neuro patho Flashcards by Shiyun Chan

Normal range of ICP

7-15 mmHG

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What am I most worried about in a patient with raised ICP?

Tonsillar herniation -> compression of brainstem -> cardiopulmonary arrest (if medulla is compressed)

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**Most common cause of epidural haemorrhage

Traumatic head injury causing rupture of middle meningeal artery

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Name some features of epidural haemorrhage I would expect to see

On CT scan, there is biconvex (lens-shaped) hematoma.

Patient experiences lucid intervals of consciousness because pressure buildup is slow, patient likely asymptomatic in the early stages and develop a sudden onset of raised ICP when cortex gets compressed.

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**Most common cause of subdural haemorrhage

Bridging veins tearing due to age related brain atrophy.

This causing an increase in space between brain and skull, larger distance and more tension is placed on bridging veins.

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What will I see on a CT scan with subdural haemorrhage?

Crescent shaped hematoma

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**Most common cause of subarachnoid haemorrhage

Berry aneurysm involving the Circle of Willis

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**Most common cause of intracerebral haemorrhage

HYPERTENSION!!!

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Name the clinical sign that if patient presents with it, i immediately suspect subarachnoid haemorrhage

Thunderclap headache

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What 2 conditions is berry aneurysm -> SAH associated with?

Polycystic kidney disease
Aortic coarctation

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What protein is Alzheimer’s associated with?

Beta amyloid proteins -> amyloid plaques

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Which part of the brain is most affected in Alzheimer’s? What happens to the brain in general?

Temporal lobe

Brain will atrophy

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Clinical manifestations of Alzheimer’s

Dementia

Progressive cognitive decline (difficulty pronouncing words - dysarthria, difficulty completing task on their own)

Progressive motor decline

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What protein and hormone is Parkinson’s associated with?

Lewy bodies and dompamine.

Loss of nerve cells from substantia nigra -> reduced dopamine to basal ganglia

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Which part of the brain is most affected in Parkinson?

Substantia nigra

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Clinical manifestations of Parkinson’s

**Cog wheel rigidity - consistent resistance to movements

** Resting tremor

Bradykinesia - slowed movement

Freezing of gait

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What is Huntington’s disease?

Autosomal dominant disease associated with the accumulation of Huntington proteins

Results in degeneration and atrophy of the dorsal striatum.

Patient will have motor dysfunction, cognitive decline and personality changes.

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Optic nerve lesion

Monocular blindness

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Centre of optic chiasm lesion

Bitemporal hemianopia

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Lateral optic chiasm lesion

Ipsilateral nasal hemianopia

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Optic tract or LGN of thalamus lesion

Contralateral homonymous hemianopia

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Optic radiation/primary visual cortex

Contralateral homonymous hemianopia with macular sparing

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Meyer’s loop + which lobe affected?

Temporal lobe

Homonymous quadrantanopia

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What is macular sparing and why?

The visual cortex/macula receives dual blood supply from the MCA and PCA. Hence, even if there is a stroke, blood supply will never be 100% compromised -> some degree of central visual field will be retained.

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Pituitary tumour is associated with

Central optic chiasm compression; bitemporal hemianopia - loss of both peripheral visions

NF type 2 is associated with

Cataracts at young age; hearing loss; schwannomas Meningioma

What type of brain tumour is more common in AIDS/HIV/immunocompromised patients?

Lymphoma

Most common brain tumour in children

Medulloblastoma Pilocytic astrocytoma

Brain infections: if bacterial, it is likely (type) and caused by (organism)

Meningitis, neissera meningitis

Brain infections: if viral, it is likely (type) and caused by (organism)

Encephalitis, herpes simplex virus

Brain infections: if fungal, it is likely (type) and caused by (organism)

Patient is immunocompromised, cryptococcosis

Brain infections: patients with AIDs is more likely to have a brain infection caused by _

Toxoplasmosis

What are the 2 unique symptoms of meningitis?

Neck stiffness Photophobia (sensitivity to light)

Name congenital brain infections (hint: TORCH)

Toxoplasmosis Others: varicella zoster, syphilis, parvovirus b19 Rubella Cytomegalovirus Herpes

3 types of congenital CNS malformations and give an example of each

Neural tube defect: - Spina bifida - Hydrocephalus Forebrain abnormalities - Polymicrogyria - Holoprosencephaly - Anencephaly - Lissencephaly Posterior fossa anomalies - Dandy walker - enlarged - Arnold chiari - small

What 2 conditions is holoprosencephaly associated with?

