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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
What are some common bacterial causes of meningitis?
- N. meningitides, S. pneumoniae, TB (base of brain)
26
Where does TB start in the brain?
Base of brain
27
What are the gross characteristics of TB meningitis?
- Gelatinous exudate - Tubercles (white granules which are granulomas) - Tuberculomas (aggregations of tubercles)
28
What are the unique signs / symptoms of TB meningitis?
1. CN deficits 2. Hydrocephalus 3. Obliterative endarteritis - thickening and fibrosing of the BVs, leading to ischaemia 4. Fibrous adhesions - in arachnoid mater
29
What are some common viral causes of meningitis?
Poliovirus, HIV
30
What is an extradural abscess?
Collection of suppurative material in the epidural space of the brain / spinal cord
31
What are some bacterial causes of an extradural abscess?
S. aureus, Streps, E.coli, TB
32
What are the cranial signs / symptoms of extradural abscess?
1. Fever, malaise 2. Neurological deficits 3. Headache 4. Raised ICP - leads to n/v, altered mental status, and optic disc swelling (papilloedema)
33
What are the spinal signs of extradural abscess?
1. Fever 2. Neurological deficits 3. Back pain with radiation 4. Paralysis
34
What is a subdural empyema?
Collection of suppurative material in the subdural space of the brain / spinal cord
35
What are some common bacterial causes of subdural empyema?
S. aureus, Streps
36
What are the signs / symptoms of subdural empyema?
1. Fever, malaise 2. Neurological deficits 3. Headache 4. Raised ICP - leads to n/v, altered mental status, neck stiffness, and papilloedema
37
What is encephalitis?
Inflammation of brain tissue, commonly due to viruses
38
What are the gross characteristics of encephalitis?
1. Cerebral oedema 2. Localised necrosis 3. Petechial haemorrhages
39
What are the histological characteristics of encephalitis?
1. Perivascular inflammation 2. Gliosis 3. Microglial nodules surrounding infected neurons
40
What are the signs / symptoms of encephalitis?
1. Fever 2. Headache 3. Neurological deficits 4. Altered mental status 5. Seizures
41
What is a cerebral abscess?
Collection of suppurative material in the brain parenchyma, life-threatening
42
What are the signs / symptoms of cerebral abscesses?
1. Swinging fever, malaise 2. Headache 3. Neurological deficits 4. Raise ICP - leading to n/v, altered mental status, and papilloedema
43
What are four serious complications of raised ICP?
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
What are the three sites of cerebral herniation?
- Falx cerebri (subfalcine herniation) - Tentorium cerebelli (transtentorial herniation) - Foramen magnum (tonsillar herniation)
45
What is Guillain-Barre syndrome?
Autoimmune disorder, characterised by demyelination and axonal degeneration in PNS
46
What is the pathophysiology of Guillain-Barre syndrome?
After C. jejuni infection, autoAbs attack myelin sheaths and axonal membranes
47
What are the signs / symptoms of Guillain-Barre syndrome?
1. Ascending numbness / weakness 2. No reflexes 3. Respiratory failure 4. Cardiac arrhythmias
48
What type of lesion pattern is Guillain-Barre syndrome?
LMN, but without wasting as the disease is rapid-onset
49

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