Ch 29 - Pathogenesis and Physiology of CNS disease and injury Flashcards
Descirbe the distribution of the grey matter in the spinal cord, brainstem and cerebral cortex
- Spinal cord - butterfly shape in the central cord, divivding the surrounding white matter into funiculi
- Brainstem - forms scattered nuclei with intervening tracts of white matter
- Cerebral cortex - external layer of grey matter with white matter connecting the cortex to other regions of the CNS
What is grey matter and white matter?
- Grey matter - high density of neuronal cell bodies
- White matter - Axons and associated glial cells
Describe the ventricles of the CNS
- One lateral ventricle within each hemisphere
- Third ventricle within diencephalon
- Fourth ventricle ventral to the cerebellum
- CSF formed within ventricles via the choroid plexus
- Flows from lateral ventricles, through interventricular foramina into 3rd, through mesencephalic aqueduct into 4th and then through lateral aperatures into subarachnoid space or continues caudally into central canal
What are the leptomeninges?
Arachnoid mater and pia mater
What are the pachymeninges?
Dura mater and arachnoid mater
Name the two forms of brain herniation
- Transtentorial
- Foramen magnum
What is the normal resting potential of neuronal cell membranes?
-80mV (inside of cell negative with respect to the outside)
How are action potentials generated?
- Rapid depolarisation of the membrane due to an influx of Na through voltage-gated Na-channels
- ELectrolyte oncentrations are returned to resting levels by active extrusion of Na from the cell in exchange for K, and K uptake by astrocytes
What cell produces myelin?
Oligodendrocytes
What is required for maintenance of a resting potential and generation/conduction of action potentials?
- Energy (Na-K/ATPase)
- Appropriate intra and extracellular electrolyte concentrations
- Ion channel function
- Myelin
What are the 2 forms of CNS perfusion autoregulation?
- Pressure autoregulation - remains constant with MAP between 50-160mmHg via vasodilation during hypotension and vasoconstriction during hypertension
- Metabolic autoregulation - astrocytes match blood flow to neuronal activity (NO, CO, K, adenosine, glutamate, arichadonic acid)
How does PaCO2 alter CNS perfusion?
- Increases during hypercapnia
- Decreases during hypocapnia
- For every 1mmHg change in PaCO2, there is a 5% change in cerebral perfusion
- PaCO2 less than 25mmHg causes vasoconstriction and potential ischaemia
How is cerebral perfusion pressure defines?
CPP = MABP - ICP
Reduction in MABP or increase in ICP can therefore impair cerebral perfusion
What is normal intracranial pressure?
8-15mmHg
Over 15 required treatment, over 30 causes significant reduction in cerebral perfusion
What are some mechanisms for accomodating for gradual increases in intracranial volume?
- Moving CSF into subarachnoid space
- Reducing CSF production
- Decreasing cerebral bloodflow
How much is ICP decreased by a craniotomy and by a durotomy?
- Craniotomy alone 15%
- Durotomy 65%
What forms the blood-brain barrier?
- Endothelial cell tight junctions
- Astrocyte foot processes
- Basal lamina
- Pericytes
- Perivascular microglia
What ABx have good penetration of the BBB?