Introduction to Neuropathology

Question 1

During neurulation, the notochord is formed from the mesoderm and then stimulates the ectoderm to differentiate into the neural tube which folds and separates from the ectoderm and goes on to form the neural tube. In addition, the neural crest cells are created from the ectoderm layer. What do the neural tube and neural crest cells go on to form?

Answer 1

• neural tube = CNS

- neural crest = PNS

Question 2

What are pyramidal cells?

1 - form of multipolar neuron found in hippocampus and amygdala
2 - form of unipolar neuron found in hippocampus and amygdala
3 - form of bipolar neuron found in hippocampus and amygdala
4 - form of pseydopolar neuron found in hippocampus and amygdala

Answer 2

1 - form of multipolar neuron found in hippocampus and amygdala

Question 3

What are ependymal cells?

1 - epithelial cells lining the venous sinuses
2 - ciliated epithelial glial cell that form the choroid plexus
3 - ciliated epithelial cells that line the ventricles
4 - epithelial cells that form the olfactory nerve

Answer 3

2 - ciliated epithelial glial cell that form the choroid plexus

Question 4

What are the main functions of the glial cells called astrocytes?

1 - support, communication, BBB, maintenance, repair
2 - immune function, communication, BBB, maintenance, repair
3 - support, communication, BBB, maintenance, repair
4 - support, myelinate neurons, BBB, maintenance, repair

Answer 4

3 - support, communication, BBB, maintenance, repair

Question 5

What are the immune cells of the CNS?

1 - macrophages
2 - microglia
3 - astrocytes
4 - neutrophils

Answer 5

2 - microglia

- think M for monocytes

Question 6

What is the main antigen presenting cell in the CNS?

Answer 6

• microglia

- can recruit macrophages as well

Question 7

The majority of the brain has the blood brain barrier (BBB), which does not let a lot pass. What is the structure of the BBB that helps it maintain such a tight barrier?

Answer 7

• endothelial cells held together by tight junctions
• basement membrane
• pericytes
• astrocyte end foot

Question 8

There are 2 main instances in the brain that do not posses the tight BBB. What are these 2 instances?

Answer 8

1 - choroid plexus (create CSF)

2 - circumventricular organs (facilitate communication between blood in CNS and PNS), such as the pituitary gland

Question 9

What are the 3 basic layers of the meninges of the brain?

Answer 9

1 - dura mater
2 - arachnoid mater
3 - pia mater

Question 10

The dura mater meningeal layer has 2 layers, what are these?

1 - endosteal layer and meningeal layer
2 - periosteum layer and meningeal layer
3 - pia layer and meningeal layer
4 - endosteal layer and subarachnoid layer

Answer 10

1 - endosteal layer and meningeal layer

Question 11

The dura mater meninges has 2 layers, endosteal/periosteal layer (closest to the bone) and the meningeal layer. These 2 layers are normally in close contact, but the areas where they do separate create space. What are these spaces called?

Answer 11

• venous sinuses

Question 12

In the subarachnoid layer of the meninges there is something that protrudes into the venous sinus and allows CSF to flow out of the brain. What are these protrusions called?

1 - arachnoid dendrites
2 - arachnoid microtubules
3 - arachnoid granulations
4 - glymphatics

Answer 12

3 - arachnoid granulations

Question 13

Below the pia mater, the deepest and closest meningeal layer to the brain is a glial membrane composed of astrocyte foot processes. These function to prevent the over-migration of neurons and neuroglia, the supporting cells of the nervous system, into the meninges. What is this called?

1 - glia radialatans
2 - glia limitans
3 - glymphatics
4 - glymphoma

Answer 13

2 - glia limitans

Question 14

The cerebral cortex is a grey matter area on the outside of the brain, composed of neuronal cell bodies. How many laters does the cerebral cortex have?

1 - 2
2 - 4
3 - 6
4 - 8

Answer 14

3 - 6 layers

Question 15

In the brain inflammation facilitates the delivery of effector molecules to aid in rapid repair through signals, such as cytokines. What happens to the blood vessels in the brain when there is inflammation?

1 - vasodilation, increased permeability, increased adhesion signalling
2 - vasodilation, decreased permeability, decreased adhesion signalling
3 - vasodilation, decreased permeability, increased adhesion signalling
4 - vasoconstriction, increased permeability, increased adhesion signalling

Answer 15

1 - vasodilation, increased permeability, increased adhesion signalling

Question 15

In the brain inflammation facilitates the delivery of effector molecules to aid in rapid repair through signals, such as cytokines by vasodilating blood vessels. What happens to the microglia (immune cells) which are generally dormant?

