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Neurology > Neuropathology 1 > Flashcards

Neuropathology 1 Flashcards

1
Q

When might acute neuronal injury occur?

A

In any events which cause hypoxia / ischaemia

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2
Q

What is another term used for acute neuronal injury?

A

Red neuron

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3
Q

What microscopic changes will be seen in ‘red neuron’ death?

A

Shrinking and agglutination of the nuclei
Loss of nucleolus
Intensely red cytoplasm due to eosinophilia

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4
Q

What is an axonal reaction?

A

Neuronal cell body reaction associated with an axonal injury

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5
Q

List some examples of axonal injuries?

A

Swelling
Enlarged nucleolus from protein synthesis
Degeneration of axon and myelin

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6
Q

Define “Wallerian degeneration”:

A

This is when degeneration occurs distal to the site of the injury

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7
Q

When might simple neuronal atrophy occur

A

In chronic disease such as MS or Alzheimer’s

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8
Q

What are some of the features of simple neuronal atrophy?

A

Shrunken Neurons
Neuron loss
Lipofuscin pigmentation
Reactive gliosis

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9
Q

What cells are responsible for anaerobic glycolysis?

A

Astrocytes

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10
Q

What cells are astrocytes metabolically coupled to and why?

A

Neurons

Neurons don’t perform anaerobic glycolysis, so depend on astrocytes for ATP production

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11
Q

What CNS cells are extremely sensitive to oxidative stress?

A

Neurons

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12
Q

Give some examples of sub-cellular alterations that can occur to neuronal organelles and cytoskeleton?

A

Neurofibrillary tangles in Alzheimer’s
Lewy bodies
Neural inclusions in aging
Intranuclear and cytoplasmic inclusions of viral disease

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13
Q

What transmitter to astrocytes take up?

A

Glutamate

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14
Q

What is the purpose of the foot processes on astrocytes?

A

Regulate the blood brain barrier and cerebral blood flow by responding to neuronal signals

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15
Q

What sign is a prominent and important indicator of CNS injury?

A

Gliosis

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16
Q

What changes occur gliosis?

A

Hyperplasia & Hypertrophy of astrocytes
Astrocytes get prominent nuclei
Cytoplasmic expansion

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17
Q

What does gliotic tissue look like?

A

Translucent and firm

Seen to form a barrier to sites of tissue damage

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18
Q

What are oligodendrocytes?

A

They are the CNS version of Schwann cells

They form the myelin sheath on axons

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19
Q

Oligodendrocyte damage is a feature of what type of disorders?

A

Demyelinating disorders e.g. MS

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20
Q

What is the term for the process of membrane depolarisation ‘jumping’ from one node to the other in depolarisation?

A

Saltatory conduction

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21
Q

Axonal loss (oligodendrocyte damage) in the CNS is reversible / irreversible?

A

Irreversible

Oligodendrocytes do not have reparative abilities

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22
Q

Where are ependymal cells found?

A

Lining the ventricular system

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23
Q

What occurs from ependymal disruption?

A

Local proliferation of sub-endymal astrocytes causing small irregularities on the ventricular surfaces termed ependymal granulations

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24
Q

What can cause changes to the ependymal cells

A

Viruses

Tumours

25
Q

How much of the bodies total O2 consumption is carried out in the brain?

A

20%

26
Q

How much can cerebral blood flow increase if in need of increasing oxygen delivery?

A

Can increase 2fold

27
Q

What occurs when after the onset of ischaemia in the brain at a cellular level?

A

Mitochondria inhibit the production of ATP, which leads to the ATP reserves being used up in a matter of minutes

28
Q

Which neurons are most susceptible to hypoxic damage?

A

3rd 5th and 6th layers of the cortex
Hippocampus cells
Purkinje cells of the cerebellum

29
Q

What is the term given for when dying cells accumulate water?

A

Cytotoxic oedema

30
Q

What is ionic oedema?

