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NSB Lectures > Introduction to Neuropathology > Flashcards

Introduction to Neuropathology Flashcards

1
Q

Which cells in embryology become the peripheral nervous system?

A

Neural crest cells

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2
Q

Which embryological structure creates the central nervous system?

A

Neural tube

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3
Q

Why do we have different types of neuron structure?

A

Because they are adapted for processing different pathways - e.g. sensory / motor

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4
Q

What do we have more of - neurons or glial cells?

A

Glial cells
86 billion neurons
100 billion glial cells

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5
Q

What function do astrocytes have?

A

Support, communication, repair & maintenance of BBB

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6
Q

What function do oligodendrocytes have?

A

Myelination of neurons in CNS

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7
Q

What do ependymal cells do?

A

Line the ventricles - make CSF

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8
Q

Which cells are the immune cells of the CNS?

A

Microglia

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9
Q

Which cells are responsible for myelination in the PNS?

A

Schwann cells

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10
Q

Which cells regulate the environment of the PNS?

A

Satellite cells

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11
Q

Why do some demyelinating disorders affect CNS rather than PNS and vice-versa?

A

Depends which type of glial cell is affected by the demyelinating disorder.

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12
Q

What protects the brain?

A

BBB & meninges

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13
Q

Why do some people argue that the brain is immune privileged?

A

Because it is separate to the immune system - no antigen-presenting cells circulate.

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14
Q

What information contradicts the idea that the brain may not be completely separated from the immune system?

A

Mice studies - mice have lymphatic system in dural venous sinuses - allows some brain cells to travel to cervical lymph nodes

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15
Q

Which is the main immune cell of the brain?

A

Microglial = brain macrophages - and also is antigen-presenting

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16
Q

How does the brain form a BBB?

A

Brain capillaries are sealed off - by astrocyte foot processes
Brain capillaries also have thick basement membrane + tight junctions
- All prevents leakage out of the brain capillaries

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17
Q
A
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18
Q

How does neuroinflammation work in the brain?

A

Vascular dilation = inc permeability + inc adhesion
Microglia activated
Macrophages recruited
Odema (vasogenic + cytotoxic)
Astrocytes repair
Demyelination

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19
Q

What does VITAMIN C stand for?

A

Vascular
Inflammation / Infection
Toxins / Drugs
Autoimmune
Metabolic
Idiopathic
Neoplastic
Congenital / Genetic

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20
Q

What is a tumour of the meninges called?

A

Meningioma

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21
Q

Today we can categorise tumours based on their genetic sequences and tailor our treatment in response. What is this called?

A

Personalised medicine (or precision cancer medicine)

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22
Q

Why is neuroinflammation dangerous?

A

Because there is limited space in the cranium - any increase to volume can cause catastrophic brain injury.

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23
Q

How can cancers affect the brain without inflitration?

A

Paraneoplastic syndromes - means that cancers can exert hormonal or autoimmune effects on the brain (e.g. antibodies can begin to attack the normal brain cells).

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24
Q

What is the name of a paraneoplastic syndrome that affects the peripheral nervous system?

A

Lambert Eaton syndrome

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25
Q

What is the name of a paraneoplastic syndrome that affects the central nervous system?

A

NMDA encephalitis

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26
Q

What are the symptoms of meningitis?

A

Headache
Nuchal rigidity (neck stiffness)
Photophobia

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27
Q

Inflammation of the leptomeninges is usually caused by?

A

Infection

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28
Q

Which meninges make up the leptomeninges?

A

Pia + Arachnoid

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29
Q

Which meninges make up the pachymeninges?

A

Arachnoid + Dura

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30
Q

Inflammation of the pachymeninges is usually caused by?

A

Cancer or TB

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31
Q

What is encephalitis?

A

Alteration in sensory/cognitive state due to inflammation (infection or AI).

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32
Q

What test can we use to diagnose meningitis?

A

LP

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33
Q

Where does the spinal cord end?

A

L2

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34
Q

Which part of the spine do you want to tap?

A

L4-5 or L5-S1

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35
Q

Name 4 things that can cause abnormal lumbar puncture results.

A

Shift (midline shift)
Trauma
Obstruction
Posterior fossa mass

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36
Q

What can happen as a consequence of unequal intracranial pressures?

