4: Neuropathology 2

Question 1

Where is CSF produced?

Answer 1

Choroid plexuses of lateral, third and fourth ventricles

Question 2

What is the other name for the cerebral aqueduct?

Answer 2

Aqueduct of Sylvius

Question 3

Where is CSF reabsorbed?

Answer 3

Arachnoid granulations -> Sagittal sinus

Question 4

What are three problems with CSF which can cause hydrocephalus?

Answer 4

Overproduction

Lack of absorption

Obstruction

Question 5

What is

a) non-communicating
b) communicating

hydrocephalus?

Answer 5

a) Non-communicating - blockage within ventricles prevents CSF flow

b) Communicating - blockage elsewhere e.g subarachnoid space or granulations causes CSF blockage and hydrocephalus

Question 6

What happens if hydrocephalus occurs before the skull bones have fused?

Answer 6

Head enlargement

Question 7

An increase in CSF volume leads to an increase in ___ ___.

Answer 7

intracranial pressure

Question 8

What happens to the brain in response to raised intracranial pressure?

Answer 8

Compression

then Herniation

Question 9

Why is brain herniation so dangerous?

Answer 9

Compression of cranial nerves and centres

Question 10

How is cerebral perfusion pressure calculated?

Answer 10

MAP - ICP

Question 11

What are the symptoms of a raised ICP?

Answer 11

Headaches

N&V

Papilloedema

Neck stiffness

Question 12

What are some examples of space occupying lesions?

Answer 12

Tumour

Abscess

Haematoma

Cerebral oedema

Question 13

Why are the focal headaches associated with SOLs worse in the morning?

Answer 13

During sleep you become slightly hypercapnic

Which increases pressure

Question 14

On which side of the tentorium cerebelli do brain tumours tend to arise in

a) adults
b) children?

Answer 14

a) above
b) below

Question 15

Brain tumours most commonly found in the population are (primary / secondary).

Answer 15

Secondary

metastatic cancers from liver, breast, lungs…

Question 16

Why are all brain tumours considered dangerous?

Answer 16

Compression effect

Even benign tumours grow slowly

Question 17

What is the most common type of primary brain tumour in adults?

Answer 17

Astrocytoma (tumour of astrocytes, supporting cells)

Question 18

Which grade of astrocytoma does not progress?

Who tends to get them?

Answer 18

Grade I

Children

Question 19

Which grades of astrocytoma have the potential to become very malignant?

Answer 19

II, III and IV

Question 20

What is a Grade IV astrocytoma called?

Answer 20

Glioblastoma

Question 21

What is the 2nd most common primary brain tumour in children?

Where in the brain is it found?

Answer 21

Medulloblastoma

Cerebellum

Question 22

Medulloblastomas are (well / poorly) differentiated and have a (good / poor) prognosis.

Answer 22

poorly differentiated

poor prognosis

Question 23

What therapy is medulloblastoma susceptible to?

Answer 23

Radiotherapy

Question 24

What is an abscess?

Answer 24

Empty space filled with pus

Question 25

What are the symptoms of a **brain abscess**?

Answer 25

**Fever** And **raised ICP symptoms** (headache, N&V, visual problems, neck stiffness)

Question 26

How are **brain abscesses** investigated and treated?

Answer 26

**Brain imaging** (CT / MRI) **Aspiration** \> **Antibiotics**

Question 27

What is meant by missile and non-missile trauma?

Answer 27

Missile - penetrating Non-missile - blunt

Question 28

Penetrating head trauma tends to affect a ___ area.

Answer 28

focal area

Question 29

The greater the ___ of a projectile, the greater the size of the injury it causes.

Answer 29

velocity

Question 30

What happens to the head in a blunt force injury?

Answer 30

Sudden change in momentum

Question 31

The greater the ___ time of a blunt force injury, the smaller the force exerted on the brain.

Answer 31

contact time

Question 32

What happens to the brain within the skull in a blunt force injury?

Answer 32

Thrown around against cranial bones and protrusions

Question 33

What is the primary injury of head trauma? Is it reversible or irreversible?

Answer 33

Initial damage to brain irreversible

Question 34

What are some examples of secondary injury to brain trauma?

Answer 34

Haemorrhage Oedema Infection Hypoxia Raised ICP

Question 35

What are a) linear b) compound c) depressed skull fractures?

Answer 35

a) Straight break b) Involving scalp, open injury c) Dents

Question 36

Skull fractures are very ___ \_\_\_ injuries.

Answer 36

high energy

Question 37

What is a coup-contracoup injury?

Answer 37

In terms of head injury: coup - injury to brain on the side of its impact within the skull contracoup - rebound injury on the opposite side of the skull

Question 38

Which impact tends to be worse in a coup-contracoup injury?

Answer 38

Contracoup

Question 39

What is **diffuse axonal injury**?

Answer 39

**Shearing damage to neurons** due to impact injury

Question 40

Diffuse axonal injury tends to affect ___ brain structures. What are the symptoms?

Answer 40

midline LOC, coma, vegetative state

Question 41

Which a) neurotransmitter b) ion is released in response to acute brain injury?

Answer 41

a) Glutamate b) Ca2+ also known as excitotoxicity

Question 42

What is a haematoma?

Answer 42

Collection of blood within the brain

Question 43

Most haematomas are found within the dura. What does the swelling of a haematoma cause?

Answer 43

Raised ICP Brain herniation

Question 44

Which **artery** may be disrupted by trauma to the area around the pterion?

Answer 44

**Middle meningeal artery**

Question 45

What type of injury occurs if the middle meningeal artery is damaged?

Answer 45

Extradural haemorrhage

Question 46

Subdural haematomas are more common in which group of patients?

Answer 46

Elderly

Question 47

Chronic Subdural haematomas are associated with ___ of the brain in elderly people.

Answer 47

atrophy