A

This occurs after cytoxic oedema

Na+ ions cross the BBB creating an osmotic gradient for accumulation - leads to swelling

31
Q

What is the term for when the blood brain barrier breaks down due to disruption of endothelial tight junctions allowing for water to pass through?

A

Vasogenic oedema

NOTE: this disruption is not enough to allow the passage of RBCs

32
Q

When does haemorrhagic conversion occur?

A

When the endothelial integrity of the BBB is completely lost and blood begins to enter the extracellular space

33
Q

What % of the cardiac output goes to the brain?

A

15%

34
Q

What cells in the brain are responsible for the immune response and surveillance?

A

Microglial cells

35
Q

Define Global Hypoxic ischaemic damage?

A

The system compromise to the circulation cannot be compensated for
There is a generalised reduction of cerebral perfusion

36
Q

What are some causes of Global hypoxic ischaemic damage?

A

Cardiac arrest

Hypovolaemia shock

37
Q

Define focal hypoxic ischaemic brain damage?

A

Restriction of blood flow to localised area of the brain

38
Q

What is the main cause of focal hypoxic ischaemic damage?

A

Vascular obstructions e.g. clot

39
Q

What are “watershed areas”?

A

These are neurons which are particularly sensitive to hypoxia

40
Q

Where are watershed areas and why is their location significant?

A

They are in the periphery of the vasculature

Most distant from the heart and least well supplied

41
Q

Define Stroke:

A

Sudden disturbance of cerebral function which is vascular in origin and lasts over 24 hours (or is fatal)

42
Q

When is a stroke classified as completed?

A

When there is irreversible tissue loss due to local arrest OR due to severe reduction in blood flow

43
Q

Which artery is most commonly affected by a thrombus/

A

The middle cerebral artery

44
Q

When will neutrophil infiltration occur in a stroke?

A

Within the first 48 hours

Microglia will then become the dominant cells type

45
Q

When will reactive gliosis begin following a stroke?

A

About a week later

46
Q

What are some signs of vertebra-basilar artery disease

A

Vertigo
Ataxia
Dysarthria
Dysphasia

47
Q

What disease is associated with the development of micro aneurysms in the brain?

A

Charcot-Bouchard

48
Q

What pathological changes would be seen in a hypertensive encephalopathy?

A

Cerebral oedema
Herniations
Petechiae
Arterial wall necrosis

49
Q

What is the morphology of a lacunar infarct (as seen on a cut surface)?

A 
Asymmetrical distortion
Various shifts and herniations
Well demarcated intra-parenchymal haematomas
Softening adjacent tissue
Surrounding oedema
50
Q

What is the most common congenital vascular abnormality of the CNS?

A

AV malformations commonly in the cerebral hemispheres (MCA territory)

51
Q

What diseases increase your chance of berry aneurysms / subarachnoid haemorrhage

A 
Polycystic kidneys
Fibromuscular dysplasia
Coartication of aorta
AV malformations
Collagen type 3 abnormality
52
Q

When is amyloid angiopathy seen?

A

Alzheimer’s disease

also associated with age related changes

53
Q

What are the three most common forms of herniation?

A

Subfalcine
Tentorium
tonsillar

54
Q

What is a subfalcine herniation?

A

Unilateral or asymmetrical expansion of the cerebral hemisphere displaces the cingulate gyrus under the falx cerebri

55
Q

What is tentorial herniation?

A

This is when the medial aspect of the temporal lobe herniates over the tentorium cerebri

56
Q

What part of the temporal lobe is involved in a tentorium herniation?

A

Hippocampal uncus

Para-hippocampal gyrus

57
Q

What cranial nerve can be compressed in a tentorium herniation and what might the clinical sign be?

A

CNIII

pupillary dilation and impairment of the ocular muscles

58
Q

What is a tonsillar herniation?

A

Displacement of the cerebellar tonsils through the foramen magnum

Neurology (15 decks)

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