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Year 2 Medicine > Neuropathology > Flashcards

Neuropathology Flashcards

1
Q

Histology of Neural Tissues

  • Neurons:
    • Nuclei or ganglia (e.g. basal ganglia)
    • Columns or layers (e.g. cortex)
  • Glia:
  • Structural and metabolic functions
    • A… (metabolism)
    • O… (structure)
    • E… (lining of fluid compartments)
    • M… (monocyte-lineage population)
  • Meninges
  • Blood vessels
A
  • Neurons:
    • Nuclei or ganglia (e.g. basal ganglia)
    • Columns or layers (e.g. cortex)
  • Glia:
  • Structural and metabolic functions
    • Astrocytes (metabolism)
    • Oligodendrocytes (structure)
    • Ependyma (lining of fluid compartments)
    • Microglia (monocyte-lineage population)
  • Meninges
  • Blood vessels
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2
Q

Histology of Neural Tissues

  • Neurons:
    • Nuclei or … (e.g. basal ganglia)
    • … or layers (e.g. cortex)
  • Glia:
  • Structural and metabolic functions
    • Astrocytes (metabolism)
    • Oligodendrocytes (structure)
    • Ependyma (lining of fluid compartments)
    • Microglia (monocyte-lineage population)
  • M…
  • Blood …
A
  • Neurons:
    • Nuclei or ganglia (e.g. basal ganglia)
    • Columns or layers (e.g. cortex)
  • Glia:
  • Structural and metabolic functions
    • Astrocytes (metabolism)
    • Oligodendrocytes (structure)
    • Ependyma (lining of fluid compartments)
    • Microglia (monocyte-lineage population)
  • Meninges
  • Blood vessels
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3
Q

Histology of neural tissues:

A
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4
Q

Meninges

  • Meninges - covering layers
  • Provide … - interface between compartments
  • … mater - covers entire brain and spinal column
  • … - BV run within
  • … mater - directly on surface of brain
A
  • Meninges - covering layers
  • Provide protection - interface between compartments
  • Dura mater - covers entire brain and spinal column
  • Arachnoid - BV run within
  • Pia mater - directly on surface of brain
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5
Q

CEREBROSPINAL FLUID

  • Normal volume 150ml
  • Production by … plexus in the … ventricles (450ml per 24h)
  • Resorption by arachnoid … in the subarachnoid space
  • Metabolic importance
  • … of the CNS
  • Role in … regulation and defense
  • Cerebral … of blood flow
A
  • Normal volume 150ml
  • Production by choroid plexus in the lateral ventricles (450ml per 24h)
  • Resorption by arachnoid granulations in the subarachnoid space
  • Metabolic importance
  • Cushioning of the CNS
  • Role in immune regulation and defense
  • Cerebral autoregulation of blood flow
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6
Q

CEREBROSPINAL FLUID

  • Normal volume …ml
  • Production by choroid … in the lateral … (450ml per 24h)
  • Resorption by arachnoid … in the … space
  • … importance
  • Cushioning of the CNS
  • Role in immune regulation and defense
  • Cerebral autoregulation of blood flow
A
  • Normal volume 150ml
  • Production by choroid plexus in the lateral ventricles (450ml per 24h)
  • Resorption by arachnoid granulations in the subarachnoid space
  • Metabolic importance
  • Cushioning of the CNS
  • Role in immune regulation and defense
  • Cerebral autoregulation of blood flow
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7
Q

CSF CIRCULATION - VENTRICLES

A
  • Blue space- ventricles
  • Main compartment where CSF is located
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8
Q

CSF Circulation:

  • Brain is completely surrounded by CSF and has … within it filled with CSF
  • … … sinus - reabsorption back into venous system
  • Constant …
A
  • Brain is completely surrounded by CSF and has ventricles within it filled with CSF
  • Superior sagittal sinus - reabsorption back into venous system
  • Constant circulation
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9
Q

