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Neuropathology Flashcards

1
Q

What are astrocytes?

A

glial cells that can multiply as part of healing process (gliosis) or can give rise to brain tumours (astrocytomas)

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2
Q

What are the most sensitive neurons in adults?What does damage to them cause?

A

Hippocampal pyramidal cells
damage causes memory impairment

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3
Q

What cells are involved in movement coordination?

A

Purkinje cells of the cerebellum

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4
Q

4 causes of global cerebral ischaemia

A

low perfusion (atherosclerosis)

acute decrease in cerebral perfusion (cardiogenic shock)

chronic hypoxia (anaemia)

hypoglycaemia

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5
Q

3 causes of global hypoxia/ischaemia

A

severe hypotension
severe hypoglycaemia
prolonged seizures (1-2 hours)

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6
Q

Pathology of ischaemic stroke

A

liquefactive necrosis
red neurons (12 hours post-infarction)
necrosis (24 hours)
neutrophil infiltration (days 1-3)
microglial cell proliferation (days 4-7)
gliosis (weeks 2-3)
fluid-filled cystic space surrounded by gliosis

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7
Q

Causes of intracranial haemorrhage

A

hypertension
cerebral amyloid angiopathy
saccular aneurysms
vascular malformations
tumours
vasculitis

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8
Q

Intracerebral haemorrhage symptoms

A

severe headache
nausea
vomiting
coma

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9
Q

Meninges layers

A

dura mater
arachnoid mater
pia mater

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10
Q

What type of aneurysm rupture can cause a subarachnoid haemorrhage?

A

berry aneurysm

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11
Q

What does a lumbar puncture show in subarachnoid haemorrhage?

A

xanthochromia due to presence of bilirubin

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12
Q

What conditions can predispose to subarachnoid haemorrhage?

A

Marfan’s syndrome
Ehler-Danlos syndrome
Autosomal dominant polycystic kidney disease

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13
Q

What is an epidural haemorrhage?

A

collection of blood between the dura and the skull

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14
Q

Rupture of what causes an epidural haemorrhage?

A

middle meningeal artery

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15
Q

What is the weakest part of the skull?

A

Pterion - junction between 4 bones (frontal, parietal, greater sphenoid and squamous part of temporal bone)

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16
Q

What artery is the middle meningeal artery a branch of?

A

maxillary artery

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17
Q

What causes a subdural haemorrhage?

A

tearing of bridging veins which lie between dura and arachnoid

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18
Q

What does a subdural haemorrhage look like on CT scan?

A

crescent-shaped lesion

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19
Q

Name 3 traumatic brain injuries

A

coup/contrecoup (brain bruising due to contact of soft tissue with skull)

contusions

diffuse axonal injury

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20
Q

What causes diffuse axonal injury?

A

RTAs/blows to unsupported head

cerebrum glides back and forth, pivoting around brain stem

stretches axons

unconscious immediately after injury

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21
Q

What is herniation (brain)?

A

displacement of brain due to mass effect or increased intracranial pressure

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22
Q

Myelin function

A

insulates axons, improving the speed and efficiency of nerve conduction

means AP jumps from one node of Ranvier to the next

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23
Q

What is multiple sclerosis?

A

chronic demyelinating disease

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24
Q

What does a lumbar puncture show in MS?

A

increased lymphocytes
increased immunoglobulins with oligoclonal IgG bands and myelin basic protein

