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Clinical Neuroscience > 8.3.1 Neuropathology I > Flashcards

8.3.1 Neuropathology I Flashcards

1
Q

What is normal intracranial pressure?

A

0-10mmHg

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2
Q

What can cause an increase in intracranial pressure?

A

Cough and straining (toilet) can increase by up to 20mmHg, (transient)

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3
Q

What compensatory mechanisms are there to ensure that normal ICP is maintained?

A

Reduction in venous blood volume
Reduce CSF volume
Brain atrophy

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4
Q

What are the causes of raised ICP?

A
  • Haematoma/haemorrhages
  • Tumours
  • Space occupying lesions
  • Cerebral oedema
  • Infections
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5
Q

What are some effects of raised ICP?

A
  • Destruction of brain tissue around lesion/mass
  • Displacement of midline structures
  • Brain shifts- internal herniation
  • Cerebral oedema
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6
Q

What is the difference between a normal brain and one affected by oedema?

A

Loss of sulci
Bulging gyri

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7
Q

What are the different types of intracranial herniation?

A

Subfalcine- herniation under flax cerebri
Transtentorial- medial temporal lobe herniates over tentorium cerebelli
Tonsillar- cerebellum herniates through foramen magnum

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8
Q

What is damaged in a subfalcine herniation?

A

Ischaemia of medial parts of frontal and parietal lobes and corpus
callosum because compression of the anterior cerebral artery

Anterior cerebral artery supplies midline structures

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9
Q

What happens in a trans-tentorial herniation?

A

Uncus/medial part of the parahippocampal gyrus
through the tentorial notch:
- Damage to CN 3 (oculomotor nerve) on
ipsilateral (same) side
- Occlusion of the blood flow in posterior cerebral
and superior cerebellar arteries
resulting in ischaemia.
COMMON mode of death (tumours and ICH)

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10
Q

What can a trans-tentorial herniation lead to?

A

Duret haemorrhage- haemorrhage into brainstem due to brain being pushed downwards which causes the pontine vessel branches to be compressed

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11
Q

What happens in a tonsillar herniation?

A

Cerebellar tonsils pushed into foramen magnum compressing the brainstem

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12
Q

What are the 4 types of intracranial haemorrhages?

A

Extradural
Subdural
Subarachnoid
Intraparenchyma (haem strokes)

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13
Q

What causes an extradural haematoma?

A

Anterior branch of middle meningeal branch ruptured, runs underneath the pterion, thinnest part of the skull

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14
Q

Where does blood accumulate in an extradural haematoma?

A

Between potenital space between dura mater and skull- Lemon shape

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15
Q

What causes an extradural haemorrhage?

A

Trauma, skull fractures and scalp bruises

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16
Q

How do extradural haemorrhages present?

A

Lucid interval, then signs of drowsiness and neurological deficits

Takes >40-50mls to have pressure effects on the brain

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17
Q

What vessel causes a subdural haemorrhage?

A

Shearing of bridging, blood accumulates between dura mater and arachnoid mater, subdural potential space

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18
Q

How much blood is needed to cause effects in a subdural haemorrhage?

A

More than 40 ml= pressure effect
80-100mls=fatal raised ICP

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19
Q

What two types of subdural haemorrhage?

A

Acute-traumatic, rapid blood accumulation

Chronic- elderly and chronic alcholics (atrophy)

20
Q

What are subdural haemorrhages commonly associated with?

A

Assaults
Falls
RTCs
Minor head injuries (elderly)

21
Q

What are the important factors which are associated with increased risk of subdural haemorrhages?

A

Anticoagulant therapy or liver cirrhosis- coagulopathies, due to reduced production of clotting factors

On CT limited to one hemisphere, falx cerebri separates

22
Q

What vessel is damaged in a subarachnoid haemorrhage?

A

Shearing of meningeal blood vessels

Circle of willis, causes film of blood over the brain

23
Q

What are the two types of subarachnoid haemorrhage?

