Anatomy and pattern recognition of the central nervous systemnormal radiographic appearances and pathology Flashcards

1
Q

What are the functions of the nervous system?

A

Sensory input- gathers info, sound, glucose levels. This involves gathering information from sensory receptors that monitor changes both inside and outside the body.For example, sensory neurons detect stimuli like temperature, light, and sound, and send this information to the central nervous system (CNS) for processing1.

Integration- Once the sensory input reaches the CNS, it is processed and interpreted. The CNS, which includes the brain and spinal cord, analyzes the sensory data and decides on an appropriate response.This step is crucial for making sense of the information and determining the necessary action2.

Motor output- response, sends signals to organs. After integration, the nervous system sends signals from the CNS to effector organs, such as muscles and glands, to initiate a response. This could be anything from moving a muscle to secreting a hormone.Motor neurons carry these signals to the target organs to execute the response3.
These functions work together seamlessly to help the body respond to its environment and maintain homeostasis

Homeostasis regulation- maintain internal stability eg temp.Homeostasis is the process by which biological systems maintain a stable internal environment despite changes in external conditions. This stability is crucial for the survival and proper functioning of organisms. Here are the key aspects of homeostasis:
Definition: Homeostasis refers to the self-regulating processes that organisms use to maintain internal stability.This includes regulating temperature, pH levels, glucose concentration, and other vital conditions1.

Mechanisms: Homeostasis involves feedback mechanisms, primarily negative feedback, which counteracts changes to bring the system back to its set point.For example, if body temperature rises, mechanisms like sweating and increased blood flow to the skin help cool the body down2.

Examples:
Body Temperature: The human body maintains a temperature around 37°C (98.6°F).If it gets too hot, the body sweats to cool down; if it gets too cold, the body shivers to generate heat1.
Blood Glucose Levels: The pancreas regulates blood sugar by releasing insulin when glucose levels are high and glucagon when they are low2.
Water Balance: The kidneys regulate water balance by adjusting the concentration of urine based on the body’s hydration levels2.
Homeostasis ensures that the body’s internal environment remains consistent, allowing cells and organs to function optimally

Mental activities

Reflex actions

Provides an immediate response when required.

Provide a slower, long term response when required through stimulation of endocrine system and release of hormones

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2
Q

The human nervous system is incredibly complex and performs several vital functions to keep the body operating smoothly. Here are the main functions:

A

Sensory Input: The nervous system gathers information from sensory receptors that detect changes both inside and outside the body.This includes sensations like touch, temperature, pain, and sound1.

Integration: The central nervous system (CNS), which includes the brain and spinal cord, processes and interprets sensory input.It integrates this information to make decisions and coordinate appropriate responses2.

Motor Output: After processing the sensory input, the nervous system sends signals to muscles and glands to elicit responses.This could involve moving a muscle, secreting a hormone, or other actions3.

Homeostasis Regulation: The nervous system helps maintain homeostasis by regulating bodily functions such as heart rate, blood pressure, digestion, and body temperature4.

Mental Activities: It is responsible for higher functions such as thinking, memory, learning, and emotions.The brain processes complex information and enables cognitive functions5.

Reflex Actions: The nervous system controls reflexes, which are automatic responses to certain stimuli.These reflexes help protect the body from harm, such as pulling your hand away from a hot surface6.
These functions are carried out by the central nervous system (CNS) and the peripheral nervous system (PNS), working together to ensure the body responds appropriately to various stimuli and maintains internal balance

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3
Q

Overview of the organisation of the nervous system

A

Central nervous system- brain and spinal cord

Peripheral nervous system- Peripheral is all the nerves outside of the CNS – divided into sensory and motor.

Sensory- – carries information from sensory receprors to the CNS

Motor- transmits signals from the CNS t effector rogans like the muscles

Somatic- voluntary movements e.g. walking, talking,

Autonomic nervous system- involuntary like heart rate, digestion and respiratory rate.
Further divided into sympathetic and parasympathetic.

Sympathetic- prepares body for flight or fight response (increases heart rate, releases energy).

parasympathetic- – rest and digest activities – slows heart raterelaxing sphincter muscles

Principal cells – glia – provide support and protection for neurons. Form myelin and maintain homeostasis

Neuron – primary cells of the CNS that transmit electrical and chemical signals.