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25
MS macroscopically
irregular, sharply demarcated grey areas in white matter
26
Describe subacute sclerosing panencephalitis
slowly progressing persistent infection caused by measles virus infection in infancy with neurologic signs years later progress debilitating encephalitis leading to death viral inclusions within neurons and oligodendrocytes
27
Describe progressive multifocal leukoencephalopathy
JC virus infection of oligodendrocytes immunosuppression leads to reactivation of latent virus presents with rapidly progressive neurological signs (visual loss, weakness and dementia)
28
Describe central pontine myelinolysis
rapid intravenous correction of hyponatremia occurs in severely malnourished patients presents as acute bilateral paralysis
29
What are leukodystrophies? Name 3
Inherited, involve white matter, cause progressive demyelination metachromatic leukodystrophy Krabbe disease Adrenoleukodystrophy (ALD)
30
What does thiamine deficiency cause?
Thiamine deficiency
31
Neurological complication of vitamin B12 deficiency
subacute combined degeneration of the spinal cord involving both ascending and descending tracts - ataxia - lower limb numbness - tingling - weakness - paraplegia
32
Degeneration of what leads to dementia?
cortex
33
Degeneration of what leads to movement disorders?
basal ganglia
34
What is the most common degenerative disease of the CNS?
Alzheimer's
35
What mutations are seen in familial cases of early onset Alzheimer's disease?
presenilin 1+2 mutations (Down's syndrome also increases risk)
36
Macroscopic brain features with Alzheimer's disease
brain atrophy dilatation of lateral ventricles due to loss of brain tissue (hydrocephalus ex vacuo) thinning of gyri and deepening of sulci
37
Microscopic features of an Alzheimer's brain
neurofibrillary triangles (NFTs) = deposits of Tau filaments in neuronal body senile plaques = contain amyloid beta deposits (congo red +ve, apple-green birefringence under polarised light) granulovacuolar degeneration in neurons cerebral amyloid angiopathy
38
What is the 2nd most common cause of dementia?
vascular dementia
39
What is Pick's disease?
similar to Alzheimer's but far less common preferentially affects frontal + temporal lobes behavioural + language symptoms arising early which eventually progress to dementia
40
Pathophysiology Parkinson's disease
degenerative loss of dopaminergic neurons in the substantia nigra of the basal ganglia (which secrete dopamine) nigrostriatal pathway of basal ganglia uses dopamine to initiate movement
41
Clinical features Parkinson's disease (TRAP)
Tremor - pill rolling at rest, disappears with movement Rigidity - leadpipe/cogwheel rigidity in extremities or axially Akinesia/bradykinesia - slowing of voluntary movement, expressionless face Postural instability + shuffling gait
42
Macroscopic brain of Parkinson's
loss of pigment in substantia nigra
43
Microscopic features of Parkinson's
round eosinophilic inclusions of alpha synuclein (Lewy bodies) in affected neurons
44
Huntington disease genetics
autosomal dominant expanded trinucleotide CAG repeats in the huntingtin gene
45
Symptoms of normal pressure hydrocephalus
3 Ws Wet (incontinence) Wobbly (gait disturbance) Wacky (dementia)
46
Pathophysiology of normal pressure hydrocephalus
increased CSF causing dilated ventricles, usually idiopathic and treated by ventriculoperitoneal shunt
47
Describe spongiform encephalopathy
normal neurons have a prion protein which has an alpha helical configuration disease occurs when it is converted to a beta pleated sheet configuration can convert normal prion into disease form accumulation of abnormal prion protein causes vacuolar damage to neurons and glial cells (spongy degeneration)
48
Microscopic features MND
muscles undergo denervation atrophy due to loss of LMNs small eosinophilic intranuclear inclusions called Bunina bodies may be seen in remaining LMNs
49
Pathogenesis MND
degeneration and loss of motor neurons in anterior horn + motor nuclei of brain stem, associated with gliosis + microglial activation
50
3 types of brain infections
meningitis brain abscess viral encephalitis
51
What is infected in acute bacterial meningitis?
infection of arachnoid membrane, subarachnoid space and CSF by bacteria
52
Bacterial meningitis most common organisms
streptococcus pneumoniae neisseria meningitidis
53
Brain abscess presentation
headache, infection symptoms, focal neurological deficits, seizures
54
What are the most common primary tumours that metastasise to brain?
lung breast kidney melanoma
55
Where do metastatic tumours occur in the brain?
multiple well-circumscribed lesions at the junction between the grey and white matter
56
Most common primary brain tumours in adults
glioblastoma meningioma schwannoma
57
Most common primary brain tumours in children
pilocytic astrocytoma ependymoma medulloblastoma
58
Describe glioblastoma
malignant high grade tumour of astrocytes (GFAP +ve) usually arises in cerebral hemisphere characteristically crosses corpus callosum - Butterfly lesion
59
Describe meningioma
derived from arachnoid cells may present with seizures benign CNS tumour round mass attached to the dura, compresses but does not invade the cortex
60
Describe schwannoma
benign tumour of schwann cells most commonly presents with deafness + tinnitus - CNVII at cerebellopontine angle bilateral tumours in neurofibromatosis type 2 S100 +ve on immunohistochemistry
61
Describe oligodendroglioma
malignant tumour of oligodendrocytes calcified tumour in white matter of frontal lobe may present with seizures fried egg appearance of cells on biopsy
62
Describe pilocytic astrocytoma
most common CNS tumour in children benign tumour of astrocytes (GFAP +ve) cystic lesion in cerebellum with mural nodule Rosenthal fibres (thick eosinophilic astrocytic processes) with eosinophilic granular bodies)
63
Describe medulloblastoma
malignant tumour derived from granular cells of the cerebellum (neuroectoderm) tumour grows rapidly and spreads via CSF malignant small round blue cells on microscopy
64
Describe ependymoma
malignant tumour of ependymal cells usually seen in children arises in 4th ventricle + may present with hydrocephalus perivascular pseudo-rosettes on microscopy
65
Describe craniopharyngioma
benign tumour which arises from epithelial remnants of Rathke's pouch, above the pituitary calcified supratentorial mass in child or young adult compression of optic chiasm, causing bitemporal hemianopia benign but can recur following resection
66

Neurology (30 decks)

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