Medical autopsy - neuro

Question 1

Clues to skull fracture

Answer 1

bleeding opposite point of impact

CSF discharge from nose or ear

Question 2

Brain contusion in head injury

Answer 2

coup and/or contrecoup

wedge shaped

micro: blood, neuronal injury, inflammation, gliosis

Question 3

Diffuse axonal injury in head injury (eg acceleration without impact)

Answer 3

axonal swelling (use silver stains), focal haemorrhage

Question 4

intracranial bleeds (4)

Answer 4

1. epidural: usu with skull #
2. subdural: rupture of weak bridging veins, organises, rebleeding from ‘subdural membranes’
3. subarachnoid: arterial, usu from berry aneurysm, also trauma
4. intracerebral: usu non-traumatic (hypertension or CAA)

Question 5

types of brain ischaemia/infarct

Answer 5

global (arrest, shock, hypotension)

focal (embolic, thrombotic)

Question 6

histology of infarcts

Answer 6

1. oedema + red neurons
2. necrosis + macrophages + vasc proliferation
3. gliosis + cavitation

Question 7

other causes of thrombotic infarct (4)

Answer 7

vasculitis

hypercoagulable state

dissecting neck arteries

drug abuse

Question 8

causes of raised ICP

Answer 8

a) oedema (fluid in brain parenchyna)

or b) hydrocephalus (build up of CSF - obstructive)

Question 9

consequence of raised ICP

Answer 9

herniation

(subfalcine, transtentorial or tonsillar)

Question 11

hypertensive brain disease

Answer 11

hyalinised vessels with fibrinoid necrosis and onion skinning

foamy macrophages

atherosclerosis

may have lacunar infarcts

Question 12

Alzheimer’s histo

Answer 12

neuritic plaques (silver stain)

neurofibrillary tangles (silver stain)

vacuolar degeneration

Hirano bodies in hippocampus

Question 13

epilepsy - causes and autopsy findings

Answer 13

most cause unknown, can be triggered by trauma, stroke, ca

SUDEP = sudden unexpected death in epilepsy

look for: tongue biting, brain lesions (previous trauma), apnoeic fibrosis in heart

Question 14

standard brain blocks at autopsy (eg unknown neuro problem or dementia)

Answer 14

frontal gryus (do tau and b-amyloid)

temporal gyrus (do tau and b-amyloid)

hippocampus (do tau)

cingulate gyrus

parietal lobule

corpus striatum

lenticular nucleus

thalamus

midbrain

pons

medulla

cerebellum

Question 15

trauma brain blocks

Answer 15

contusion, corpus callosum, midbrain, pons

Question 16

hypoxia, epilepsy, alcohol brain blocks

Answer 16

borderzone occipital, frontal gyrus, hippocampus, striatum, thalamus, lens, pons, borderzone cerebellum (+mammillary bodies for alcohol)