Lecture 21 Pathology for CNS 2 Flashcards
Give examples of cerebrovascular diseases?
Strokes, TIA and intercerebral haemorrhage
How much for the brain weigh?
1-2% of body weight
How much O2% does the body use?
20%
When blood flow is reduced to brain, tissue survival depends on?
Collateral circulation, duration of ischaemia and magnitude/rapidity of flow reduction
Global hypoperfusion (blood flow reduce to whole brain) causes?
Hypotentsion or cardiac arrest -> generalised neuronal dysfunction
How many patients/year have stroke?
130,000
What are the risk factors for strokes?
Diabetes M, hypertension, hyperlididaemia, heart disease or previous TIA
Define TIA
Transient ischaemic attack is temp loss of function that resolves itself within 24 hours
Risk of having full stroke after TIA?
1 in 10 chance of having full stroke within 4 weeks if left untreated
Treatments for TIA?
Aspirin/clopidogrel as antiplatelets. Control BP and lower cholesterol
Define aphasia?
Loss of speech
Define hemianopia?
Loss of vision
What causes an intracerebral haemorrhage?
Hypertension ‘capsular haemorrhage’. Arterial origin.
What causes a subarachnoid haemorrhage?
Spontaneous. 80% rupture of saccular aneurysms
What causes subdural haemorrhage?
Minor trauma (elderly). Anticoagulants. Bleeding from bridging veins between cortex & venous sinuses
What causes extradural haemorrhage?
Middle meningeal artery, post head injury
What are the symptoms of a intracranial haemorrhage?
Headache, rapid or gradual loss of consciousness
What are the symptoms of a subarachnoid haemorrhage?
Thunderclap headache. Spontaneous -> catastrophic
What are the symptoms of a subdural haemorrhage?
Fluctuant conscious level, minor trauma.
What are the symptosms of a extradural haemorrhage?
Head injury with #skull. Slowly decreasing conscious level.
What is dementia?
Irreversible clinical synddromewith widespread impairment of mental function
Who is at risk of dementia?
> 65yo. 80,000 people in uk
Side effects of dementia?
Memory loss, speed of thought, language, understanding, disinterested, difficulties in controlling emotions.
What can mimic dementia?
Depression or delirium
What are the types of dementia?
Alzheimer’s disease (70%), Vascular dementia (15%) and dementia with lewy bodies (15%). RARE cause (syphilis)
What assessments are done for dementia?
Ensure thyroid function is normal, CT scan, Check vit B12 (alcoholism)
What is alzheimer’s disease due to?
AB amyloid accumulation. Tau - neurofibrillary tangles and plaques, loss of neurones and synapses.
What does alzhimers lead to?
defects in visual-spatial skills (gets lost), memory loss, decreasing cognition and ansognosia (lack of awareness)
What is alzhimers treated with?
cholinesterase inhibitors
What is epilepsy?
Recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain -> seizures.
What can cause epilepsy?
Space occupying lesions, stroke, alcohol withdrawal.
How can epilepsy be managed?
Sodium valproate, carbamazepine, phenytoin, lamotragine
What bacteria can cause meningitis?
Neisseria meningitides, pneumocococcus, meningococcus
Meningitis can be what?
Bacterial, viral or fungal
What are the symptoms of brain abscesses?
Headaches, seizures and temperaures
Radiologically what is found with a brain abscess?
Ring enhancing lesion
How are brain abscesses spread?
Via blood (embolus from bacterial endocarditis,IV drug users at risk) or directly (from infected ear)
What is parkinson’s disease?
Movement disorder, sporadic or familial. 1 in 1000
What is the postural instability of parkinson’s disease due to?
Progressive degeneration of the dopaminergic nigrostriatal system.
What are the clinical features of parkinson’s disease?
Bradykinesis, rigidity, resting tremor, posterural instability
Define bradykinesis?
Slowed ability to start and continue movements & impaired ability to adjust the body’s postition
What is the treatment for parkinson’s disease?
L-dopa e.g modopar to replace the lost dopamine. (Start when necessary & lowest poss dose) OR anticholinergic drugs
What drug can induce parkinson’s and how can it be helped?
Haloperidol and can be helped me procyclidine
Side effects of tumours?
Headaches, seizures, cognitive behaviour change, vomiting, altered consciousness
Where can the primary tumours be that cause brain tumours?
Breast, small cell lung cancer
What are the four types of brain tumours?
Meningiomas, astrocytomas, glioblastomas and pituitary tumours
Notes on meningiomas?
Slow growing, don’t often infiltrate brain, surgically removed.
Notes on astrocytomas?
Range from WHO grade 1-IV. ^ malignant potential. Grade 4 fatal
Notes on glioblastoma?
Ring enhancing lesion in frontal lobe
Define transphenoidally
Surgery where instruments are inserted into part of the brain through nose