Hydrocephalus

  • … to CSF flow
  • Impaired resorption at arachnoid …
  • … of brain tissue (e.g. dementias) = ex vacuo
  • Very rarely …
A
  • Obstruction to CSF flow
  • Impaired resorption at arachnoid granulations
  • Shrinking of brain tissue (e.g. dementias) = ex vacuo
  • Very rarely overproduction
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10
Q

Types of hydrocephalus

A
  • Types:
  • Communicating
  • Non-communicating
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11
Q

Raised intracranial pressure

  • Mean CSF pressure above 200mm H20
  • Increased CSF volume (…)
  • How?
    • Intracranial … occupying lesion (neoplasm, haemorrhage, abscess)
    • Cerebral …
A
  • Mean CSF pressure above 200mm H20
  • Increased CSF volume (hydrocephalus)
  • How?
    • Intracranial space occupying lesion (neoplasm, haemorrhage, abscess)
    • Cerebral oedema
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12
Q

Consequences of raised intracranial pressure - Herniation

  • Sub… (cingulate)
  • …/transtentorial
  • …/cerebellar
    • …/Cerebellar herniation may cause compression of the medulla with impairment of vital respiratory and cardiac functions
A
  • Subfalcial (cingulate)
  • Central/transtentorial
  • Tonsillar/cerebellar
    • Tonsillar/Cerebellar herniation may cause compression of the medulla with impairment of vital respiratory and cardiac functions
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13
Q

Tonsillar/Cerebellar herniation may cause compression of the … with impairment of vital respiratory and cardiac functions

A
  • Tonsillar/Cerebellar herniation may cause compression of the medulla with impairment of vital respiratory and cardiac functions
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14
Q

A brain …, or cerebral …, occurs when brain tissue, blood, and cerebrospinal fluid (CSF) shifts from their normal position inside the skull.

A

A brain herniation, or cerebral herniation, occurs when brain tissue, blood, and cerebrospinal fluid (CSF) shifts from their normal position inside the skull.

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15
Q

Tonsillar herniation at autopsy

  • Coning herniation and compression of the … …
  • Duret haemorrhages
A
  • Coning herniation and compression of the medulla oblongata
  • Duret haemorrhages
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16
Q

What type of herniation?

A

TONSILLAR HERNIATION

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17
Q

Space occupying lesion

  • …/epidural haemorrhage
  • … haemorrhage
  • … haemorrhage
  • Intracerebral haemorrhage
  • Ischaemic infarct with subsequent oedema or haemorrhage
  • Neoplasm
  • Abscess
A
  • Extradural/epidural haemorrhage
  • Subdural haemorrhage
  • Subarachnoid haemorrhage
  • Intracerebral haemorrhage
  • Ischaemic infarct with subsequent oedema or haemorrhage
  • Neoplasm
  • Abscess
18
Q

Space occupying lesion

  • Extradural/… haemorrhage
  • Subdural haemorrhage
  • Subarachnoid haemorrhage
  • … haemorrhage
  • … infarct with subsequent oedema or haemorrhage
  • Neo…
  • Ab…
A
  • Extradural/epidural haemorrhage
  • Subdural haemorrhage
  • Subarachnoid haemorrhage
  • Intracerebral haemorrhage
  • Ischaemic infarct with subsequent oedema or haemorrhage
  • Neoplasm
  • Abscess
19
Q

Head Trauma

  • Skull fracture
  • Parenchymal injury:
    • … (bruising) concussion is a clinical term/syndrome
    • … (penetration or tearing)
    • Diffuse … injury
  • Coup and …
    • Important - clue to how injury has occurred
  • After trauma, 2 areas of contusion in brain (one at front, one at back)
A
  • Skull fracture
  • Parenchymal injury:
    • Contusion (bruising) concussion is a clinical term/syndrome
    • Laceration (penetration or tearing)
    • Diffuse axonal injury
  • Coup and contrecoup
    • Important - clue to how injury has occurred
  • After trauma, 2 areas of contusion in brain (one at front, one at back)
20
Q

