Pathology

Question 1

What is normal intra cranial pressure?

Answer 1

0-10mmHg

Question 2

Value of raised intracranial pressure

Answer 2

20mmHg

Question 3

What is subfalcine herniation?

Answer 3

Herniation of cingulate gyrus under falx cerebri

Question 4

What is a transtentorial herniation?

Answer 4

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

Question 5

What is a tonsilliar herniation?

Answer 5

Herniation of cerebellar tonsils through foramen magnum (coning)

Question 6

What is at risk in a uncal/transtenorial herniation?

Answer 6

Oculomotor nerve
Posterior cerebral artery
Superior cerebellar arteries

Question 7

What is a duret haemorrhage?

Answer 7

Secondary haemorrhage into brainstem due to downwards displacement of brain

Question 8

What is an extra dural haemorrhage between?

Answer 8

Inner table to periosteum + dura mater

Question 9

What vessel is damaged in an extra dural haemorrhage?

Answer 9

Middle meningeal artery

Question 10

What is a sub dural haemorrhage between?

Answer 10

Dura mater + arachnoid mater

Question 11

What vessel is damaged in subdural haemorrhage?

Answer 11

Bridging veins

Question 12

Categories of subdural haemorrhage + causes

Answer 12

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

Question 13

Categories of subarachnoid haemorrhages + causes

Answer 13

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

Question 14

What are contusions?

Answer 14

Brain bruising

Question 15

What is the most common cause of subarachnoid haemorrhage?

Answer 15

Ruptured berry aneurysm

Question 16

What is the most common location of berry aneurysm?

Answer 16

Anterior cerebral artery

Question 17

Who are subarachnoid haemorrhages more common in?

Answer 17

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

Question 18

Risk factor for a stroke

Answer 18

Hyperlipidaemia
Hypertension
Diabetes mellitus

Question 19

Two categories of strokes

Answer 19

Ischaemic (cerebral infarct) (most common)
Haemorrhagic

Question 20

What can ischaemic strokes be caused by?

Answer 20

Thrombotic occulsion
Embolic occulsion (most common)

Question 21

What type of necrosis do you get in the brain?

Answer 21

Coagulative necrosis (wedge shaped)

Question 22

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

Answer 22

Middle cerebral artery
Direct extension of ICA

Question 23

What is the most common type of stroke?

Answer 23

Embolic occlusion ischaemic stroke

Question 24

Common sites of strokes due to isachemic stroke

Answer 24

Carotid bifurcation
Basilar artery
Origin of middle cerebral artery

Question 25

Common causes of spontaneous intra cerebral haemorrhage (stroke)

Answer 25

- Hypertension (most common) - cerebral amyloid angiopathy - arteriovenous + cavernous malformations - tumours

Question 26

Most common cause of spontaneous intracerebral haemorrhage

Answer 26

Hypertension > rupture of small intraparenchymal blood vessels

Question 27

Common sites affected in spontaneous intracerebral haemorrhage

Answer 27

Basal ganglia Thalamus Pons Cerebellum

Question 28

What is cerebral amyloid angiopathy?

Answer 28

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

Question 29

Difference between hypertensive + cerebral amyloid angiopathy stroke

Answer 29

- **hypertension**: deeper within the brain - **CAA**: lobar

Question 30

What are cavernous malformations? Where are they commonly?

Answer 30

- Loose vascular channels with are distended + thin walled - Cerebellum + pons

Question 31

What are arteriovenous malformations

Answer 31

Wormlike (tangled) vascular channels

Question 32

Types of primary CNS tumours

Answer 32

- gliomas - parenchymal - meningeal - neuronal - poorly differentiated - medulloblastoma

Question 33

What are secondary CNS tumours?

Answer 33

Tumours which have metastasised from elsewhere

Question 34

Types of gliomas tumours

Answer 34

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

Question 35

What are ependymomas?

Answer 35

Tumours of brain ventricles

Question 36

Are gliomas benign or malignant?

Answer 36

Malignant

Question 37

Where do germ cell tumours arise in the CNS

Answer 37

Midline tumours Pineal Suprasellar

Question 38

Are meingiomas benign or malignant?

Answer 38

Benign

Question 39

How can microbes enter the CNS?

Answer 39

- **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

Question 40

What can infections of the CNS affect?

Answer 40

Meninges Aggregates of acute inflammation Brain parenchyma

Question 41

What is meningitis?

Answer 41

Inflammation of leptomeninges

Question 42

Types of meningitis

Answer 42

- **acute pyogenic** (bacteria) - **aseptic** (viral) - **chronic** (mycobacterium TB, fungi) - **carinomastosis**

Question 43

Symptoms of meningitis

Answer 43

- headache - photophobia - stiff neck - non blanching rash - altered consciousness

Question 44

What is encephalitis?

Answer 44

Infection of brain parenchyma

Question 45

Examples of viral causes of encephalitis + where they effect

Answer 45

- **herpes zoster virus**: temporal lobe - **polio**: spinal cord motor neurones - **rabies**: brain stem

Question 46

What is prion disease?

Answer 46

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

Question 47

Types of causes of prion disease

Answer 47

Sporadic Familial Iatrogenic

Question 48

Types of prion disease

Answer 48

- Creutzfeldt-Jakob disease - Scrapies - Bovine spongiform encephalopathy (mad cow disease)

Question 49

Mechanism of prion disease

Answer 49

- 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

Question 50

Why is prion disease classified as infective?

Answer 50

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

Question 51

Outline creutzfeld Jakob disease

Answer 51

- familial - >70 years old - rapidly progressive dementive illness - subtle changes in memory - cerebellar ataxis + global dementia

Question 52

Definitive diagnosis of creutzfeld Jakob disease

Answer 52

Post mortem examination

Question 53

Presentation of creutzfeld Jakob disease

Answer 53

Dementia Early neurological signs

Question 54

Outline variant creutzfeld Jakob disease

Answer 54

- young adults - slower progression to CKD - starts with behavioural issues - due to exposure to prion disease in cattle BSE

Question 55

Presentation of variant creutzfeld Jakob disease

Answer 55

- behavioural issues - painful dyesthesiasis - delayed neurological signs

Question 56

What is dysesthesia?

Answer 56

Abnormal physical touch sensation without outside cause