Answer 15

• become activated
• can be seen histologically
• top left is inactive, all others are various forms of activation

Question 16

In the brain inflammation facilitates the delivery of effector molecules to aid in rapid repair through signals, such as cytokines. Due to increase permeability and dilation of blood vessels there is oedema. There are 2 kinds of oedema, what are they?

Answer 16

1 - vasogenic (extracellular)

2 - cytotoxic (intracellular)

Question 17

In inflammation blood vessels of the brain vasodilate and have an increase in permeability. This can cause 2 types of oedema, vasogenic and cytotoxic. What is vasogenic oedema?

1 - fluid collects intracellularly, BBB is disrupted, white matter is affected and is common in tumours
2 - fluid collects intracellularly, BBB is in tact, white matter is affected and is common in tumours
3 - fluid collects extracellularly, BBB is disrupted, grey matter is affected and is common in tumours
4 - fluid collects extracellularly, BBB is disrupted, white matter is affected and is common in tumours

Answer 17

4 - fluid collects extracellularly, BBB is disrupted, white matter is affected and is common in tumours

• fluid accumulation in extracellular space (spaces surrounding then brain)
• disruption of the BBB
• white matter affected (causes demyelination)
• common in tumours and abscess

Question 18

In inflammation in the brain blood vessels vasodilate and have an increase in permeability. This can cause 2 types of oedema, vasogenic and cytotoxic. What is cytotoxic oedema?

1 - fluid collects intracellularly, BBB intact, white matter is affected and is common in ischaemia
2 - fluid collects intracellularly, BBB intact, grey matter is affected and is common in ischaemia
3 - fluid collects extracellularly, BBB is disrupted, grey matter is affected and is common in tumours
4 - fluid collects extracellularly, BBB is disrupted, white matter is affected and is common in tumours

Answer 18

2 - fluid collects intracellularly, BBB intact, grey matter is affected and is common in ischaemia

• swelling caused by intracellular accumulation of fluid
• BBB not disrupted
• affects grey and white matter
• common in ischemia

Question 19

Astrocytes are involved in repair in the brain. During inflammation when there is tissue damage, astrocytes will repair this tissue. Is this good or bad repair generally?

1 - generally good with no glial scars
2 - generally good with the help of macrophages
3 - repairs with help of macrophages but glial scars form
4 - repairs with help of macrophages and no glial scars form

Answer 19

3 - repairs with help of macrophages but glial scars form

Question 20

In the image below, which is vasogenic and cytotoxic oedema indicated by the solid lines?

Answer 20

• left = vasogenic
• right = cytotoxic
• dashed lines show the brain herniating to other side of the brain

Question 21

In chronic inflammation there will be damage to the nerves, called neuronal degeneration. This can cause retrograde/wallerian degeneration, what is this?

1 - following axonal damage, distal axon degenerates
2 - following axonal damage, the whole axon degenerates
3 - following axonal damage, proximal axon degenerates
4 - following axonal damage, distal and proximal end of axon degenerates

Answer 21

1 - following axonal damage, distal axon degenerates

- neuron dies or can regenerate depending on extend of injury

Question 22

In chronic inflammation there will be damage to the nerves, called neuronal degeneration. This can cause retrograde/wallerian degeneration, which is damage to the axon distally, which can then cause neuronal death. We can also have trans-synaptic degeneration, what is this?

1 - following axonal damage, distal axon degenerates
2 - following axonal damage, injury spreads to unaffected neurons through synapse
3 - following axonal damage, proximal axon degenerates
4 - following axonal damage, distal and proximal end of axon degenerates

Answer 22

2 - following axonal damage, injury spreads to unaffected neurons through synapse

Question 23

In chronic inflammation there will be damage to the nerves, called neuronal degeneration. This can cause demyelineation, what is this?

