12 - pathology of CNS

Question 1

In meningitis, which meninges are inflamed?

Answer 1

Pia mater and arachnoid mater

Question 2

Symptoms of meningitis?

Answer 2

headache, neck stiffness, fever, photophobia, vomiting

Question 3

Causative organisms of meningitis in neonates, 2-5 years, 5-30 years, and 30+?

Answer 3

neonates - e coli 2-5 - Haemophilius influenzae 5-30 - Neisseria meningitides 30+ - Strep pneumoniae

Question 4

Complications of meningitis?

Answer 4

RICP, cerebral infarction, epilepsy, subdural empyema

Question 5

What is encephalitis?

Answer 5

Infection of neural parenchyma

Question 6

Symptoms of encephalitis?

Answer 6

Headache, fever, confusion, drowsiness, fatigue

Question 7

Causative organisms of encephalitis?

Answer 7

HSV, CMV, HIV

Question 8

What are prion disease examples?

Answer 8

Kuru, nvCJD, spongiform encephalopathy

Question 9

What is normal ICP?

Answer 9

0-10 mmHg, up to 20mmHg when coughing or straining

Question 10

What is raised ICP?

Answer 10

>60 mmHG

Question 11

How is cerebral blood flow maintained in raised pressure?

Answer 11

Reduced blood flow, reduced CSF volume, brain atrophy

Question 12

Symptoms of RICP?

Answer 12

headache, vomiting, papilloedema. Cushing reflex - increased blood pressure, reduced HR, irregular respiration

Question 13

What are the 3 types of herniation of the brain? Explain them and their resulting effects

Answer 13

Subfalcine - cingulate gyrus pushed under free edge of falx cerebri. results in ischemia in parietal and frontal lobe and corpus callosum due to compression of ACA.

Tentorial - Uncus herniates through tentorial notch. Damage to CN 3 and occlusion of cerebellar arteries

Tonsillar - cerebellar tonsils pushed into foramen magnum wtih compression of brainstem. cardiac arrest and apnoea

Question 14

Most common primary tumours of CNS? benign and malignant

Answer 14

benign - meningioma malignant - astrocytoma

Question 15

What is primary damage of a head injury?

Answer 15

The movement of the brain inside the skull. Can be divided into: - focal damage - bruising and laceration of brain at initial site of impact as well as the opposite side of the brain - Diffuse damage - tearing of axons due to injury. results in gliotic scarring, can lead to dementia

Question 16

What is the cause of a tension headache? How does it present? how do you treat?

Answer 16

neurovascular irritation from excessive tension in the scalp muscles. symptoms - tight band sensation, pressure behind eyes treat - paracetemol, analgesic withdrawal

Question 17

`What is a migraine headache? How does it present?

Answer 17

Recurrent headache with visual and GI disturbances. 4 phases - well being before attack, prodromal symptoms, main attack, sleep and feeling of being drained after. prodromal symptoms - aphasia and sensory changes

Question 18

What is a cluster headache? Which age group is it most common in?

Answer 18

Severe pain clustering around one eye. Most common in males from 30-40 yo

Question 19

What is temporal arteritis? Symptoms?

Answer 19

Inflammation of the arteries of the head.Artery becomes hard, tortuous, thickened. Symptoms - facial pain and visual provlems. severe malaise and tiredness.