusion ischaemic stroke

24
Q

Common sites of strokes due to isachemic stroke

A

Carotid bifurcation
Basilar artery
Origin of middle cerebral artery

25
Q

Common causes of spontaneous intra cerebral haemorrhage (stroke)

A
  • Hypertension (most common)
  • cerebral amyloid angiopathy
  • arteriovenous + cavernous malformations
  • tumours
26
Q

Most common cause of spontaneous intracerebral haemorrhage

A

Hypertension > rupture of small intraparenchymal blood vessels

27
Q

Common sites affected in spontaneous intracerebral haemorrhage

A

Basal ganglia
Thalamus
Pons
Cerebellum

28
Q

What is cerebral amyloid angiopathy?

A

Amyloid deposition in walls of small + medium sized meningeal + cortical vessels

29
Q

Difference between hypertensive + cerebral amyloid angiopathy stroke

A
  • hypertension: deeper within the brain
  • CAA: lobar
30
Q

What are cavernous malformations?
Where are they commonly?

A
  • Loose vascular channels with are distended + thin walled
  • Cerebellum + pons
31
Q

What are arteriovenous malformations

A

Wormlike (tangled) vascular channels

32
Q

Types of primary CNS tumours

A
  • gliomas
  • parenchymal
  • meningeal
  • neuronal
  • poorly differentiated - medulloblastoma
33
Q

What are secondary CNS tumours?

A

Tumours which have metastasised from elsewhere

34
Q

Types of gliomas tumours

A
  • astrocytic tumours (most common - astrocytoma)
  • glioblastoma multiforme
  • olgiodendrogliomas
  • ependyomas
  • colloid cysts of 3rd ventricle
35
Q

What are ependymomas?

A

Tumours of brain ventricles

36
Q

Are gliomas benign or malignant?

A

Malignant

37
Q

Where do germ cell tumours arise in the CNS

A

Midline tumours
Pineal
Suprasellar

38
Q

Are meingiomas benign or malignant?

A

Benign

39
Q

How can microbes enter the CNS?

A
  • direct local spread: air sinuses, skull fractures, infected teeth, middle ear infections
  • haematogenous: arterial blood, retrograde venous between face + skull
  • iatrogenic: lumbar puncture, VP shunts
  • peripheral nerves: herpes zoster virus
40
Q

What can infections of the CNS affect?

A

Meninges
Aggregates of acute inflammation
Brain parenchyma

41
Q

What is meningitis?

A

Inflammation of leptomeninges

42
Q

Types of meningitis

A
  • acute pyogenic (bacteria)
  • aseptic (viral)
  • chronic (mycobacterium TB, fungi)
  • carinomastosis
43
Q

Symptoms of meningitis

A
  • headache
  • photophobia
  • stiff neck
  • non blanching rash
  • altered consciousness
44
Q

What is encephalitis?

A

Infection of brain parenchyma

45
Q

Examples of viral causes of encephalitis + where they effect

A
  • herpes zoster virus: temporal lobe
  • polio: spinal cord motor neurones
  • rabies: brain stem
46
Q

What is prion disease?

A

Abnormal cellular protein accumulation > cell injury > neurone cell death | synapse loss | microvasculations

47
Q

Types of causes of prion disease

A

Sporadic
Familial
Iatrogenic

48
Q

Types of prion disease

A
  • Creutzfeldt-Jakob disease
  • Scrapies
  • Bovine spongiform encephalopathy (mad cow disease)
49
Q

Mechanism of prion disease

A
  • Mutation of protein > conformational change
  • change from a helix to B pleated sheet
  • abnormal protein is more resistance to proteolysis
    + harder to get rid of
  • causes normal proteins to undergo conformational change > both become abnormal
50
Q

Why is prion disease classified as infective?

A

Abnormal protein can cause normal proteins to undergo conformational change > more abnormal proteins

51
Q

Outline creutzfeld Jakob disease

A
  • familial
  • > 70 years old
  • rapidly progressive dementive illness
  • subtle changes in memory
  • cerebellar ataxis + global dementia
52
Q

Definitive diagnosis of creutzfeld Jakob disease

A

Post mortem examination

53
Q

Presentation of creutzfeld Jakob disease

A

Dementia
Early neurological signs

54
Q

Outline variant creutzfeld Jakob disease

A
  • young adults
  • slower progression to CKD
  • starts with behavioural issues
  • due to exposure to prion disease in cattle BSE
55
Q

Presentation of variant creutzfeld Jakob disease

A
  • behavioural issues
  • painful dyesthesiasis
  • delayed neurological signs
56
Q

What is dysesthesia?

A

Abnormal physical touch sensation without outside cause

Clinical Neuroscience (20 decks)

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