Answer 23

• myelin coveing axon is destroyed and nerve cannot conduct as effectively if at all

Question 24

In chronic inflammation there will be damage to the nerves, called neuronal degeneration. This can cause gliotic scars formed by astrocytes that are trying to repair the damage. What is one common neurological disorder these gliotic scars could then cause? 1 - parkinsons disease 2 - Alzheimers disease 3 - epileptic foci 4 - multiple sclerosis

Answer 24

3 - epileptic foci - scar causes abnormal neural flow and connections - can cause epileptic foci leading to epilepsy

Question 25

The symptoms a patient presents in neuropathophysiology is determined by what?

Answer 25

- location of the pathology in the nervous system

Question 26

When trying to diagnose patients with neuropathy, we need a differential diagnosis and use the acronym VITAMIN C, what does this stand for?

Answer 26

- V = vascular - I = inflammation/infection - T = toxins/drugs - A = autoimmune - M = metabolic - I = idiopathic - N = neoplastic (malignant/cancerous) - C = congenital/genetic

Question 27

Glioblastoma is a common cancer that can present in the brains of adults, what is it? 1 - form of cancer formed from choroid cells 2 - form of cancer formed from dura mater 3 - form of cancer formed from glial cells, commonly astrocytes 4 - form of cancer formed from glial cells, commonly oligodendrocytes

Answer 27

3 - form of cancer formed from glial cells, commonly astrocytes - aggresive form of cancer resembling a butterflies that crosses the midline of the brain

Question 28

Meningioma is a common cancer that can present in the brains of adults, what is it? 1 - form of cancer formed from choroid cells 2 - form of cancer formed within the meningeal layers 3 - form of cancer formed from glial cells, commonly astrocytes 4 - form of cancer formed from glial cells, commonly oligodendrocytes

Answer 28

2 - form of cancer formed within the meningeal layers | - outside the brain in the meninges, but still presses on the brain

Question 29

Is a tumour more likely in a glial or neuronal cell?

Answer 29

- glial cells due to their ability to divide and proliferate

Question 30

What does para-neoplastic syndrome? 1 - tumour in glial cells that triggers an abnormal immune response 2 - tumour in glial cella 3 - tumour in neuronal cells 4 - tumour in neuronal cells that triggers abnormal immune response

Answer 30

4 - tumour in neuronal cells that triggers abnormal immune response - symptoms are due to immune cells response - triggers an autoimmune process

Question 31

Paraneoplastic syndromes are when the immune cells detect a cancer and an abnormal immune response is stimulated, triggering an autoimmune process. Which cells are heavily involved in this?

Answer 31

- T cells | - attack normal brain tissue

Question 32

Paraneoplastic syndromes are when the immune cells detect a cancer and an abnormal immune response is stimulated, triggering an autoimmune process. If the PNS is involved this can lead to Lambert Eaton, what is this? 1 - type II hypersensitivity, immune cells attack pre-synaptic receptors so no depolarisation 2 - type II hypersensitivity, immune cells attack pre-synapse, no Ca2+ released despite action potential 3 - type V hypersensitivity, cytotoxic T cels cells attack attack pre-synapse so no vesicles to release neurotransmitters 4 - type II hypersensitivity, immune cells attack post-synaptic receptors so no depolarisation

Answer 32

2 - type II hypersensitivity, immune cells attack pre-synapse, no Ca2+ released despite action potential - leads to impaired pre-synapse response to action potential

Question 33

Paraneoplastic syndromes are when the immune cells detect a cancer and an abnormal immune response is stimulated, triggering an autoimmune process. If the PNS is involved this can lead to Lambert Eaton, which is a type II hypersensitivity. Here the immune system attacks Ca2+ channels on NMJ and nerves, leading to impaired pre-synapse response to action potentials. What tissue is heavily affected by this syndrome?

Answer 33

- skeletal muscles become weak | - temporarily improve with activity

Question 34

Paraneoplastic syndromes are when the immune cells detect a cancer and an abnormal immune response is stimulated, triggering an autoimmune process. If the PNS is involved this can lead to Lambert Eaton, which is a type II hypersensitivity. Here the immune system attacks Ca2+ channels on NMJ and nerves, leading to impaired pre-synapse response to action potentials. This causes muscle weakness, that can temporarily get better with exercise. What tumour is heavily linked with this? 1 - bladder cancer 2 - bone cancer 3 - breast cancer 4 - lung cancer

