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MD2 - Pathology > Cerebrovascular Disease and CNS Trauma 2 > Flashcards

Cerebrovascular Disease and CNS Trauma 2 Flashcards

1
Q

What are the two major pathogenic mechanisms and one less common mechanism behind haemorrhagic stroke

A

Major:

  • High pressure in normal vessels (e.g. Malignant hypertension)
  • Abnormal vessel structure (e.g. Berry aneurysm)

Lesser:

  • Bleed easily (e.g. Coagulopathies, anti-coag)
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2
Q

List some causes of haemorrhagic stroke:

A
  • Hypertension
  • Ruptured berry aneurysm
  • Amyloid angiopathy
  • Coagulopathy
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3
Q

Is thrombolytic treatment indicated in haemorrhagic stroke

A

NOoooooo

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4
Q

What is the major macroscopic differential between ischaemic and haemorrhagic stroke?

A

Haemorrhagic stroke is red/brown/black

Ischaemic should be pale.

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5
Q

What are the 4 types of intracranial haemorrhage?

A
  • Intracerebral haemorrhage(ICH)
  • Sub-arachnoid haemorrhage (SAH)
  • Extradural haemorrhage (EDH)
  • Sub-dural haemorrhage (SDH)
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6
Q

Association between trauman and intracranial haemorrhage types?

A

EDH - always trauma

SDH - usually trauma

SAH - sometimes trauma

ICH - rarely trauma

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7
Q

Which types of intracranial haemorrhage are associated with hypertension?

A

Intracerebral haemorrhage (ICH) and sub-arachnoid haemorrhage (SAH)

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8
Q

Which haemorrhages can lead to haemorrhagic stroke?

A

ICH always, SAH sometimes

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9
Q

What is ICH and the primary (1) and secondary (3) causes?

A

Intra-parenchymal bleeding

Primary - HTN

Secondary - Vascular malformation, amyloid angiopathy, trauma

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10
Q

What is SAH and its causes (traumatic and non-traumatic)

A

Sub-arachnoid bleeding

Sudden onset.

Does NOT cause space occupying lesion - no rise in ICP

Caused by traumatic or non-traumatic (berry aneurysm)

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11
Q

Differences between EDH and SDH

A

EDH:

  • Traumatic
  • Arterial bleed (lemon shaped - peels dura away from bone)
  • Fast onset of symptoms

SDH:

  • Low level trauma
  • Venous bleed (banana shaped - under dura)
  • Slowly progressive symptoms compared to EDH
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12
Q

What is a vertebral artery dissection and waht does it lead to?

A

Trauma to the vertebral artery can cause an artery dissection:

  • Direct trauma - RIP phil hughes
  • Rotational movement
  • Minimal trauma- chiro manipulation

Leads to SAH

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13
Q

What is a contusion?

A

BLunt force trauma without tearing of tissue, but causing compression

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14
Q

What pathological changes can be seen in a contusion injury?

A
  • Bleeding
  • Resolution = turns yellow/brown
  • Occurs where compressive force was, not necessarily point of trauma
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15
Q

What is coup and contrecoup?

How does head mobility related to this?

A

Coup = contusin +/- injury at point of impact

Contrecoup = contusion +/- injury at brain surface opposite impact

If head is immobile at point of impact = COUP

If head is mobile = COUP + CONTRECOUP may be found

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16
Q

What is diffuse/traumatic axonal injury?

A

Movement of one region of the brain relative to another can disrupt axonal integrity.

E.g. rapid deceleration in absence of impact

17
Q

What pathology is found in traumatic axonal injury?

A

WIdepsread axonal swelling.

Gliosis.

50% of patients who develop coma after trauma have this

18
Q

How is concussion assessed?

A

Glasgow COma Scale (GCS)

19
Q

What are neurodegenerative diseases (NDDs)?

A

Umbrella term for disorders that result in loss of neurones. Disorders have cognitive, sensory and motor aspects.

20
Q

What are the shared features of all NDDs?

A
  • Progressive, relentless
  • Loss of neurones
  • Associated with aging
  • Fatal outcome
21
Q

What histopathology would you expect in any NDD?

A
  • Neuronal atrophy
  • Gliosis (increased astrocytes)
22
Q

NDDs can be classified based on cognitive vs movement dysfunction. Give examples (4)

A

Cortical degeneration (cognitive decline)

  • Alzheimer’s disease
  • Dementia with Lewy bodies

Movement disorders:

  • Akinetic syndrome: Parkinson’s disease
  • Hyperkinetic syndrome: Huntington’s disease
23
Q

What protein accumulation causes Alzheimer?

A

Beta-amyloid and Tau

24
Q

What protein accumulation causes Parkinsons?

A

Alpha-synuclein

25
Q

What causes Huntington disease?

A

Polyglutamine repeate expansion

26
Q

What is dementia? Define.

A

Acquired progressive global dysfunction of intellect, memory, personality without impairment of consciousness.

Reflects dysfunction and cell death in neurones widely distributed through the brain.

27
Q

Main causes of dementia?

A
  • Alzheimer’s (70%)
  • Dementia with Lewy bodies (10%)
  • Frontotemporal lobe degeneration (10%)
  • Vascular pathology (10%)
28
Q

What are Lewy bodies?

A

Accumulation of alpha-synuclein proteins.

ARe toxic to neurones, and cause Lewy body dementia and Parkinsons

29
Q

What is the common cause of death in Alzheimer patients?

A

Terminal infection, e.g. pneumonia

30
Q

What is the gold standard of diagnosis for Alzheimers?

What 5 pathological features would we see?

A

Gold standard = pathology.

We would expect to see:

  • Reduced cerebral weight
  • Ventricular effacement (loss of white matter)
  • Atrophy of medial temporal lobe
  • Atrophy of limbic structures (hippocampus, white matter)
  • Symmetrical cerebral atrophy
31
Q

What histopathological features are expected in Alzheimer’s?

A

Beta-amyloid accumulation - forms cortical plaques

Tau accumulation - forms neurofibrillary tangles

32
Q

What is the amyloid hypothesis?

A

Abnorma accumulation of beta-amyloid protein and reduced clearance thought to play a neurotoxic role in development of dementia/alzheimers.

33
Q

What genetic factors are involved in development of dementia?

A

Mostly sporadic - 90% of cases >65

Familial - can see onset from 40-65

Trisomy 21 - Almost all get dementia by age 35 (APP gene on chromosome 21) APP gene codes amyloid precursor protein

34
Q

What is the ABC score?

A

Diagnostic criteria for Alzheimer’s:

Look at stains of:

  • Amyloid plaques
  • Tau neurofibrillary tangles
  • Neuritic plaques
35
Q

What macroscopic and microscopic features would you expect in Lewy body dementia?

A

Macroscopic - similar to AD

Microscopic features idential to Parkinsons, with Lewy bodies in cortex.

36
Q

WHat is the mechanism behind parkinsons?

A

Loss of dopaminergic neruones from substantia nigra - hypokinetic movement disorder.

MD2 - Pathology (8 decks)

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