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YR5 Histopathology > Crash course: Neuro > Flashcards

Crash course: Neuro Flashcards

1
Q

What are the 6 components of the brain?

A

4 lobes: Frontal, temporal, parietal, occipital
Cerebellum
Brainstem

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2
Q

Frontal lobe

A

Thinking
Memory
Behaviour
Movement

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3
Q

Temporal lobe

A

Hearing
Learning
Feelings

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4
Q

Parietal lobe

A

Language
Touch

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5
Q

Occipital lobe

A

Sight

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6
Q

Cerebellum

A

Balance
Coordination

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7
Q

Brainstem

A

Breathing
HR
Temperature

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8
Q

What is a stroke?

A

focal neurological deficit of presumed vascular origin that lasts > 24h

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9
Q

What is a TIA?

A

focal neurological deficit of presumed vascular origin that resolves within 24h

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10
Q

What are the 2 types of stroke? What is the prevalence of each?

A

Ischaemic 80%

Haemorrhage 20%

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11
Q

Give 4 causes of ischaemic stroke

A

ATHEROSCLEROSIS
Thromboembolic e.g. AF
Diabetes
Vasculitis

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12
Q

Give 4 causes of haemorrhage stroke

A

HTN
AV malformation (<50s)
Cavernous angiomas (recurrent low pressure bleed)
Subarachnoid haemorrhage

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13
Q

What is the single most important modifiable factor (and cause) for both haemorrhage an ischaemic strokes?

A

HTN

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14
Q

What is the difference between ischaemia and infarction?

A

Ischaemia: lack of O2 supply to tissue

Infarction: death of tissue due to lack of O2 supply

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15
Q

What are the 2 broad aetiologies haemorrhagic stroke?

A

Traumatic: extradural or subdural haemorrhage

Non traumatic: Intraparenchymal or SAH

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16
Q

Where do Intraparenchymal haemorrhages usually occur? What causes them?

A

Basal ganglia

Vessel rupture due to HTN

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17
Q

What is the main cause of subarachnoid haemorrhage? Where does this occur?

A

Ruptured berry aneurysms

Posterior communicating artery
or
Bifurcation of internal carotid

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18
Q

What is the classic history of a patient with SAH?

A

Bilateral abdominal masses
FH of brain bleeds
(a/w Polycystic kidney disease)

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19
Q

What can be seen on CT in SAH? (buzzword/ phrase)

A

Hyperattenuation around the Circle of Willis

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20
Q

If NAD on CT head, what further investigation can be performed for SAH? What will be seen?

A

LP at 12h:
Xanthochromia + oxyhaemoglobin

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21
Q

What causes extradural haemorrhage? What is the pathophysiology?

A

Fracture of pterion caused by trauma (e.g. RTA, punch to temples)

Rupture of middle meningeal artery

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22
Q

What buzzword describes extradural haemorrhage on CT?

A

“lemon” shape

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23
Q

What causes subdural haemorrhage? What is the pathophysiology?

A

Hx of minor head trauma

Rupture of bridging veins leading to collection of blood between dura + arachnoid mater

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24
Q

Give 4 risk factors for subdural haemorrhage

A

Alcoholics
Anti-coagulations
Elderly
NAI

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25
Q

What buzzword describes subdural haemorrhage on CT?

A

“Banana” shape
Crescent shape

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26
Q

What is the single largest cause of death in <45s?

A

Traumatic brain injury

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27
Q

Give 4 red flags of TBI

A

Otorrhoea
Rhinorrhoea
“Straw-coloured” fluid (CSF) from nose or ears
Battle’s sign

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28
Q

What are the 2 types of TBI?

A

Diffuse axonal injury
Contusion (more common)

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29
Q

What is diffuse axonal injury?

A

shear tensile forces tearing axons apart in midline structures
(Corpus callosum, rostral brainstem + septum pellucidum)

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30
Q

What is the commonest cause of traumatic coma?

A

Diffuse axonal injury

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31
Q

What is a contusion? What are the 2 types?

A

collision between brain + skull
Coup: impact of brain on skull
Countercoup: injury to opposite side of brain

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32
Q

What is the most common cell type in the brain? What is the most common tumour type in the brain?

A

Astrocytes
Astrocytomas

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33
Q

What are primary brain tumours? What are 2 subtypes?

A

Originate within CNS

Extra-axial: Cranium, soft tissue, meninges, nerves

Intra-axial: glia, neurons, neuroendocrine cells

34
Q

What are secondary brain tumours? (4)

A

Mets from other parts of body
Commonest form of brain tumour
Well demarcated, solitary nodules
Poor prognosis

35
Q

Which 3 cancers metastasise most commonly to the brain?

A

Lung
Skin
Breast

36
Q

Give 3 genetic risk factors for brain tumours

A

FH brain tumours
NF 1/2
Tuberous sclerosis

37
Q

Give 2 features in PMH for brain tumours

A

Cancer
Radiotherapy

38
Q

Define staging and grading

A

S: how far the tumour has spread
G: how differentiated the tumour cells are compared with native cells

39
Q

What is the survival rate for the 4 grades of brain cancer?

A

Grade 1 → benign
Grade 2 → >5y survival
Grade 3 → 1-5y survival
Grade 4 → <1y survival

40
Q

Give 4 features of pilocytic astrocytoma

A

Indolent
Most common brain tumour in kids 0-20y
Good prognosis
Grade 1

41
Q

Give 2 features of diffuse gliomas

A

20-40y
Grade 2-3

42
Q

Give 3 features of gliomoblastoma multiforme

A

> 50s
Most common (aggressive) primary tumour in adults
Grade 4

43
Q

What features on microscopy indicate higher grade in brain tumours?

