neuro patho

Question 1

Normal range of ICP

Answer 1

7-15 mmHG

Question 2

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

Answer 2

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

Question 3

**Most common cause of epidural haemorrhage

Answer 3

Traumatic head injury causing rupture of middle meningeal artery

Question 4

Name some features of epidural haemorrhage I would expect to see

Answer 4

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.

Question 5

**Most common cause of subdural haemorrhage

Answer 5

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.

Question 6

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

Answer 6

Crescent shaped hematoma

Question 7

**Most common cause of subarachnoid haemorrhage

Answer 7

Berry aneurysm

Question 8

**Most common cause of intracerebral haemorrhage

Answer 8

HYPERTENSION!!!

Question 9

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

Answer 9

Thunderclap headache

Question 10

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

Answer 10

Polycystic kidney disease
Aortic coarctation

Question 11

What protein is Alzheimer’s associated with?

Answer 11

Beta amyloid proteins -> amyloid plaques

Question 12

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

Answer 12

Temporal lobe

Brain will atrophy

Question 13

Clinical manifestations of Alzheimer’s

Answer 13

Dementia

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

Progressive motor decline

Question 14

What protein and hormone is Parkinson’s associated with?

Answer 14

Lewy bodies and dompamine.

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

Question 15

Which part of the brain is most affected in Parkinson?

Answer 15

Substantia nigra

Question 16

Clinical manifestations of Parkinson’s

Answer 16

**Cog wheel rigidity - consistent resistance to movements

** Resting tremor

Bradykinesia - slowed movement

Freezing of gait

Question 17

What is Huntington’s disease?

Answer 17

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.

Question 18

Optic nerve lesion

Answer 18

Monocular blindness

Question 19

Centre of optic chiasm lesion

Answer 19

Bitemporal hemianopia

Question 20

Lateral optic chiasm lesion

Answer 20

Ipsilateral nasal hemianopia

Question 21

Optic tract or LGN of thalamus lesion

Answer 21

Contralateral homonymous hemianopia

Question 22

Optic radiation/primary visual cortex

Answer 22

Contralateral homonymous hemianopia with macular sparing

Question 23

Meyer’s loop + which lobe affected?

Answer 23

Temporal lobe

Homonymous quadrantanopia

Question 24

What is macular sparing and why?

Answer 24

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.

Question 25

Pituitary tumour is associated with

Answer 25

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

Question 26

NF type 2 is associated with

Answer 26

Cataracts at young age; hearing loss; schwannomas
Meningioma

Question 27

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

Answer 27

Lymphoma

Question 28

Most common brain tumour in children

Answer 28

Medulloblastoma
Pilocytic astrocytoma

Question 29

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

Answer 29

Meningitis, neissera meningitis

Question 30

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

Answer 30

Encephalitis, herpes simplex virus

Question 31

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

Answer 31

Patient is immunocompromised, cryptococcosis

Question 32

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

Answer 32

Toxoplasmosis

Question 33

What are the 2 unique symptoms of meningitis?

Answer 33

Neck stiffness
Photophobia (sensitivity to light)

Question 34

Name congenital brain infections (hint: TORCH)

Answer 34

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

Question 35

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

Answer 35

Neural tube defect:
- Spina bifida
- Hydrocephalus

Forebrain abnormalities
- Polymicrogyria
- Holoprosencephaly
- Anencephaly
- Lissencephaly

Posterior fossa anomalies
- Dandy walker - enlarged
- Arnold chiari - small

Question 36

What 2 conditions is holoprosencephaly associated with?

Answer 36

Trisomy 13
Maternal diabetes

Question 37

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

Answer 37

Fat embolism
Malaria

Question 38

Vitamin B1 (thiamine) deficiency can result in

Answer 38

Wernicke’s encephalopathy
- Psychotic symptoms + ophthalmoplegia

Question 39

Vitamin B12 (folate) deficiency can result in

Answer 39

Peripheral neuropathy accompanied by megaloblastic anaemia

Question 40

Wernicke’s encephalopathy is caused primarily by

Answer 40

Vitamin B1 thiamine deficiency

Question 41

Chronic alcoholism can affect the brain as it causes _

Answer 41

Cerebellar atrophy -> dysfunction

Wernicke-korsarkoff’s syndrome (amnesia, invented memories - confabulation, ophthalmoplegia)