Trisomy 13 Maternal diabetes

In autopsy, the cut surface of patient's brain showed intracerebral petechial. What top 2 causes do I suspect?

Fat embolism Malaria

Vitamin B1 (thiamine) deficiency can result in

Wernicke's encephalopathy - Psychotic symptoms + ophthalmoplegia

Vitamin B12 (folate) deficiency can result in

Peripheral neuropathy accompanied by megaloblastic anaemia

Wernicke's encephalopathy is caused primarily by

Vitamin B1 thiamine deficiency

Chronic alcoholism can affect the brain as it causes _

Cerebellar atrophy -> dysfunction Wernicke-korsarkoff's syndrome (amnesia, invented memories - confabulation, ophthalmoplegia)

Histologically, what will I see in the brain of a patient who had a stroke?

1. Foamy macrophages 2. Oedematous fluids 3. Reactive gliosis (increased number of astrocytes) 4. **** LOSS OF GREY WHITE MATTER DIFFERENTIATION

SAH is associated with

Polycystic kidney disease and aortic coarctation

If patient's brain has petechial haemorrhage, what are the top 2 causes?

Fat embolism Malaria

Glioblastoma on CT scan looks like?

Butterfly lesion

Medulloblastoma is the most common form of brain cancer in _

Children

Name the pathogen that is the most common cause of meningitis

Neissera meningitis

Is hypertension a cause of SAH?

No!!! Hypertension is the most common cause of INTRACEREBRAL HAEMORRHAGE But SAH is a extracerebral haemorrhage!!

Which artery in the Circle of Willis is the most prone to aneurysm?

Anterior communicating artery

Describe the microscopic changes of the brain after an infarction

12h: Neurons become red, there is oedema Reactive gliosis (increase number of astrocytes) Foamy macrophages

Describe the gross apperance of the brain following an infarction

Within the first 48h, the brain will be pale, swollen and there will be an indistinct grey-white matter junction In the next 2-10 days, the brain becomes gelatinous and friable. After 10 days, the area of infarct becomes a liquid filled cavity (liquefactive necrosis).

Patient has an acute onset of hemiparesis and hemisensory loss, specifically in her right leg only. She says that her face and upper limb feel okay but she has lost total sensation of her right leg. I suspect that she is having a stroke. What artery in the brain is likely occluded?

Anterior cerebral artery

Patient complains that she has suddenly lost sensation in one side of her arms and legs. She is also observed to have facial drooping. I suspect that she is having a stroke. What artery in the brain is likely occluded?

Middle cerebral artery

Patient complains of sudden loss of vision and is experiencing hemiparesis and hemisensory loss in one side of her body. I suspect that she is having a stroke. What artery in the brain is likely occluded?

Posterior cerebral artery

_ is the MOST COMMON opportunistic CNS infection in patients with AIDS

Toxoplasmosis

Most common fungal infection causing meningitis in patients with AIDS

Cryptococcus

Name some congenital CNS infections

Toxoplasmosis Others - varicella zoster, syphilis, parvovirus b19 Rubella Cytomegalovirus Herpes simplex virus 2

What are the 3 types of CNS malformations?

1. Neural tube defect 2. Forebrain abnormalities 3. Posterior fossa abnormalities

Maternal diabetes is associated with what type of CNS congenital malformation?

Incomplete separation of cerebral hemispheres across midline (looks connected) = Holoprosencephaly Baby has one eye - cyclopia

Lewy bodies is seen in what type of neurodegenerative disease?

Parkinson

Dizziness, greying vision points towards

Syncope

Patient has symptoms only in the ipsilateral half of his face. Where is the lesion? And what is this condition called?

LMN Bell's palsy -> lesion to facial nerve CN7

Patient has symptoms only in the contralateral lower half of his face. Where is the lesion?

UMN

Define apraxia

Inability to carry out movements/perform learned actions upon command

Define aphasia

Impairment of speech; inability to comprehend and/or produce speech

Define ataxia

Lack of muscle control or coordination of voluntary movements, such as walking or picking up objects

Define neuralgia

Severe, shooting pain that occurs due to a damaged or irritated nerve

Define myalgia

Painful sensation evolving from muscle tissue