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4
Q

What is myelin?

A

It is a fatty sheath that wraps around the axons of neurons (the bit of the neuron that conducts electrical impulses away from the neuron cells body)
Composed of lipids and proteins
Insulates the axons and increases the speed of electrical impulses as they travel along nerve cells.
Produced by Glia cells
CNS – oligodendrocytes
PNS – Schwann cells

Helps transmit electrical impulses. helps with all responses.

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5
Q

What are neuron’s?

A

Sometimes called a ‘nerve cell’
Is the fundamental structural unit of the nervous system which transmits information throughout the body.

Types of neurons
Sensory neurons
Motor neurons
Interneurons

Special characteristics
Longevity
Amitotic
High metabolic rate

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6
Q

What is longevity in neurons?

A

Neurons can live and function for a lifetime.Unlike many other cells in the body, which are regularly replaced, neurons are generally not replaced once they are lost1.

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7
Q

What is amitotic in neurons?

A

Most neurons do not undergo mitosis after they are fully developed. This means they do not divide and reproduce.Once a neuron is damaged or dies, it is typically not replaced2.

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8
Q

What is High Metabolic Rate?

A

Neurons have an exceptionally high metabolic rate. They require a continuous supply of oxygen and glucose to function properly.This high demand for energy is due to their role in transmitting electrical impulses and maintaining the ionic gradients necessary for signal transmission.

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9
Q

What is grey and white matter?

A

Grey Matter – collections of nerve cell bodies and their dendrites
Nuclei
Ganglia

White matter – myelinated fibres – tracts conveying nerve impulses from generation site to target

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10
Q
A

Membrane potential
Difference of charges across the plasma membrane. refers to the difference in electrical charge across a cell’s plasma membrane.This difference is due to the unequal distribution of ions inside and outside the cell1.

Resting potential is the membrane potential of a neuron when it is not actively transmitting a signal. In this state, the inside of the neuron is negatively charged relative to the outside.Typically, the resting potential is around -70mV2.
Difference of Charges: At rest, there are more positive ions (Na⁺) outside the cell and more negative ions (K⁺) inside the cell.This creates a negative charge inside the cell and a positive charge outside2.
Resting cells are (-) inside and (+) outside
Large amounts of Na+ outside the cell and K+ inside

Action potential/impulse. Anaction potentialis a rapid change in membrane potential that travels along the axon of a neuron. It is the electrical impulse that neurons use to communicate.
Rapid Reversals: During an action potential, the charges across the membrane reverse rapidly.The inside of the cell becomes positive relative to the outside3.
Ion Exchange: This reversal is caused by the movement of ions across the neuron’s membrane.Sodium ions (Na⁺) rush into the cell, followed by potassium ions (K⁺) rushing out3.
Rapid reversals in charges across the plasma membrane
Caused by the exchange of ions across the membrane of the neuron
Threshold level (-55mV) needed to stimulate neurons ALL-OR-NONE principle. Thethreshold levelis the critical level to which the membrane potential must be depolarized to initiate an action potential. For most neurons, this threshold is around -55mV.

All-or-None Principle
Theall-or-none principlestates that once the threshold level is reached, an action potential will fire completely. If the threshold is not reached, no action potential will occur. This means that action potentials are always the same size; they do not vary in strength

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11
Q

How are impulses terminated? – termination of neurotransmitter effects

A

Degradation of neurotransmitter by enzyme

Reuptake of neurotransmitter

Diffusion of neurotransmitter from synapse

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12
Q

Synapse: Excitatory or Inhibitory

A

Excitatory Synapses and Excitatory Postsynaptic Potentials (EPSPs)- : Increase the likelihood of an action potential by depolarizing the postsynaptic membrane.

Inhibitory Synapses and Inhibitory Postsynaptic Potentials (IPSPs). Decrease the likelihood of an action potential by hyperpolarizing the postsynaptic membrane.
These processes are essential for the complex regulation of neural activity, allowing the nervous system to integrate and respond to a vast array of signals.