Answer 34

4 - lung cancer

Question 35

Paraneoplastic syndromes are when the immune cells detect a cancer and an abnormal immune response is stimulated, triggering an autoimmune process. If the CNS is affected this can lead to NMDA (glutamate receptors) encephalitis (inflammation of the brain). What is this? 1 - antibodies target NMDA receptors meaning less glutamate neuronal activity 2 - antibodies target AMPA receptors meaning less glutamate neuronal activity 3 - antibodies target dopamine receptors meaning less glutamate neuronal activity 4 - antibodies target serotonin receptors meaning less glutamate neuronal activity

Answer 35

1 - antibodies target NMDA receptors meaning less glutamate neuronal activity - can cause a neuropsychiatric condition

Question 36

Paraneoplastic syndromes are when the immune cells detect a cancer and an abnormal immune response is stimulated, triggering an autoimmune process. If the CNS is affected this can lead to NMDA (glutamate receptors) encephalitis (inflammation of the brain). This is where antibodies attack NMDA receptors, which are glutamate receptors affecting mood and emotions, causing neuropsychiatric condition. How can this syndrome initially present?

Answer 36

- flu like symptoms with a headache - paranoia, unstable mood, anxiety - seizures

Question 37

Paraneoplastic syndromes are when the immune cells detect a cancer and an abnormal immune response is stimulated, triggering an autoimmune process. If the CNS is affected this can lead to NMDA (glutamate receptors) encephalitis (inflammation of the brain). This is where antibodies attack NMDA receptors, which are glutamate receptors affecting mood and emotions, causing neuropsychiatric condition. This syndrome can present initially like flu like symptoms with a headache the progress to paranoia, unstable mood, anxiety and even catatonia (statue like presentation). What type of cancer is this highly linked with? 1 - bladder cancer 2 - ovarian teratoma 3 - breast cancer 4 - lung cancer

Answer 37

2 - ovarian teratoma | - germ cell tumour with multiple tissue types (hair, bone, skin)

Question 38

What is meningoencephalitis?

Answer 38

- serious neurological condition causing inflammation of the outer protective layers of the brain - generally caused by a viral infection leading to inflammation - meningo = inflammation of meninges - encephalo = inflammation of the brain

Question 39

Meningoencephalitis is a serious neurological condition affecting both the meninges and the brain: - meningo = inflammation of meninges - encephalo = inflammation of the brain It is commonly caused by an infection leading to inflammation. What are some common problems a patient may present with?

Answer 39

- headache - sensitivity to light - neck stiffness - confused state

Question 40

What is the leptomeningeal (from the Greek lepto, meaning 'fine' or 'slight')?

Answer 40

- combination of the arachnoid and pia mater

Question 41

Meningoencephalitis is a serious neurological condition affecting both the meninges and the brain: - meningo = inflammation of meninges - encephalo = inflammation of the brain It is commonly caused by a viral infection leading to inflammation. If we suspect this condition, what is the most useful test to diagnose? 1 - MRI 2 - lumbar puncture/spinal tap 3 - blood test 4 - CT scan

Answer 41

2 - lumbar puncture/spinal tap | - can see if the CSF is infected

Question 42

What is luschka magendie, also called the media aperture? 1 - opening of the venous sinuses 2 - end of the arachnoid granulations where they enter the venous sinuses 3 - opening from 4th ventricle into the cisterna magna and then into the subarachnoid space 4 - where lateral ventricle meets the 3rd ventricle in the brain

Answer 42

3 - opening from 4th ventricle into the cisterna magna and then into the subarachnoid space - opening that drains CSF

Question 43

What are the 3 most likely causes of an increase pressure associated with CSF?

Answer 43

1 - blockage of flow (stenosis, cyst etc) 2 - CSF over production (papilloma) 3 - reduced re-absorption into venous sinuses

Question 44

When we talk about hydrocephalus (increased fluid, generally CSF, in the brain), what does communicative and non-communicative refer to?

Answer 44

- relates to the flow of CSF between the ventricles - communicative = flow remains - non-communicative = flow obstructed

Question 45

The brain can be damaged by trauma. What are the 2 groups that this can fall into? 1 - trauma and direct 2 - direct and indirect 3 - trauma and indirect 4 - lesion and trauma

Answer 45

2 - direct and indirect - direct (coup, french for blow) is first bang on front of head - indirect (contra-coup, french for counter blow) is second bang as brain hits back of cranium

Question 46

The brain can be damaged by trauma, which can be direct (coup, french for blow) or indirect (contra-coup, french for counter blow). How can this occur if someone banged their heads at the front?