A

Traumatic
- Basal skull fractures
- Contusions

Spontaneous
- Ruptured berry aneurysm
- Amyloid angiopathy
- Vertebral artery dissection
- Arteriovenous malformations

24
Q

What is the usual cause of a subarachnoid haemorrhage?

A

Acute rise in ICP
e.g. from:
- Straining on the toilet
- Sex

Blood is forced into the subarachnoid space and causes ruptures

25
How do subarachnoid haemorrhages present?
Sudden onset of the worst ever headache in their life Rapid neurological deterioration Sudden collapse
26
Label the image and **complete the chance of berry aneurysm in each artery**
27
What is cerebrovascular disease (stroke)?
Sudden event producing a distubrance of CNS function due to vascular disease Clinical signs and symptoms dependent on vascular territory occluded and its size
28
What are the two types of stroke?
**Ischaemic (cerebral infarct)** - 85% of the time - Thrombotic occlusion - Embolic occlusion **Haemorrhagic stroke** - 15% of the time (10% intracerebral and 5% subarachnoid)
29
What are the risk factors of stroke?
Hyperlipidaemia Hypertension Diabetes mellitus
30
What happens in ischaemic stroke?
Obstruction of blood supply Damage can be limited if there is collateral supply from circle of willis
31
What vessel occlusion can lead to cerebral infarction?
Deep penetrating arteries with no collateral supply e.g. basal ganglia, thalamus etc. Watershed areas, areas that lie at most distal portion of artery territory
32
What are embolic ischaemic strokes caused by?
**Cardiac mural thrombus** - Attaches to walls of vessels and chambers in the heart, e.g. from MI **Atherosclerosis** - Carotid arteries and COW **Other emboli** - Via DVT and PFO
33
What artery is most commonly affected by embolic ischaemic occlusions?
Middle Cerebral artery Direct continuation of the ICA, emboli lodge in branches and areas where there is already atherosclerosis causing narrowing
34
What is the cause of thrombotic ischaemic stroke?
Thrombi overyling atherosclerotic plaques causing occlusion
35
What are the common sites of thrombotic ischaemic strokes?
Carotid bifurcation MCA origin Basilar artery Fragments can fall off and embolise to distal sites
36
What are lacunar infarcts?
Small penetrating arteries occluded causing tiny infarcts
37
Identify what this and describe the histology
Cerebral ischaemia Infiltration of infaction by neutrophils at edges of the lesion where there is intact vascular supply Infarction has macrophages (middle pic)
38
What is **spontaneous intracerebral** haemorrhage (stroke) caused by?
**Hypertension- 60 years +, rupture of small intraparenchymal blood vessels** Cerebral amyloid angiopathy Arteriovenous and cavernous malformations Tumours
39
What sites are commonly affected by spontaneous intracerebral haemorrhages?
Basal ganglia Thalamus Pons Cerebellum
40
What are the complications of spontaneous intracerebral haemorrhages?
Accumulation of hamorrhage leads to raised ICP Raised ICP causes midline shift and compression of adjacent brain parenchyma
41
What does this CT scan show?
Intracerebral and intraventricular haemorrhage
42
What does hypertension lead to within the brain?
Arteriosclerosis (thickened walls) Affects deep penetrating arteries and arterioles supplying : - Basal ganglia and thalamus - White matter - Brainstem
43
What is cerebral amyloid angiopathy?
Amyloid deposition in walls of small and medium sized meningeal and cortical vessels Leads to vessels becoming rigid and inflexible causing weakening Haemorrhage risk Causes lobal haemorrhages involving cerebral cortices and tiny microhaemorrhages
44
What are arteriovenous malformations?
* Worm-like tangled vascular channels * M>F 10-30 years * Affects subarachnoid vessels to brain / vessels in brain
45
What are cavernous malformations?
* Loose vascular channels * Distended and thin walled * Affects cerebellum and pons
46
What is capillary telangiectasia?
Microscopic foci of dilated thin walled vessels
47
What is a venous angioma?
Dilated venous channels

Clinical Neuroscience (45 decks)

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