A

Increased cellularity
Increased mitotic figures
Microvascular proliferation

44
Q

What is the location and buzzword associated with Meningioma?

A

Meninges/ arachnoid cells
Psammoma bodies

45
Q

What is the location and buzzword associated with medulloblastoma? (embryonal)

A

Cerebellum
Children, balance problems, Squint

46
Q

What is the location and buzzword associated with ependyoma?

A

Posterior fossa
Tuberous sclerosis

47
Q

What is the location and buzzword associated with craniopharyngioma?

A

Pituitary sella
Inferior bitemporal hemianopia

48
Q

What is the location and buzzword associated with pituitary tumour?

A

Pituitary sella
Superior bitemporal hemianopia

49
Q

What is the management for primary brain tumours?

A

Surgical resection
Radiotherapy
NOT chemo (most don’t penetrate BBB)

50
Q

What is dementia?

A

global impairment of cognitive function + personality without impairment of consciousness.
(beyond normal ageing)

51
Q

List the 5A’s of dementia

A

Amnesia
Apraxia
Aphasia
Agnosia
Anomia

52
Q

List the 4 types of dementia in order of decreasing prevalence

A

Alzheimers
Vascular
Lewy body
Frontotemporal

53
Q

Give the 2 main theories of Alzheimer’s aetiology

A

Accumulation of β-amyloid plaques: interferes with neuronal communication

Hyperphosphorylation of Tau proteins → formation of neurofibrillary tangles

54
Q

Which lobes are most commonly affected first in Alzheimer’s?

A

Medial temporal lobes + hippocampus

55
Q

What tool is used to stage Alzheimers?

A

BRAAK staging

56
Q

What is seen on MRI in Alzheimer’s?

A

Global atrophy

57
Q

Give 2 associations of vascular dementia

A

Mini strokes
Step-wise deterioration

58
Q

Give 3 associations of Lewy body dementia

A

Fluctuating course
Little people/ animals running around
Parkinsonian Sx

59
Q

Give 4 buzzwords associated with Frontotemporal dementia

A

Personality change
Disinhibition
Overeating
Emotional blunting

60
Q

Give 3 patient characteristics commonly seen in frontotemporal dementia

A

Younger: 40-60
Strong +ve FH (autosomal dominant)
Dx of Huntingtons disease

61
Q

What is seen on microscopy in frontotemporal dementia?

A

Pick bodies

62
Q

What is Parkinson’s disease?

A

Depletion of dopaminergic neurons projecting from basal ganglia to the substantia nigra

63
Q

What is the pathophysiology of Parkinson’s?

A

Alpha synuclein mutation + misfolding to form Lewy bodies
Accumulation of Lewy bodies in nigrostriatal pathway

64
Q

What causes loss of smell in Parkinson’s?

A

Accumulation of lewy bodies in olfactory bulb

65
Q

What is seen on microscopy in Parkinson’s?

A

Lewy bodies
Melanin deposition

66
Q

What are the 5 Parkinson’s plus syndromes?

A

Vascular Parkinson’s
Drug-induced Parkinson’s
Multiple system Atrophy (MSA)
Progressive supranuclear palsy (PSP)
Corticobasal dysfunction

67
Q

What characterises drug-induced Parkinson’s?

A

Bilateral motor deficit
+ PD

68
Q

What characterises multiple system atrophy?

A

Autonomic dysfunction + PD

69
Q

What characterises progressive supranuclear palsy?

A

Vertical gaze dysfunction + PD

70
Q

Describe CSF production and circulation

A

CSF produced by ependymal cells of choroid plexus (mainly in lateral ventricles)

From lateral ventricles, goes through interventricular foramina to 3rd ventricle

Flows down cerebral aqueduct to 4th ventricle

Enters subarachnoid space (via medial + lateral apertures)

Drains back into superior sagittal sinus via arachnoid granulations

71
Q

What is communicating hydrocephalus?

A

Increased production or decreased absorption of CSF

72
Q

What is non-communicating hydrocephalus?

A

intraventricular obstruction of CSF flow

73
Q

What triad characterises normal pressure hydrocephalus ?

A

Gait disturbance
Urinary incontinence
Confusion

74
Q

What is seen on MRI in hydrocephalus?

A

Massive ventricles

75
Q

What are the 3 types of brain herniation?

A

Subfalcine: cingulate gyrus pushed under falx cerebri

Uncal/ transtentorial: medial temporal lobe pushed under tentorium cerebelli

Tonsilar: cerebellar tonsils pushed through foramen magnum.

76
Q

Which type of herniation does not involve the cerebral cortex?

A

Tonsilar herniation
(cerebellum through foramen magnum)

77
Q

What are the consequences of tonsilar herniation?

A

Cardiorespiratory failure + death

78
Q

What percentage of patients who experience a TIA will have a significant infarct within 5 years?

A

33%

79
Q

What is the most common cause of non-traumatic intraparenchymal haemorrhages?

A

HTN

80
Q

Give 2 signs of skull fracture

A

Battle sign: haemorrhage over mastoid process, post traumatic basilar skull fracture

Panda eyes: base of skull fracture in anterior cranial fossa

YR5 Histopathology (27 decks)

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