Anaction potentialis a rapid and temporary change in the electrical membrane potential of a neuron or muscle cell. This change allows the cell to transmit an electrical signal along its membrane. Here’s a detailed breakdown:

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13
Q

What is meninges?

A

Cover and protect Central Nervous System (CNS)

Contains Cerebrospinal fluid (CSF)

Protect blood vessels

Dura mater – 2 layers of fibrous tissue mostly attached, fibrous outer attached to skull and an inner enclosing the Central Nervous System

Arachnoid mater– separated from the dural by the sub-dural space and covers the pia mater. Connects to this by web like extensions forming the sub-arachnoid space. This is a large space filled with CSF and blood vesssels

Pia mater – innermost layer attaches to the brain

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14
Q

What is Meninges – Dura mater ?

A

Dura mater
Separation of layers forms:
Dural partition of brain:
Falx cerebri, tentorium cerebelli, Falx cerebelli.

Intracranial venous structures (sinuses) Superior sagittal sinus, inferior sagittal sinus, confluence of sinuses, straight sinus, transverse sinus

Extradural space between periosteal (outer) layer and bone of skull

Subdural space between meningeal (inner) layer and arachnoid mater.

Spinal cord

Extends as a loose sheath from foramen magnum to the 2nd sacral vertebra.

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15
Q

What is Meninges – Arachnoid mater?

A

Arachnoid mater

Passes over the convolutions of the brain.

Merges with the dura mater to at the 2nd sacral vertebra.

Arachnoid mater separated from :

Dura mater by subdural space

Pia mater by subarachnoid space.

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16
Q

What is Meninges – Pia mater?

A

Pia mater

Connective tissue

Adheres to brain covering dipping into fissures

Continues beyond spinal cord with filum terminale

Sheaths (covers) blood vessels

Fuses to periosteum of the coccyx with dura mater.

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17
Q

What are ventricles (brain relation)?

A

Irregular shaped cavities located within the brain.

Protects brain, acts as a shock absorbent.

Contain cerebrospinal fluid (CSF)

CSF: Suspends brain cells – provides buoyancy and a fluid environment for biochemical activity. Thus protects and maintains viability.

CSF is like plasma with less protein and a different electrolyte composition. It is essential for brain function, e.g. very sensitive to pH, affecting breathing and perfusion of blood.

Consist of defined aspects:
Left and right lateral ventricles
Third ventricle
Fourth ventricle

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18
Q

What does the ventricle system consist of?

A

The ventricular system of the brain consists of four interconnected cavities filled with cerebrospinal fluid (CSF). These ventricles play a crucial role in protecting the brain, providing nutrients, and removing waste. Here’s a breakdown of each component:

Left and Right Lateral Ventricles
Location: These are the largest ventricles and are located within each hemisphere of the cerebrum.
Structure: Each lateral ventricle has three extensions called horns: the frontal (anterior) horn, the occipital (posterior) horn, and the temporal (inferior) horn1.
Function: They produce and contain CSF, which flows through the interventricular foramina (foramina of Monro) into the third ventricle2.

Third Ventricle
Location: Situated in the midline of the brain, between the two halves of the thalamus.
Structure: It is a narrow, slit-like cavity that connects to the lateral ventricles via the foramina of Monro and to the fourth ventricle via the cerebral aqueduct (aqueduct of Sylvius)3.
Function: The third ventricle also produces CSF and serves as a pathway for its flow from the lateral ventricles to the fourth ventricle.

Fourth Ventricle
Location: Located between the pons and the medulla oblongata, and anterior to the cerebellum.
Structure: It has a characteristic diamond shape and connects to the central canal of the spinal cord and the subarachnoid space via three openings: the median aperture (foramen of Magendie) and two lateral apertures (foramina of Luschka)4.
Function: The fourth ventricle continues the flow of CSF from the third ventricle and distributes it around the brain and spinal cord4.
These ventricles are essential for the production, circulation, and removal of cerebrospinal fluid, which cushions the brain and spinal cord, maintains chemical stability, and removes waste products.

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19
Q

ventricles further info

A

Left and right lateral ventricles

Located with respective cerebral hemisphere

separated from each other by the septum pellucidum (lucidum).