… Only occur if brain moving hits a stationary object

A

Contrecoup Only occur if brain moving hits a stationary object

21
Q

… injury is associated with a moving object impacting a stationary head

A

Coup injury is associated with a moving object impacting a stationary head

22
Q

Coup vs Contrecoup

  • COUP
    • Head hits … object (wall) first - contusion at front (coup) then…
  • CONTRECOUP
    • Brain … within skull - rebound - brain rebounds back within skull to other side (… to force)
    • Second injury caused (contrecoup injury)
A
  • COUP
    • Head hits stationary object (wall) first - contusion at front (coup) then…
  • CONTRECOUP
    • Brain moves within skull - rebound - brain rebounds back within skull to other side (opposite to force)
    • Second injury caused (contrecoup injury)
23
Q

Vascular injury- ….. rupturing

A

Vascular injury- BV rupturing

24
Q

Vascular injury

  • … - severe trauma with arterial laceration (middle meningeal artery)
  • … - trauma may be minor in atrophy (bridging veins)
  • Subarachnoid - rupture of saccular (berry) aneurysm (Circle of willis)
  • Intracerebral - ….tension
A
  • Extradural - severe trauma with arterial laceration (middle meningeal artery)
  • Subdural - trauma may be minor in atrophy (bridging veins)
  • Subarachnoid - rupture of saccular (berry) aneurysm (Circle of willis)
  • Intracerebral - hypertension
25
Q

Vascular injury

  • Extradural - severe trauma with arterial laceration (… meningeal artery)
  • Subdural - trauma may be minor in atrophy (… veins)
  • … - rupture of saccular (berry) aneurysm (Circle of willis)
  • … - hypertension
A
  • Extradural - severe trauma with arterial laceration (middle meningeal artery)
  • Subdural - trauma may be minor in atrophy (bridging veins)
  • Subarachnoid - rupture of saccular (berry) aneurysm (Circle of willis)
  • Intracerebral - hypertension
26
Q

EXTRADURAL - SUBDURAL

  • An extradural haematoma is a collection of blood in the ‘potential’ space between the skull and the outer protective lining that covers the brain (the … …).
  • A subdural hematoma (SDH) is a type of bleeding in which a collection of blood—usually associated with a … brain injury—gathers between the inner layer of the … mater and the … mater of the meninges surrounding the brain.
A
  • An extradural haematoma is a collection of blood in the ‘potential’ space between the skull and the outer protective lining that covers the brain (the dura mater).
  • A subdural hematoma (SDH) is a type of bleeding in which a collection of blood—usually associated with a traumatic brain injury—gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain.
27
Q

SUBARACHNOID HAEMORRHAGE

  • Arachnoid layer is relatively … - not easily visualised
  • Most easily recognised at base of brain
  • Confined to base of the brain
  • … aneurysm - vascular abnormalities often seen in circle of willis
  • … = subarachnoid haemorrhage
A
  • Arachnoid layer is relatively thin - not easily visualised
  • Most easily recognised at base of brain
  • Confined to base of the brain
  • Berry aneurysm - vascular abnormalities often seen in circle of willis
  • Rupture = subarachnoid haemorrhage
28
Q

INTRACEREBRAL HAEMORRHAGE

  • … brain matter itself
  • … associated
A
  • Within brain matter itself
  • Hypertension associated
29
Q

Cerebral oedema

  • … of brain matter
    • … - increased vascular permeability
    • … - neuronal, glial or endothelial cell damage
A
  • Swelling of brain matter
    • Vasogenic - increased vascular permeability
    • Cytotoxic - neuronal, glial or endothelial cell damage
30
Q