A

Brain can herniate

37
Q

Spinal tap results show:

High pressure
Turbid Appearance
High protein
Low glucose
Presence of neutrophils

What is the likely cause?

A

Bacterial infection

Protein + pus/cloudy CSF + low glucose

38
Q

Spinal tap results show:

High-normal pressure
Clear appearance
Normal-high protein
Normal glucose
Presence of lymphocytes

What is the likely cause?

A

Viral / Aseptic

39
Q

Spinal tap results show:

High-normal pressure
Fibrin web appearance
Normal-high protein
Normal-low glucose
Presence of lymphocytes

What is the likely cause?

A

Fungal or TB

40
Q

What is the treatment for viral meningitis?

A

Supportive treatment as no specific treatment

41
Q

Why is a patient’s age important in determining a likely diagnosis?

A

Because Ps at different ages are more susceptible or likely to encounter certain pathogens (e.g. Mono - uni students).

42
Q

How can the following affect CSF circulation? (They all have the same effect…)

Blockage of flow
Overproduction
Reduced reabsorption

A

Cause pressure to become too high

43
Q

What can cause the CSF circulation to have low pressure?

A

Trauma or spinal tap

44
Q

What are the names of the foramina that the CSF exits through?

A

Foramina of Lushka & Magendie

45
Q

How can you identify hydrocephalus on MRI?

A

Enlarged ventricles & shrunken white matter

46
Q

What is the name for water on the brain?

A

Hydrocephalus

47
Q

What is the name for a direct and indirect brain injury?

A

Direct = coup (e.g. blow to head)

Indirect = contre-coup (brain moves backwards and accelerates into the back of the skull - injury is on opposite side to where the force is implemented)

48
Q

What is the name for a brain injury that has immediate and transient alteration in brain function - leading to headache, drowsiness, concentration deficits & amnesia

A

Concussion

49
Q

What is the name for bruising of the brain tissue?

A

Contusion

50
Q

How can contusion of the brain present?

A

Confusion, altered consciousness, focal neurological deficits

51
Q

Name 3 secondary effects of blunt trauma

A

Cerebral oedema
Ischemia
Blood vessel damage

52
Q

In acceleration-deceleration brain injuries - what happens to the axons?

A

Rotational movements = shearing forces - cause axons to stretch.

53
Q

What is the name of the injury caused to axons by stretching in trauma?

A

Diffuse axonal injury

54
Q

What can a diffuse axonal injury cause?

A

Loss of consciousness
Coma

55
Q

What imaging can determine a diffuse axonal injury?

A

Not CT

MRI (T2-Flair) - may show hyperintensity at grey-white junction - white matter may also look less white due to removed myelin.

56
Q

What are the possible symptoms of increased cerebral pressure?

A

Headaches
Meningism
Vision changes
Papilloedema (optic nerve swelling)
CN6 palsy - abduction of eye impaired
Loss of consciousness
High BP –> reflexive bradycardia & irregular respirations

57
Q

What is Cushing’s reflex

A

High intercranial pressure - widening pulse pressure, reflexive bradycardia & irregular respirations

58
Q

What do repetitive brain injuries put Ps at risk of developing?

A

Chronic Traumatic Encephalopathy

59
Q

How does CTE present pathologically?

A

Tauopathy (lots of Tau protein accumulations) present in superficial cortical layers. (+ inc tau-immunoreactive astrocytes)

Deposition of β-amyloid is far less common in these Ps

60
Q

Which is the primary protein seen in all three of these diseases:
- Chronic Traumatic Encephalopathy
- Progressive Supranuclear Palsy
- Corticobasla Degeneration

A

Tau (Tauopathies)

61
Q

Which is the primary protein seen in all of these diseases:
- Alzheimer’s Disease
- Cerebral Amyloid Angiopathy
- Posterior Cortical Atrophy
- Agrammatic Primary Progressive Aphasia

A

Β-amyloid (Amyloidopathies)

62
Q

Which protein is seen in high levels of these diseases:
- Parkinson’s Disease
- Dementia with Lewy Bodies
- Multiple System Atrophy

A

Α-synuclein (Synucleinopathies)

63
Q

Which protein is seen in v-CJD (new variant Creutzfeld-Jakob) & Kuru?

