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Pathology > CNS Pathology > Flashcards

CNS Pathology Flashcards

1
Q

What pathologies can affect the CNS?

A

Trauma, neurodegenerative disorders, cerebrovascular diseases, neoplasia, infectious disorders, demyelinating disorders

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2
Q

What is trauma (to CNS)?

A

Injury or damage to living CNS tissue caused by an extrinsic force or agent by either direct or indirect mechanisms

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3
Q

What can a concussion lead to?

A

Bruising, swelling, tearing of blood vessels, injury to nerves

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4
Q

What are two types of traumatic brain injury?

A

Diffuse and focal

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5
Q

What is a diffuse brain injury?

A

Generalised injury to all areas of brain

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6
Q

What are two examples of a diffuse traumatic brain injury?

A

Diffuse traumatic axonal injury, diffuse hypoxic injury

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7
Q

What is a focal traumatic brain injury?

A

Localised injury of the brain

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8
Q

What are two examples of focal traumatic brain injury?

A

Lobar cerebral contusion, subdural haemorrhage

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9
Q

What causes diffuse TBI?

A

Outside mechanical force applied to head, eg. fall, car crash, struck by/against object, assault, blasts (war)

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10
Q

What are primary brain injuries in diffuse TBI?

A

Mechanical damage, eg. laceration, cerebral contusion, diffuse axonal injury, haemorrhage

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11
Q

What are secondary injuries in diffuse TBI?

A

Indirect result of TBI, eg., intracranial hypertension, brain shift and herniation, biochemical processes, swelling, cerebral ischemia

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12
Q

What causes diffuse axonal injury?

A

Global disruption of axons due to severe shearing forces

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13
Q

What does diffuse axonal injury result in?

A

Immediate primary axotomy, delayed secondary axotomy due to ischemia

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14
Q

How does diffuse axonal injury present?

A

Immediate loss of consciousness, no lucid interval, sustained unconsciousness and vegetative state until death

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15
Q

Describe the histology of diffuse axonal injury

A

4-5 hours: focal accumulations of beta-amyloid precursor protein (APP)
12-24 hours: axonal varicosities, swelling
24 hours-2 months: axonal swellings
2 weeks-5 months: micro-gliosis
2 months-years: loss of myelinated fibres

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16
Q

What causes cerebral contusion in focal TBI?

A

Blunt trauma, ie. blow to the head, leading to rapid tissue displacement. Contact between brain and rough skull surfaces like orbital floor and petrous ridges

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17
Q

What does a cerebral contusion result in?

A

Rupture of vessels leads to haemorrhage, tissue injury and edema

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18
Q

What are the clinical symptoms of a cerebral contusion?

A

Drowsiness, confusion, agitation, hemiparesis, unequal pupil size

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19
Q

What is a brain hematoma?

A

Haemorrhaging from ruptured blood vessel caused by brain trauma

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20
Q

What is an epidural hematoma?

A

Hematoma between skull and dura mater caused by torn artery and branches

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21
Q

What does an epidural hematoma result in?

A

Increased intracranial pressure

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22
Q

What is the mortality rate for epidural hematomas?

A

30% when treated quickly

23
Q

What is a subdural hematoma?

A

Hematoma between dura mater and arachnoid mater caused by torn subdural veins

24
Q

What causes subdural hematoma?

A

Blunt trauma to frontal or occipital lobes

25
Q

What causes Parkinson's disease?

A

Atrophy and loss of dopaminergic neurons in substantia nigra pars compacta (SNPc) in basal ganglia

26
Q

What change can be seen in SNPc in PD?

A

Depigmentation

27
Q

What symptoms does loss of dopamine in deep structures cause?

A

Resting tremor, bradykinesia, rigidity, postural imbalance

28
Q

Describe the histology of PD.

A

Levy bodies visible. Result of accumulation of intracellular fibrillar aggregates, mutant alpha-synuclein forms fibrils together with ubiquitin and neurofilaments

29
Q

What is the median age of PD onset?

A

60 years

30
Q

What percentage of PD cases are sporadic and genetic?

A

95% sporadic, 5% genetic

31
Q

What is an example of a cerebrovascular disease?

A

Stroke

32
Q

What is a stroke?

A

Transient or permanent reduction to cerebral blood flow

33
Q

What are two types of stroke?

A

Ischemic and haemorrhagic

34
Q

What is a haemorrhagic stroke?

A

Rupture of weakened blood vessel in brain

35
Q

What causes haemorrhagic stroke?

A

Weakened blood vessels, as a result of uncontrolled hypertension (mainly) and atherosclerosis

36
Q

Where do most haemorrhagic strokes occur?

A

In cerebrum, bleed in to lateral ventricle

37
Q

What symptoms precede a haemorrhagic stroke?

A

Intense headache and vomiting

38
Q

What are the two types of haemorrhagic stroke?

A

Subarachnoid and intracerebral

39
Q

What is an ischemic stroke?

A

Stroke in which a clot blocks an artery to the brain

40
Q

What causes ischemic stroke?

A

Narrowed arteries in brain. Embolism, thrombosis of cerebral artery (thrombotic ischemic stroke), hypoperfusion

41
Q

What is the result of ischemic stroke?

A

Decreased cerebral blood flow

42
Q

What is and infarct in ischemic stroke?

A

Area of dead tissue at site of occlusion

43
Q

What is penumbra in ischemic stroke?

A

Tissue surrounding ischemic event, which is also injured. Will succumb to death

44
Q

What occurs immediately after ischemic event (stroke)?

A

Blood flow and oxygen reduced leading to hypoxia of local cells

45
Q

Describe the ischemic cascade.

A

Energy depletion -> failure of Na and K pumps -> depolarisation of neuronal membrane -> glutamate released in synaptic cleft -> excitotoxin -> glutamate acts on channel receptors (NMDA, AMPA) -> calcium influx -> activation of catabolic enzymes or activation of NO synthase -> cellular injury (free radicals, destruction of structural proteins leads to necrosis; mitochondrial injured leads to apoptosis)

46
Q

Describe the histology of ischemic stroke.

A

1 day- Injured neurons shrink and become eosinophilic (red anoxic neurons), nuclei condense, 1 week- damaged neurons disintegrate and removed by macrophages, >3 weeks- cortical atrophy and gliosis

47
Q

How is ischemic stroke treated?

A

First line therapy: intravenous alteplase initiated within 4.5 hours of symptoms
Surgical thrombectomy in large blood vessels

48
Q

What are gliomas?

A

Malignancy arising from glial cells in CNS

49
Q

What are types of gliomas?

A

Astrocytoma, ependymoma, oligodendroglioma, glioblastoma

50
Q

What are meningiomas?

A

Non-aggressive neoplasm arising from arachnoidal cells

51
Q

What can result from a meningioma?

A

Hydrocephalus caused by interference with CSF circulation

52
Q

What are two types of infectious disorders affecting the CNS?

A

Encephalitis and meningitis

53
Q

What is encephalitis?

A

Infection causing inflammation of the brain, mostly caused by viruses

54
Q

What is meningitis?

A

Inflammation of meninges of brain or spinal cord

Pathology (5 decks)

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