Cerebral infarction/Stroke

  • 15% of cardiac output into brain
  • …% of O2 demand in brain
  • Stroke = … onset of neurological symptoms
  • Hypoxia vs ischaemia (global vs focal)
  • … are the most O2 sensitive cells
  • … infarction in emboli (petechial lesions e.g. BM)
  • … infarction in thrombosis
    • Tolerate hypoxia better than ischaemia - lack of blood flow - damages neuronal tissue more than lack of oxygen
A
  • 15% of cardiac output into brain
  • 20% of O2 demand in brain
  • Stroke = sudden onset of neurological symptoms
  • Hypoxia vs ischaemia (global vs focal)
  • Neurons are the most O2 sensitive cells
  • Haemorrhagic infarction in emboli (petechial lesions e.g. BM)
  • Ischaemic infarction in thrombosis
    • Tolerate hypoxia better than ischaemia - lack of blood flow - damages neuronal tissue more than lack of oxygen
31
Q

Cerebral infarction/Stroke

  • …% of cardiac output into brain
  • 20% of O2 demand in brain
  • Stroke = sudden onset of neurological symptoms
  • Hypoxia vs ischaemia (global vs focal)
  • Neurons are the most O2 sensitive cells
  • Haemorrhagic infarction in emboli (petechial lesions e.g. BM)
  • Ischaemic infarction in …
    • Tolerate … better than … - lack of blood flow - damages neuronal tissue more than lack of oxygen
A
  • 15% of cardiac output into brain
  • 20% of O2 demand in brain
  • Stroke = sudden onset of neurological symptoms
  • Hypoxia vs ischaemia (global vs focal)
  • Neurons are the most O2 sensitive cells
  • Haemorrhagic infarction in emboli (petechial lesions e.g. BM)
  • Ischaemic infarction in thrombosis
    • Tolerate hypoxia better than ischaemia - lack of blood flow - damages neuronal tissue more than lack of oxygen
32
Q

Ischaemic infarct histology

  • … neuronal injury
  • ‘… neurons’
  • Pyknosis of nucleus
  • … of the cell body
  • Loss of …
  • Intense … of cytoplasm
  • Owing to irreversible hypoxic/ischaemic insult
A
  • Acute neuronal injury
  • ‘red neurons’
  • Pyknosis of nucleus
  • Shrinkage of the cell body
  • Loss of nucleoli
  • Intense eosinophilia of cytoplasm
  • Owing to irreversible hypoxic/ischaemic insult
33
Q

What is this showing?

A

ischaemic infarct

34
Q

What is this showing?

A
  • Old ischaemic infarct
  • Huge loss of tissue
  • Healing artifact - scarring
35
Q

Neoplasms

  • Primary or metastatic?
    • Approximately 75% … (hence 25% …)
  • 20%of malignant childhood tumours are located in the …
  • Gliomas (astrocytoma, oligodendroglioma, glioblastoma)
  • …iomas
  • Poorly differentiated neoplasms (medulloblastoma)
  • Primary CNS …
  • Meta… (lung, breast, skin/melanoma, kidney, GI tract)
  • … nerve tumours (schwannoma, neurofibroma, MPNST)
A
  • Primary or metastatic?
    • Approximately 75% primary (hence 25% metastatic)
  • 20%of malignant childhood tumours are located in the CNS
  • Gliomas (astrocytoma, oligodendroglioma, glioblastoma)
  • Meningiomas
  • Poorly differentiated neoplasms (medulloblastoma)
  • Primary CNS lymphoma
  • Metastasis (lung, breast, skin/melanoma, kidney, GI tract)
  • Peripheral nerve tumours (schwannoma, neurofibroma, MPNST)
36
Q