Answer 46

- front trauma to the head would be coup | - the force of the front head trauma would cause the brain to move and hit the back of the head, counter coup

Question 47

In boxing head trauma is common and can lead to coup (direct) and counter-coup (indirect) and cause loss of sight or blurred vision, why?

Answer 47

- punch to front of head of face is the coup | - but back of brain could hit the skull and damage occipital lobe, which would be the counter coup

Question 48

What does concussion mean relating to neurology? 1 - clinical syndrome relating to consciousness 2 - clinical syndrome relating to cognitive state 3 - clinical syndrome relating to dementia 4 - clinical syndrome relating to awareness

Answer 48

1 - clinical syndrome relating to consciousness | - causes headaches, drowsiness or amnesia

Question 49

What does contusion mean relating to neurology? 1 - pathological term relating to consciousness 2 - pathological term relating to fluid on the brain 3 - pathological term relating to lesions of the brain 4 - pathological term relating to bruising of the brain

Answer 49

4 - pathological term relating to bruising of the brain | - can cause confusion and neural deficits

Question 50

Although the consequences of the coup (direct) or counter-coup (indirect) trauma can be dangerous, there are also secondary consequences we must be aware of. What are the 2 most common in the brain? 1 - lesions and cerebral oedema/ischaemia 2 - blood vessel damage and cerebral oedema/ischaemia 3 - bruising and cerebral oedema/ischaemia 4 - cerebral oedema/ischaemia and neuronal atrophy

Answer 50

2 - blood vessel damage and cerebral oedema/ischaemia

Question 51

Acceleration - Deceleration injuries can also be dangerous. What are these?

Answer 51

- brain is shifted in the skull - causes cell damage - common in car crashes and shaken baby syndrome

Question 52

Acceleration - Deceleration injuries can also be dangerous. This is when the brain is shifted in the skull, causing cell damage and is common in car crashes and shaken baby syndrome. The cell damage can be due to diffuse axonal injury, which is essentially stretching of the axons. What can this cause? 1 - axonal degeneration, neuronal cell death, activated glial cells causing oedema 2 - axonal hyperplasia, neuronal cell death, activated glial cells causing oedema 3 - axonal degeneration, neuronal cell hypertrophy, activated glial cells causing oedema 4 - axonal degeneration, neuronal cell death, glial cells apoptosis

Answer 52

1 - axonal degeneration, neuronal cell death, activated glial cells causing oedema

Question 53

Increased cerebral pressure is generally caused by an increase in the fluid and oedema in the brain. This causes the brain to be squashed in the cranium. What can this lead to in the blood vessels?

Answer 53

- compression of blood vessels - vessels dilate and increase BP - vessel permeability increases - leads to ischemia and further fluid loss

Question 54

If a patient has an increase in cerebral pressure, what are the 3 most common symptoms they can present with? 1 - headaches, loss of sensations, loss of consciousness 2 - headaches, muscle weakness, loss of consciousness 3 - pain, loss of sensations, loss of consciousness 4 - headaches, vision changes (papilloedema), loss of consciousness

Answer 54

4 - headaches, vision changes (papilloedema), loss of consciousness

Question 55

In addition to the common symptoms of headaches, vision change and loss of consciousness, increased cerebral pressure (ICP) can also cause Cushings reflex, what is this? 1 - increased ICP causes increased BP, irregular breathing and increased heart rate 2 - decreased ICP causes increased BP, irregular breathing and decreased heart rate 3 - decreased ICP causes increased BP, irregular breathing and increased heart rate 4 - increased ICP causes increased BP, irregular breathing and decreased heart rate

Answer 55

4 - increased ICP causes increased BP, irregular breathing and decreased heart rate - called the Cushing reflex or cushings triad.

Question 56

Encephalopathy relates to damage to the brain. If there has been trauma to the brain this can lead to chronic traumatic encephalopathy. This is most commonly caused by repeated blows to the head as in boxing, football etc.. What 2 proteins have been detected in the brains of patients with this type of chronic head injury? 1 - BDNF and tau protein 2 - tau protein and alpha-synuclein 3 - B-amyloid and tau protein 4 - alpha-synuclein and B-amyloid

Answer 56

3 - B-amyloid and tau protein - tau protein (maintains intracellular microtubule structure in neurons) INTRACELLULAR - B-amyloid (aggregates of proteins that form plaques in the brain) EXTRACELLULAR

Question 57

What is tau protein? 1 - protein found inside neurons, maintains microtubule structure 2 - protein found inside neurons, maintains vesicles 3 - protein found outside neurons, maintains pre-synapse 4 - protein aggregates that form extracellular plaques in the brain

Answer 57

1 - protein found inside neurons, maintains microtubule structure - increased accumulation of tau immunoreactive astrocytes

Question 58

What is the only way we can definitively diagnose a patient with a neurological disorder such as parkinsons?

