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Neuro > CNS Pathologies > Flashcards

CNS Pathologies Flashcards

1
Q

What are the two main causes of cerebrovascular diseases?

A
  1. Ischaemia
  2. Haemorrhage
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2
Q

What are the two types of ischaemic cerebrovascular disease?

A
  1. Global hypoperfusion - systemic circulatory failure > drop in cerebral perfusion > watershed infarcts + cortical pseudolaminar necrosis
  2. Focal cerebral ischaemia - thrombosis/embolism leads to haemorrhagic (red) infarcts; atherosclerosis/arteriosclerosis + vasculitis lead to pale infarcts; both undergo liquefactive necrosis + macrophages and gliosis (fibrous proliferation of glial cells)
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3
Q

What can cause haemorrhagic cerebrovascular disease?

A
  1. Vascular structural abnormalities
  2. Hypertension
  3. Coagulopathies
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4
Q

What is a stroke?

A
  • aka cerebrovascular accident
  • disruption of blood flow to the brain, causing neurological deficits for >24h
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5
Q

If a disruption of cerebral blood flow causes neurological deficits that last for <24h, is this a stroke?

A

No, a TIA

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6
Q

What are the two types of strokes?

A
  1. Ischaemic stroke
  2. Haemorrhagic stroke
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7
Q

What causes ischaemic stroke?

A
  • Thrombosis / Embolism
  • Leads to pale infarct
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8
Q

What causes haemorrhagic stroke?

A
  • Ruptured blood vessel
  • Leads to red infarct + raised ICP + mass effect
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9
Q

What are the signs / symptoms of a stroke?

A
  1. Neurological deficits
    - Sensorimotor deficits (Face drooping, Arm weakness)
    - Speech disturbances
    - Visual disturbances
    - Cognitive / Memory disturbances
    - Ataxia
  2. Severe headache (haemorrhagic stroke)
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10
Q

What are the possible complications of a stroke?

A
  1. Unilateral hemiparesis / hemiplegia
  2. Aphasia
  3. Visual defects
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11
Q

What does a stroke involving ACA, MCA, and PCA cause respectively?

A
  • ACA: lower limbs affected
  • MCA: body affected + aphasia
  • PCA: visual / cognitive disturbances
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12
Q

How do you differentiate a haemorrhagic and ischaemic stroke?

A

CT scan; dark areas = ischaemia / bright areas = haemorrhage

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13
Q

What are hypertensive cerebrovascular diseases?

A

A group of brain diseases arising from chronic hypertension

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14
Q

What are the three hypertensive cerebrovascular diseases?

A
  1. Lacunar infarcts
  2. Hypertensive encephalopathy
  3. Hypertensive intracerebral haemorrhage
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15
Q

Describe lacunar infarcts.

A
  1. Hypertension causes arteriosclerosis, leading to occlusion
  2. Occlusion leads to small, localised areas of ischaemia and liquefactive necrosis (lacunar infarcts)
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16
Q

Describe acute hypertensive encephalopathy.

A
  1. Malignant hypertension causes cerebral oedema, cerebral herniation, petechial haemorrhages, fibrinoid necrosis of arteries
  2. Manifests as headaches, convulsions, confusion > coma
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17
Q

Describe multi-infarct dementia.

A
  1. LT hypertension leads to multiple infarcts
  2. Causes progressive dementia, gait instabilities, and other focal neurological deficits
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18
Q

Describe hypertensive intracerebral haemorrhage

A
  1. Hypertension leads to hyaline arteriosclerosis and fibrinoid necrosis of arteries and arterioles
  2. Typically affects basal ganglia, in the form of Charcot-Bouchard aneurysms
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19
Q

What is meningitis?

A

Inflammation of the meninges

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20
Q

What are the gross characteristics of meningitis?

A
  • Swollen, opaque meninges
  • Purulent exudate (bacterial only)
21
Q

What are the histological characteristics of meningitis?

A
  • B: neutrophils, bacterial colonies
  • V: lymphocytes
  • F: MNGC granulomas
22
Q

What are the signs / symptoms of meningitis?

A
  1. Fever - HG in B, LG in V
  2. Intense, generalised headache
  3. Neck stiffness
  4. Photophobia
23
Q

What are the complications of meningitis?

A
  1. Meningeal fibrosis
  2. Raised ICP from cerebral oedema - cerebral herniation, structural damage
24
Q

How can you diagnose meningitis?