Consists of frontal (anterior) horn, body (atrium), temporal (inferior) horn and posterior (occipital) horn )

Communicate with the 3rd ventricle by the interventricular foramina

Third ventricle

Located below lateral ventricles

Between the 2 parts of the thalamus

Communicates with 4th ventricle by the cerebral aqueduct.

Fourth ventricle

Diamond shaped, cavity

Below and behind the 3rd ventricle

Between the cerebellum and the pons

Continuous inferiorly with the central canal of the spinal cord. Communicates with the subarachnoid space

20
Q

What is the CSF?

A

Is produced in the choroid plexuses.
Located in lateral ventricles, 3rd ventricle roof and 4th ventricle

Clusters of fine capillaries hanging from the ventricles.

Ependymal cells filter blood and modify composition.

CSF locates between the pia mater and arachnoid mater, within the sub-arachnoid space.

CSF secreted continuously
Volume of CSF constant (150 ml)

21
Q

Functions of CSF

A

Keeps brain moist.

Supports and protects brain and spinal cord

Transports glucose, oxygen and other needed chemicals from blood to neurons and waste product removal

Supports and protects brain and spinal cord through maintaining equal pressure, acting as a shock absorber / cushion between skull and brain (Jankins 399 vertebral foramina and spinal cord. Brain floats in the cranial cavity due to it being surrounded by fluid ).
Maybe exchange of waste and nutrients between csf and nerve cells.

CSF though to be involved in regulation of breathing due to bathing surface of medulla where the central respiratory chemoreceptors are located.

(Jenkins 399 protects the brain and spinal from chemical and physical injury
Transports glucose, oxygen and other needed chemicals from blood to neurons and neuroglia.)

(Jenkins 399 contributes to homeostasis in 3 ways: Mechanical protection. Shock absorber. Chemical protection provides optimal chemical environment for function. Even slightest changes result in serious disruption to production of action potentials and post synaptic potentials. Circulation CSF exchange of nutrients between blood and nervous tissue)

22
Q

What is the brain structure?

A

Cerebrum

Diencephalon:
Epithalmus
Thalamus
Hypothalamus

Cerebellum

Brain stem:
Midbrain
Pons
Medulla oblongata

23
Q

The brain description

A

Texture of blamange…and is too complicated to fully understand…

Made of conducting nervous tissue ‘neurons’ and supporting connective tissue ‘neuro-glial’ tissue

Organisation 4 main regions or 3 fore, mid, hind brain
Cerebral hemispheres (2 hemispheres)
Dicephalon (thalamus and hypothalamus)
Cerebellum
Brain stem (mid brain, pons and medulla oblongata)
Essentially, a central fluid filled cavity (s) , surrounded by brain tissue, covered with membrane (s) inside a rigid box

24
Q

The brain- cerebrum

A

Located in the anterior and middle cranial fossae

Biggest part in two hemispheres left and right divided by a fissure

2 hemispheres are connected by a mass of white fibres (corpus callosum)

Comprises of:
Outer cortex: grey matter, contains gyri, sulci and fissures
Inner white matter, containing nuclei (basal ganglia)

Has 4 main structural ‘lobes’ that are broadly associated with ‘known’ function.
Frontal
Parietal
Temporal
Occipital
Boundaries of the lobes are marked by sulci, central, lateral, parieto-occipital

Function
3 main types of activity

Motor
Primary motor area anterior to central sulcus
Brocas area

Sensory perception to central sulcus
Primary visual area, auditory area, gustatory and olfactory areas

Association (mental activity)
Prefrontal area

25
Q

Cerebral hemispheres

A

Hemispheric lateralisation
There is a difference in function between the left and right hemispheres

Left receives somatic sensory signals from and controls muscles of the right side of body

Right receives somatic sensory signals from and controls muscles of the left side of body

Normally the left hemisphere: Reasoning, Numerical and scientific skills

Ability to use and understand sign language, Spoken and written language

Normally right: Musical and artistic awareness, Space and patter perception

Recognition of faces and emotional content of facial expression, Generating emotional content of language, Generating mental images to compare spatial relationship, Identifying and discriminating among odours.

26
Q

What is Deeper white matter?