Answer 58

- tissue sample from brain | - generally from autopsy when deceased

Question 59

A haematoma is an abnormal collection of blood outside of a blood vessels. If we have an epidural haematoma, where is the fluid? 1 - generally between dura and arachnoid mater 2 - between dura mater and cranium 3 - below the subarachnoid 4 - within the brain parenchyma means functioning tissue, which is the brain

Answer 59

2 - between dura mater and cranium - epi is greek for upon - durals = dura mater

Question 60

A haematoma is an abnormal collection of blood outside of blood vessels. If we have an subdural haematoma, where is the fluid? 1 - generally between dura and arachnoid mater 2 - between dura mater and cranium 3 - below the subarachnoid 4 - within the brain parenchyma means functioning tissue, which is the brain

Answer 60

1 - generally between dura and arachnoid mater - sub = below - dural = dura mater

Question 61

A haematoma is an abnormal collection of blood outside of a blood vessels. If we have an subarachnoid haematoma, where is the fluid? 1 - generally between dura and arachnoid mater 2 - between dura mater and cranium 3 - below the subarachnoid 4 - within the brain parenchyma means functioning tissue, which is the brain

Answer 61

3 - below the subarachnoid | - sub = below

Question 62

A haematoma is an abnormal collection of blood outside of a blood vessels. If we have an intraparenchymal haematoma, where is the fluid? 1 - generally between dura and arachnoid mater 2 - between dura mater and cranium 3 - below the subarachnoid 4 - within the brain parenchyma means functioning tissue, which is the brain

Answer 62

4 - within the brain parenchyma means functioning tissue, which is the brain

Question 63

What is the difference between Haematoma and Haemorrhage?

Answer 63

- Haematoma = collection of blood | - Haemorrhage = leaking or bursting of blood vessel

Question 64

Looking at the MRI image below, what type of haematoma's can we see here from: - epidural - subarachnoid - subdural - intraparenchymal