Neoplasms

  • Primary or metastatic?
    • Approximately …% primary (hence …% metastatic)
  • 20%of malignant … tumours are located in the CNS
  • … (astrocytoma, oligodendroglioma, glioblastoma)
  • Meningiomas
  • … differentiated neoplasms (medulloblastoma)
  • Primary CNS lymphoma
  • Metastasis (lung, breast, skin/melanoma, kidney, GI tract)
  • Peripheral … tumours (schwannoma, neurofibroma, MPNST)
A
  • Primary or metastatic?
    • Approximately 75% primary (hence 25% metastatic)
  • 20%of malignant childhood tumours are located in the CNS
  • Gliomas (astrocytoma, oligodendroglioma, glioblastoma)
  • Meningiomas
  • Poorly differentiated neoplasms (medulloblastoma)
  • Primary CNS lymphoma
  • Metastasis (lung, breast, skin/melanoma, kidney, GI tract)
  • Peripheral nerve tumours (schwannoma, neurofibroma, MPNST)
37
Q
  • Top left - early … (…) increase in area, increase in areas of brain by tumour
  • Top right - … - fast growing-haemorrhagic and necrotic
  • Bottom left - …
  • Bottom right - … - histologically
A
  • Top left - early glioblastoma (oligodendroglioma) increase in area, increase in areas of brain by tumour
  • Top right - glioblastoma - fast growing-haemorrhagic and necrotic
  • Bottom left - meningioma
  • Bottom right - meningioma - histologically
38
Q

Infections - Neuropathology

  • Meningitis - … of …
    • Bacterial (acute or chronic)
    • …
    • …
    • RMSV, neurosyphilis, lyme disease, malaria
  • … - usually bacterial
  • Encephalitis - viral (HSV, CMV, HIV, JC polyoma virus)
  • Localised - toxoplasmosis, cysticercosis
A
  • Meningitis - inflammation of meninges
    • Bacterial (acute or chronic)
    • Viral
    • Fungal
    • RMSV, neurosyphilis, lyme disease, malaria
  • Abscess - usually bacterial
  • Encephalitis - viral (HSV, CMV, HIV, JC polyoma virus)
  • Localised - toxoplasmosis, cysticercosis
39
Q

Infections - Neuropathology

  • Meningitis - inflammation of meninges
    • … (acute or chronic)
    • Viral
    • Fungal
    • RMSV, neurosyphilis, … disease, malaria
  • Abscess - usually …
  • E… - viral (HSV, CMV, HIV, JC polyoma virus)
  • Localised - toxoplasmosis, cysticercosis
A
  • Meningitis - inflammation of meninges
    • Bacterial (acute or chronic)
    • Viral
    • Fungal
    • RMSV, neurosyphilis, lyme disease, malaria
  • Abscess - usually bacterial
  • Encephalitis - viral (HSV, CMV, HIV, JC polyoma virus)
  • Localised - toxoplasmosis, cysticercosis
40
Q

What is this image showing?

41
Q

Toxoplasmosis

A

Toxoplasmosis is a common infection that you can catch from the poo of infected cats, or infected meat.

42
Q

PROGRESSIVE / DEGENERATIVE CONDITIONS

  • … diseases (Alzheimer d., Parkinson d.,)
  • … degenerative diseases
    • Accumulation of protein aggregates leading to loss of cellular and subsequent loss of CNS functions: Dementia, behavioural and personality changes, language disturbance, movement and coordination disturbance, paralysis.
  • … diseases (multiple sclerosis)
  • … diseases (Creutzfeldt-Jakob disease)
  • … metabolic diseases (Neuronal storage diseases)
  • Toxic & … metabolic diseases (Vit B1 & B12 def., CO toxicity, alcohol toxicity, radiation toxicity)
A
  • Neurodegenerative diseases (Alzheimer d., Parkinson d.,)
  • Spinocerebellar degenerative diseases
    • Accumulation of protein aggregates leading to loss of cellular and subsequent loss of CNS functions: Dementia, behavioural and personality changes, language disturbance, movement and coordination disturbance, paralysis.
  • Demyelinating diseases (multiple sclerosis)
  • Prion diseases (Creutzfeldt-Jakob disease)
  • Genetic metabolic diseases (Neuronal storage diseases)
  • Toxic & acquired metabolic diseases (Vit B1 & B12 def., CO toxicity, alcohol toxicity, radiation toxicity)

Year 2 Medicine (162 decks)

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