A

Contains Tracts. Bundles of axons on the central nervous system

Allows: Two hemispheres to connect and integrate ‘talk’

Association (arcuate) tracts:
Commissural tracts:
Projection tracts: Internal capsule

Project activity to and from the CNS

Contains the 3 Basal Nuclei/ganglia – Globus palilidus, Putamen and Caudate nucleus relays to/from the premoter and prefrontal cortex: influences movement, especially starting, stopping and ‘coordinated’ movement such as arm swinging.

Produces the neurotransmitter dopamine.

27
Q

Under the cerebrum – the diencephalon

A

Under the cerebrum

3 areas: Thalamus, Epithalamus and Hypothalamus

Thalamus two groups of nuclei – fibres to and from the cerebrum. Receives all sensory input and relays virtually all fibres to the cerebrum. ‘Gateway’ to the cerebrum. Provides crude sensations of pleasant/unpleasant. Concerned with sleep and alertness
28
Q

What is the epithalamus?

A

Forms the roof of the 3rd ventricle

Connected to the pineal gland – secretes melatonin, regluates sleep/wake cycle with the hypothalamus.

Provides connections with the limbic system ‘emotions and feelings’.

29
Q

What is the Hypothalamus?

A

Below the …
Main ‘visceral’ centre – vital to homeostasis

Control centre for the autonomic nervous system and endocrine function

Centre for emotional responses,thermoregulation, water balance and thirst, food intake, sleep/wake cycle.

30
Q

What is the pituitary gland?

A

Hypothalamus
secretes hormones that
stimulate the pituitary gland
to secrete hormones that
stimulate other endocrine glands to secrete hormones

Position
Sits in sella turcica

Pea size and shape
Attached to hypothalamus

2 major lobes
Anterior pituitary (adenohypophysis)
Posterior pituitary (neurohypophysis

31
Q

What is the Brain stem?

A

Contains Midbrain, Pons varioli, and medulla oblongata

Provides a pathway between the spinal cord and the cerebrum

Contains 10 of 12 pairs of cranial nerves

Essential for regulation of physiology essential for life

Pathway between spinal cord+ brain.

32
Q

Mid brain and pons

A

Mid Brain: Relays auditory and visual information
Pons: Relays sensory information between the cerebrum and cerebellum. Very important in regulating the rhythm of breathing

33
Q

What is the medulla?

A

Medulla: blends into the spinal cord

Contains essential motor nuclei such as:
Cardiovascular centre, respiratory centres and Reflex centres of vomiting, coughing, sneezing and swallowing.

Under influence of the hypothalamus

Broadens out to form two pyramids ‘cones’ formed by the cortico-spinal tracts that descend from the motor cortex. These cross over just before reaching the medulla called ‘decussation of the pyramids’ before descending down the spinal cord.

34
Q

Cerebellum

A

Beneath and protruding under the cerebrum

Processes input from the cerebral motor cortex, brain stem and peripheral sensory receptors.

Provides spatial awareness, balance, precise timing and subconscious regulation of muscular movement (>600 named skeletal muscles).

35
Q

What is the Spinal cord?

A

Continuous with the medulla oblongata superiorly

It is covered by meninges and bathed in CSF.

Is larger in the cervical and lumbar regions.

cervical enlargement (superiorly) supplies nerves to and from the upper limbs.

lumbar enlargement (inferiorly) supplies nerves to and from the lower limbs. 

The cord typically extends down to the intervertebral disc between the 1st and 2nd lumbar vertebrae.

Conus medullaris – narrowing below lumbar enlargement

Cauda equina - below the conus medularis spinal nerves descent inferior to exit lower intervertebral foramina and have the appearance of a horses tail.

The meninges extend down to 2nd sacral vertebra

Filum terminale arises from the conus medularis.

