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4 Neurology > 12 Neuropathology > Flashcards

12 Neuropathology Flashcards

1
Q

How can microorganisms gain entry to the CNS (the CNS is normally sterile) (3)?

A
  1. Direct spread (from middle ear, basal skull fracture, even through ethmoid bone)
  2. Blood-borne in sepsis or infective endocarditis
  3. Iatrogenic (post neurosurgery, ventriculoperitoneal shunt, lumbar puncture)
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2
Q

Give some causative organisms for meningitis.

A

Neonates – E. coli

2-5 years old – Haemophilus influenza

5-30 years – Neisseria meningitidis (‘meningococcus’)

Immunocompromised patients – a variety of organisms e.g. fungi

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3
Q

What is the causative organism for chronic meningitis? What complications can occur as a result of chronic meningitis? (3)

A

Caused: Mycobacterium tuberculosis

Complications:

  1. Meningeal fibrosis
  2. Cranial nerve entrapment
  3. Bilateral adrenal haemorrhage (Waterhouse-Friederichsen syndrome)h
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4
Q

State some local complications of meningitis (other than the 3 known for chronic meningitis: meningeal fibrosis, cranial nerve entrapment, bilateral adrenal haemorrhage).

A
  • Raised ICP
  • Cerebral abscess
  • Cerebral infarction (stroke)
  • Subdural empyema
  • Epilepsy
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5
Q

What is encephalitis and how is usually caused?

A

ENCEPHALITIS= Inflammation of brain parenchyma not meninges (but can occur as a complication of meningitis)

Cause: usually viral

Virus:

  • Kills neurones causing:
    • inflammation
    • presence of intracellular viral inclusions
  • Lymphocytic infiltrate=typical
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6
Q

Which virus usually causes encephalitis in each of the following?

  • Temporal lobe
  • Spinal cord
  • Brainstem
A
  • Temporal lobe: Herpesviruses (most common)
  • Spinal cord: Polio (now eradicated)
  • Brainstem: Rabies (very rare)
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7
Q

How is the damage in alzheimer’s dementia caused? (2)

A

Damage= caused by:

  • Neurofibrillary tangles
    • Intracellular twisted filaments of Tau protein- caused by hyperphosphorylation
    • Tau normally binds to microtubules
  • Amyloid plaques
    • Foci of enlarged axons, synaptic terminals and dendrites
    • Amyloid deposition in centre of plaque associated with vessels
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8
Q

Explain why having trisomy 21 is associated with Alzheimer’s disease.

A

Amyloid precursor protein (APP) found on chromosome 21 –> extra dose of gene in patients with Down’s syndrome

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9
Q

Give 2 gene mutuations associated with alzheimer’s dementia.

A
  1. APP
  2. Presenelin
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10
Q

What is normal intracranial pressure? What can coughing or straining increase it to?

A

Normal: 0-10 mmHg

Coughing/straining: up to 20 mmHg

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11
Q

What compensatory mechanisms are in place to compensate for increased intracranial pressure?

A

Compensatory mechanisms:

  • Reduce blood flow and CSF volume
  • Brain atrophy is chronically elevated

Cerebral blood flow- can be maintained as long as ICP <60mmHg

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12
Q

What are the consequences of having a space occupying lesions (in the brain tissue)?

A
  • Deforms/destroys surrounding brain
  • Displaces midline structures- loss of symmetry, shift
  • Brain herniation
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13
Q

State 2 major types of brain herniation.

A

Subfalcine herniation

  • Cingulate gyrus pushed under free edge of falx cerebri
  • Can become ISCHAEMIC if anterior cerebral artery compressed

Tentorial herniation

  • Uncus (medial temporal lobe) pushed down through tentorial notch (free edge of tentorium cerebelli)
  • Can compress OCULOMOTOR NERVE and ispisilateral CEREBRAL PEDUNCLE causing ipsilateral 3rd nerve palsy but contralateral UMN signs in limbs
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14
Q

What complication can follow on from a tentorial herniatiton which is the usual mode of death for those with a large brain tumour ?

A

Secondary brainstem haemorrhage (Duret haemorrhage)

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15
Q

Give an example of a benign brain tumour.

A

Meningioma

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16
Q

Give an examples of a malignant brain tumour.

How does it spread?

A

Astrocytoma

Low grade= slow growing but difficult to remove

High grade= glioblastoma multiforme

Spread:

  • Direct spread along white matter pathways
  • Can spread to distant parts of CNS via CSF
17
Q

Give some other types of brain tumours other than meningiomas and astrocytomas.

A
18
Q

What is a stroke? What are the main risk factors? (4)

A

A sudden event- producing a disturbance in CNS function due to vascular disease

2/1000 of general population per year

Risk factors:

  1. Hyperlipidaemia
  2. Hypertension
  3. Smoking
  4. Diabetes
19
Q

85% of strokes result in cerebral infarction. Differentiate between regional and lacunar infarction.

A
20
Q

Cerebral haemorrhages result from about 15% of all strokes. Differentiate between an intracerebral haemorrhage and a subarachnoid haemorrhage.

A
21
Q

Explain how spongiform encephalopathies can be caused by abnormal prion proteins.

A

4 Neurology (22 decks)

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