A

Prions

64
Q

Which protein is found in MND & Amyotrophic Lateral Sclerosis?

A

TAR DNA-Binding Protein 43 (AKA TDP-43)

65
Q

Can you know for certainty which dementia a P actually has?

A

Cannot make definitive classification until autopsy - clinically we look at “possible and probable”.

66
Q

What is a secondary headache?

A

One caused by something else in the body - e.g. infection, malignancy, stroke, medications, toxins & homeostasis imbalance

67
Q

What is a primary headache?

A

Not caused by something else in the body - literally pain from the brain.

68
Q

Name 3 types of primary headache

A

Tension-type
Migraine
Trigeminal autonomic cephalagias (inc cluster headaches)

69
Q

When do you need to investigate a headache for cause (to determine if secondary or primary)?

A
  • Increases with Valsalva (pinch nose & blow)
  • Wakens OUT of sleep (not waking up with it)
  • Change in character of the headache
  • Age of onset
  • Sudden onset (thunderclap)
  • Focal neurological deficits
  • Constitutional symtoms (fever, meningism, rash & weight loss)
70
Q

What is the mnemonic for red flags for headaches?

A

SNNOOP 10

Systemic symptoms
Neoplasm history
Neurological deficit
Onset sudden
Older age
Pattern change
Positional
Precipitated by sneezing, coughing or exercise
Papilloedema (optic disc swelling - vision disturbances)
Progressive headache + atypical presentation
Pregnancy / Pueperium (6 weeks post birth)
Painful eye with ANS features
Post-traumatic onset
Pathology of immune system (e.g. HIV)
Painkiller overdose

71
Q

Which is the most common type of primary headache?

A

Tension-type headache

72
Q

How does a tension-type headache present?

A

Featureless, band-like pressure - squeezing / vice pressure
Bilateral
No usual associated features (but photophobia or phonophobia can occur)

73
Q

How can you determine whether a headache is frequent or infrequent?

A

Frequent = 10 episodes occurring on 1-14 days per month for > 3 months

74
Q

What is the definition of a chronic headache?

A

> 15 days/month for >3 months

75
Q

What are the symptoms of migraine?

A

Photophobia
Incapacity
Nausea

(PIN)

76
Q

What is a migraine termed that happens on 15 or more days per month >3 months (and for 8 of those days has migraine features?)

A

Chronic migraine

77
Q

What is the difference between a common and classical migraine?

A

Common migraine = without aura
Classical migraine = with aura

78
Q

What is the name for a migraine that lasts longer than 72 hours?

A

Status migrainosus

79
Q

How common are cluster headaches?

A

Very rare - 1 in 1000

80
Q

How do cluster headaches present?

A

Sharp, excruciating pain - can cause agitation
Lasting 15-180 mins
Up to x8 per day - for weeks
Unilateral side pain
Stabbing eye pain
Has associated autonomic features (ptosis, mitosis, nasal congestion & lacrimation)

81
Q

How do migraines present

A

Can last 4-72 hours
Unilateral (mostly)
Throbbing pain
Nausea + vomiting + photo/phonophobia
Aura possible

82
Q

What is the latest theory on the cause of headaches?

A

Neuromuscular theory - that sensory neurons in trigeminocervicocomplex = source of pain

83
Q

How is it thought that headaches are triggered in the sensory pathway?

A

Trigeminal ganglion is stimulated (1st order)
Stimulates the pars caudalis (pain & temp) in 2nd order
Stimulates the ventromedial nucleus of thalamus (3rd order)
Stimulates the sensory cortex of the Insula Cingulate (4th order)

84
Q

Which is the main complex that is associated with headaches?

A

Trigeminocervical complex (TCC)

85
Q

Which pathway is thought to be dysregulated in TAC (cluster) headaches?

A

Trigeminal Autonomic Reflex Pathway

86
Q

How can you prevent medication overuse headaches?

A

Triptans <10 days
Non-opiod analgesics <15 days
Opioids <10 days

87
Q

What is it called when the brain cells are deprived of oxygen?

A

Anoxic brain injury

88
Q

What can anoxic brain injuries cause clinically?

A

Seizures
Myoclonus (twitching of muscles)
Coma / Minimally conscious states / Unresponsive wakefulness syndrome)
Brain death

NSB Lectures (48 decks)

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