A
  1. Lumbar puncture
  2. Kernig’s sign - when hip is flexed, lower back pain + cannot extend leg
  3. Brudzinski’s sign - when neck is flexed, knees involuntarily bend
25
Q

What are some common bacterial causes of meningitis?

A
  • N. meningitides, S. pneumoniae, TB (base of brain)
26
Q

Where does TB start in the brain?

A

Base of brain

27
Q

What are the gross characteristics of TB meningitis?

A
  • Gelatinous exudate
  • Tubercles (white granules which are granulomas)
  • Tuberculomas (aggregations of tubercles)
28
Q

What are the unique signs / symptoms of TB meningitis?

A
  1. CN deficits
  2. Hydrocephalus
  3. Obliterative endarteritis - thickening and fibrosing of the BVs, leading to ischaemia
  4. Fibrous adhesions - in arachnoid mater
29
Q

What are some common viral causes of meningitis?

A

Poliovirus, HIV

30
Q

What is an extradural abscess?

A

Collection of suppurative material in the epidural space of the brain / spinal cord

31
Q

What are some bacterial causes of an extradural abscess?

A

S. aureus, Streps, E.coli, TB

32
Q

What are the cranial signs / symptoms of extradural abscess?

A
  1. Fever, malaise
  2. Neurological deficits
  3. Headache
  4. Raised ICP - leads to n/v, altered mental status, and optic disc swelling (papilloedema)
33
Q

What are the spinal signs of extradural abscess?

A
  1. Fever
  2. Neurological deficits
  3. Back pain with radiation
  4. Paralysis
34
Q

What is a subdural empyema?

A

Collection of suppurative material in the subdural space of the brain / spinal cord

35
Q

What are some common bacterial causes of subdural empyema?

A

S. aureus, Streps

36
Q

What are the signs / symptoms of subdural empyema?

A
  1. Fever, malaise
  2. Neurological deficits
  3. Headache
  4. Raised ICP - leads to n/v, altered mental status, neck stiffness, and papilloedema
37
Q

What is encephalitis?

A

Inflammation of brain tissue, commonly due to viruses

38
Q

What are the gross characteristics of encephalitis?

A
  1. Cerebral oedema
  2. Localised necrosis
  3. Petechial haemorrhages
39
Q

What are the histological characteristics of encephalitis?

A
  1. Perivascular inflammation
  2. Gliosis
  3. Microglial nodules surrounding infected neurons
40
Q

What are the signs / symptoms of encephalitis?

A
  1. Fever
  2. Headache
  3. Neurological deficits
  4. Altered mental status
  5. Seizures
41
Q

What is a cerebral abscess?

A

Collection of suppurative material in the brain parenchyma, life-threatening

42
Q

What are the signs / symptoms of cerebral abscesses?

A
  1. Swinging fever, malaise
  2. Headache
  3. Neurological deficits
  4. Raise ICP - leading to n/v, altered mental status, and papilloedema
43
Q

What are four serious complications of raised ICP?

A
  1. Loss of consciousness, coma - due to compression of brainstem components involved in maintaining consciousness
  2. Cushing’s triad (hypertension, bradycardia, irregular breathing) - low cerebral perfusion = BP forced to increase via Cushing’s reflex = HR forced to decrease to compensate; respiratory centers compressed
  3. Neurogenic pulmonary oedema - due to hypertension
  4. Cerebral herniation
44
Q

What are the three sites of cerebral herniation?

A
  • Falx cerebri (subfalcine herniation)
  • Tentorium cerebelli (transtentorial herniation)
  • Foramen magnum (tonsillar herniation)
45
Q

What is Guillain-Barre syndrome?

A

Autoimmune disorder, characterised by demyelination and axonal degeneration in PNS

46
Q

What is the pathophysiology of Guillain-Barre syndrome?

A

After C. jejuni infection, autoAbs attack myelin sheaths and axonal membranes

47
Q

What are the signs / symptoms of Guillain-Barre syndrome?

A
  1. Ascending numbness / weakness
  2. No reflexes
  3. Respiratory failure
  4. Cardiac arrhythmias
48
Q

What type of lesion pattern is Guillain-Barre syndrome?

A

LMN, but without wasting as the disease is rapid-onset

49
Q
A

Neuro (18 decks)

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