Answer 64

``` 1 = epidural 2 = subdural 3 = subarachnoid 4 = intraparenchymal ```

Question 65

There are 4 types of haematoma's that can occur in the brain: 1 - epidural 2 - subarachnoid 3 - subdural 4 - intraparenchymal Which is most likely to result in a quick death despite the patient talking?

Answer 65

1 - epidural - fracture to skull, meningeal artery is ripped open causing high pressure on brain - VERY DANGEROUS

Question 66

Cerebrovascular disease is a group of conditions and diseases that affect the blood vessels to where?

Answer 66

- the brain - cerebro = cerebral cortex - vascular = blood vessels

Question 67

Cerebrovascular disease is a group of conditions and diseases that affect the blood vessels to the brain and is a leading cause of disease worldwide with similar risk factors as coronary artery disease. What is a stroke?

Answer 67

- reduction in blood supply to the brain | - neurological deficits last >24 hours

Question 68

What are the 3 main places that a stroke can affect?

Answer 68

1 - brain 2 - spinal cord 3 - retina

Question 69

Often called a mini stroke, but more accurately called a transient ischaemic attack can also cause symptoms. What is transient ischaemic attack?

Answer 69

- a brief period of blood loss to a part of the brain | - transient episode of neurological dysfunction

Question 70

Are ischemic or hemorrhagic strokes more common?

Answer 70

- ischaemic stroke (lack of blood supply) | - accounts for 78% of strokes

Question 71

Ischaemic stroke (lack of blood supply) is the most common stroke, accounting for 78% of strokes. What are some of the things that can happen to the blood vessels to cause this?

Answer 71

- occlusion - thrombus (blood clot) - embolus (particle or mass, air, fat, etc..) - vasospasms - hypotension

Question 72

What are the 2 ways in which we can block blood vessels in the brain, leading to an ischaemic stroke?

Answer 72

- thrombus (blood clot) | - embolus (particle or mass, such as fat, air, etc...)

Question 73

Virchows triad is when 3 factors that are critically important in the development of venous thrombosis occur. What are the 3 factors? 1 - venous stasis, activation of blood coagulation, endothelial damage 2 - infection, activation of blood coagulation, endothelial damage 3 - venous stasis, activation of blood coagulation, endothelial hyperplasia 4 - venous stasis, excessive aspirin, endothelial damage

Answer 73

1 - venous stasis, activation of blood coagulation, endothelial damage (1) venous stasis (slow moving blood due to inactivity) (2) activation of blood coagulation (trauma) (3) endothelial damage (lifestyle factors)

Question 74

Virchows triad is when 3 precipitating factors occur that can then lead to venous thrombosis. The 3 factors are: 1 - venous stasis (slow moving blood due to inactivity) 2 - activation of blood coagulation (trauma) 3 - endothelial damage (lifestyle factors) How can Virchows triad cause a stroke?

Answer 74

- atrial fibrillation causes blood to become stagnant (stasis) and thicken (coagulation) and damage endothelial cells - thrombosis (blood clot) can break away and become lodged in blood vessels in the brain

Question 75

How can an atherosclerosis cause cause a stroke?

Answer 75

- lipid plaque can build up and lead to partial or complete blockage - can also break off forming thrombosis (blood clots)

Question 76

When a patient has a stroke, what drives the patients symptoms that they present with?

Answer 76

- the location of the stroke in the brain | - for example if frontal, cognitive function will be impaired

Question 77

What does ischaemic penumbra mean?

Answer 77

- penumbra = latin for almost - part of an acute ischaemic stroke that has reduced O2 due to core lesion - but can be salvaged if reperfused

Question 78

In an ischaemic stroke what is the core lesion? 1 - location downstream of original blockage causing dead tissue 2 - location where original blockage occurred 3 - location where tissue has died downstream of original blockage

Answer 78

1 - location downstream of original blockage causing dead tissue - core lesion blocks blood to further tissue, leading to further tissue death

Question 79

What does time is tissue mean in terms of stroke?

Answer 79

- longer it takes to re-perfuse = more tissue death

Question 80

Haemorrhage strokes account for aprox 20% of strokes. What is this?

Answer 80

- blood vessels rupture causing incredible headache | - signs of bleeding will appear following the sealing of the haemorrhage

Question 81

Global brain injury can be caused by anoxic (latin for lack of) brain injury. What is anoxic brain injury?

Answer 81

- a complete lack of O2 to the brain

Question 82

Global brain injury can be caused by anoxic brain injury, which is a complete lack of O2 to the brain. This can be grouped into hypoxia or ischaemia. What are the most common causes of hypoxia?

Answer 82

- essentially anything that stops blood to the brain - drowning - strangulation - asphyxia - CO2

Question 83

Global brain injury can be caused by anoxic brain injury, which is a complete lack of O2 to the brain. This can be grouped into hypoxia or ischaemia. What are the most common causes of ischaemia?

Answer 83

- essentially anything that reduces blood flow - cardiac arrest - increased intracranial pressure - hypovolemia (low extracellular fluid)

Question 84

What protein is commonly found in the brain tissue of patients with parkinsons? 1 - tau protein 2 - alpha synuclein 3 - B-amyloid 4 - BDNF

Answer 84

2 - alpha synuclein

Question 85

What are lewy bodies?

Answer 85

- protein deposits found in neurons | - common cause of lewy body dementia

Question 86

What neuropathology's are lewy bodies, protein aggregates common in?

Answer 86

- lewy body dementia | - parkinsons

Question 87

What is cranial nerve XII (12) and what is its function?

Answer 87

- hypoglossal nerve | - innervates the tongue

Question 88

Cranial nerve XII (12) is the hypoglossal nerve, whose function is to innervate the tongue. Does the left CN XII supply the left or right side of the tongue?

Answer 88

- ipsilateral - means left supplies left side of the tongue - means right supplies right side of the tongue

Question 89

Cranial nerve XII (12) is the hypoglossal nerve, whose function is to innervate the tongue. CN XII (12) is ipsilateral, meaning left supplies left side of the tongue and right supplies right side of the tongue. If there is a lesion on one of these nerves what would happen with the tongue?

Answer 89

- the tongue would deviate to the side with the lesion | - lesion of left side of CN XII means tongue moves towards the left