36
Q

Spinal cord – cross section

A

Thumb width, a little flattened front to back with two grooves

Anterior median fissure and posterior median sulcus

Essentially dividing the cord into two connected halves

Grey matter on the inside (core) white matter on the outside

Gray matter looks like a capital H surrounded by columns of white fibres cross bar of H know as the transverse commissure

Gray matter forms 2 anterior, 2 lateral and 2 posterior horns following the entire length of the cord

In the centre of the grey matter is a central canal which contains cerebrospinal fluid

37
Q

Spinal cord injury

A

C3 and above: loss of diaphragm function –requires artificial ventilation

C4 significant loss of use of biceps and shoulders

C5 also loss of use of wrists and hands

C6 limited wrist control, loss of hand control

C7 and T1 some use if arms but limited, tends to represent a threshold for independent living

T1-T8 intercostal and abdominal muscles affected

Lumbar region effects on hips and legs

38
Q

Pathology of the CNS

A

Vascular
Stroke
Subarachnoid, subdural, extradural haemorrhage

Infections
Meningitis
Encephalitis

Structural disorders
Brain or spinal cord injury
Brain or spinal cord tumours

Seizure disorders
Epilepsy

Degeneration
Parkinson’s
Alzheimer’s

Autoimmune / inflammatory
Multiple sclerosis
Bells palsy
Mental health disorders
Schizophrenia
Depression

39
Q

Subarachnoid haemorrhage: description, causes, symptoms, diagnosis, complications, treatment and differential diagnosis.

A

Description
Intracranial haemorrhage with blood in the subarachnoid space.

Causes
Risk factors include family history, hypertension, heavy alcohol consumption, connective tissue disorders, trauma, due to an aneurysm or AVM

Symptoms
Worst headache ever.
Photophobia

Diagnosis
CT – generally done first.
MRI – more sensitive and can look for causes. Identify where blood is coming from. Classified by fissures scale to see whether angiography or screening may be needed.
Angiography – gold standard for diagnosis of vascular abnormalities

Complications
Increased intracranial pressure – may require shunt / drain
Patients can develop neurogenic pulmonary oedema
Can result in PEA (pulseless electronic activity)

Treatment
Depends on cause

Differential diagnosis
Meningitis
Pre imaging = other causes of bleeding e.g. subdural / extradural haemorrhage

40
Q

Subdural haemorrhage: description, causes, symptoms, diagnosis, complications, treatment and differential diagnosis.

A

Description
Blood within the subdural space between the dura and the arachnoid
Generally look crescent shaped.

Causes
Mainly trauma

Symptoms
Unconscious or decreased conscious level
Abnormal pupil reaction to light.

Diagnosis
Unilateral in adults, often bilateral in children
CT – homogenous, hyper dense collection
MRI – most sensitive standard sequence if FLAIR
Complications
Can be chronic in older patients

Treatment
Depends on size and effect on surrounding brain
May watch and wait
If large will surgically evacuate

Differential diagnosis
Subarachnoid haemorrhage
Motion artefact

41
Q

Subdural Haematoma Phases (CT Imaging Summary)

A

Hyperacute Phase (First Hour):

Rarely imaged in this phase.
Appearance:
Isodense to the cortex with a “swirled” pattern (clot, serum, unclotted blood).
May show cerebral swelling (common in younger patients, exacerbating mass effect).
Acute Phase (0-3 Days):

Classic Appearance:
Crescent-shaped, homogeneously hyperdense collection over the hemisphere (>50-60 HU).
Variations:
Mixed density (hyper-/hypodense) due to unclotted blood, CSF, or clot retraction.
May appear isodense if:
Coagulopathies, severe anaemia, or anticoagulation present.
Haematocrit fluid-fluid levels in coagulopathy cases.
Subacute Phase (3-21 Days, Typical: 10-14 Days):

Appearance:
Density decreases to ~35-40 HU, becoming isodense with cortex (harder to detect).
Clues to Identification:
CSF-filled sulci fade before reaching the skull.
Mass effect: sulcal effacement or midline shift.
Apparent cortical thickening.
Consider contrast-enhanced CT or MRI for better detection.
Chronic Phase (≥3 Weeks):

Appearance:
Hypodense relative to the cortex (~0 HU), resembling CSF (mimics subdural hygroma).
Shape: Crescentic, but may become biconvex.
Rarely: Calcification along the periphery (calcified chronic subdural haematoma).

42
Q

Extradural haemorrhage: description, causes, symptoms, diagnosis, complications, treatment and differential diagnosis.

A

Description
Acute haemorrhage between the dura mater and the skull. Very outer part of the brain.
Increases intracranial pressure. Cause herniation, more cerebellum, react to skull fracture.

Causes
Skull trauma, most commonly with a fracture

Symptoms
History of head trauma with decreasing consciousness, nausea, pain

Diagnosis
CT head is the gold standard – ‘lemon shaped’ mass. May also see midline shift and brainstem herniation.
MRI – not used acutely but may be useful for assessing contusions

Complications
Infection
Cerebral ischaemia- tissue death
Seizures

Treatment
Conservative
Surgery – craniotomy

Differential diagnosis
Other intracranial haemorrhages.
Simple skull fracture

43
Q

Meningitis: description, causes, symptoms, diagnosis, complications, treatment and differential diagnosis.

A

Description
Infection of the meninges

Causes
Bacterial or viral infection

Symptoms
Stiff neck, fever, headache, vomiting

Diagnosis
CSF analysis is required to confirm cause and plan treatment (spinal tap)
CT is often performed pre spinal tap to assess for increased intracranial pressure or brain herniation / bleed
MRI with contrast can demonstrate abnormal meningeal enhancement (seen in up to 50%). Can also exclude other causes

Complications
Seizures, long term disabilities, meningococcal meningitis can lead to loss of extremities

Treatment
Antibiotics

Differential diagnosis
Generally cause – bacterial, fungal or viral

44
Q

Spinal cord tumours: description, causes, symptoms, diagnosis, complications, treatment and differential diagnosis.

A

Description
Rare, many different types.
Schwannoma – benign tumour of schwann cells – most common tumour of the peripheral nerves

Causes
Generally solitary and random
May be linked to patients with neurofibromatosis type 2

Symptoms
Local pain and nerve dysfunction

Diagnosis
MRI is the best imaging method. If in acute pain patients may have a CT
Will see a well defined mass, may have a fatty appearance
Rarely calcify

Complications
Slow growing
Very rarely undergo malignant change

Treatment
Surgery
Differential diagnosis

Other causes of localised pain e.g. arthritis, degenerative changes.

45
Q

Incidence of CNS Tumors (Simplified)

A

Tumor Distribution:
1/3 Metastatic lesions.
1/3 Gliomas (from glial cells).
1/3 Non-glial tumors.

Gliomas:
Tumors originating from glial cells (e.g., astrocytes, oligodendrocytes, ependymal, choroid plexus cells).
Astrocytomas are the most common glioma and are categorized into:
Low-grade: Pilocytic type.
Intermediate-grade: Anaplastic type.
High-grade: Malignant glioblastoma multiforme (GBM).
GBM is the most common glioma (50% of astrocytomas).

Non-Glial Tumors:
A diverse group, with meningioma being the most common.

Update:
Metastatic brain lesions now outnumber primary brain tumors due to improved cancer survival rates.

46
Q

Alzheimer’s: description, causes, symptoms, diagnosis, complications, treatment and differential diagnosis.

A

Description
Neurodegenerative disease (60-80% of all dementias)
Thought to be due to amyloid plaques which form in the brain and stop the neurons functioning correctly along with decreased production o acetylcholine

Causes
risk factors include age, female gender, hypertension

Symptoms
Memory deficits

Diagnosis
Generally done by clinical examination.
CSF to exclude other causes
CT can show cortical atrophy but not detailed
MRI demonstrated atrophy better
SPECT / PET – can help give a prognosis of decline

Complications
Progressive decline

Treatment
There are many drugs to slow or delay progress but no definitive cure.

Differential diagnosis
Other forms of dementia

47
Q

MS: description, causes, symptoms, diagnosis, complications, treatment and differential diagnosis.

A

Description
Demyelinating disorder.
There is destruction of normally myelinated structures
Patients develop lesions in different areas of the brain and at different times

Causes
May be an infective link

Symptoms
depends on plaque location

Diagnosis
Generally clinical history, oligoclonal bands in the CSF and MRI findings
CT – non specific and may look normal
MRI – good for diagnosis and follow up to assess disease progression
T1 – black holes (hypointense lesions)
Complications
Disease progression

Treatment
Prognosis varies widely from patient to patient
Medicines aim to stop progression and provide symptomatic relief

Differential diagnosis
Other infections e.g. fungal, or spinal cord tumours