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Neurology > Neuropathology > Flashcards

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
Q

MS macroscopically

A

irregular, sharply demarcated grey areas in white matter

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26
Q

Describe subacute sclerosing panencephalitis

A

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

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27
Q

Describe progressive multifocal leukoencephalopathy

A

JC virus infection of oligodendrocytes

immunosuppression leads to reactivation of latent virus

presents with rapidly progressive neurological signs (visual loss, weakness and dementia)

28
Q

Describe central pontine myelinolysis

A

rapid intravenous correction of hyponatremia

occurs in severely malnourished patients

presents as acute bilateral paralysis

29
Q

What are leukodystrophies? Name 3

A

Inherited, involve white matter, cause progressive demyelination

metachromatic leukodystrophy
Krabbe disease
Adrenoleukodystrophy (ALD)

30
Q

What does thiamine deficiency cause?

A

Thiamine deficiency

31
Q

Neurological complication of vitamin B12 deficiency

A

subacute combined degeneration of the spinal cord involving both ascending and descending tracts

  • ataxia
  • lower limb numbness
  • tingling
  • weakness
  • paraplegia
32
Q

Degeneration of what leads to dementia?

A

cortex

33
Q

Degeneration of what leads to movement disorders?

A

basal ganglia

34
Q

What is the most common degenerative disease of the CNS?

A

Alzheimer’s

35
Q

What mutations are seen in familial cases of early onset Alzheimer’s disease?

A

presenilin 1+2 mutations
(Down’s syndrome also increases risk)

36
Q

Macroscopic brain features with Alzheimer’s disease

A

brain atrophy
dilatation of lateral ventricles due to loss of brain tissue (hydrocephalus ex vacuo)
thinning of gyri and deepening of sulci

37
Q

Microscopic features of an Alzheimer’s brain

A

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
Q

What is the 2nd most common cause of dementia?

A

vascular dementia

39
Q

What is Pick’s disease?

A

similar to Alzheimer’s but far less common
preferentially affects frontal + temporal lobes

behavioural + language symptoms arising early which eventually progress to dementia

40
Q

Pathophysiology Parkinson’s disease

A

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
Q

Clinical features Parkinson’s disease (TRAP)

A

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
Q

Macroscopic brain of Parkinson’s

A

loss of pigment in substantia nigra

43
Q

Microscopic features of Parkinson’s

A

round eosinophilic inclusions of alpha synuclein (Lewy bodies) in affected neurons

44
Q

Huntington disease genetics

A

autosomal dominant
expanded trinucleotide CAG repeats in the huntingtin gene

45
Q

Symptoms of normal pressure hydrocephalus

A

3 Ws
Wet (incontinence)
Wobbly (gait disturbance)
Wacky (dementia)

46
Q

Pathophysiology of normal pressure hydrocephalus

A

increased CSF causing dilated ventricles, usually idiopathic and treated by ventriculoperitoneal shunt

47
Q

Describe spongiform encephalopathy

A

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
Q

Microscopic features MND

A

muscles undergo denervation atrophy due to loss of LMNs
small eosinophilic intranuclear inclusions called Bunina bodies may be seen in remaining LMNs

49
Q

Pathogenesis MND

A

degeneration and loss of motor neurons in anterior horn + motor nuclei of brain stem, associated with gliosis + microglial activation

50
Q

3 types of brain infections

A

meningitis
brain abscess
viral encephalitis

51
Q

What is infected in acute bacterial meningitis?

A

infection of arachnoid membrane, subarachnoid space and CSF by bacteria

52
Q

Bacterial meningitis most common organisms

A

streptococcus pneumoniae
neisseria meningitidis

53
Q

Brain abscess presentation

A

headache, infection symptoms, focal neurological deficits, seizures

54
Q

What are the most common primary tumours that metastasise to brain?

A

lung
breast
kidney
melanoma

55
Q

Where do metastatic tumours occur in the brain?

A

multiple well-circumscribed lesions at the junction between the grey and white matter

56
Q

Most common primary brain tumours in adults

A

glioblastoma
meningioma
schwannoma

57
Q

Most common primary brain tumours in children

A

pilocytic astrocytoma
ependymoma
medulloblastoma

58
Q

Describe glioblastoma

A

malignant high grade tumour of astrocytes (GFAP +ve)

usually arises in cerebral hemisphere

characteristically crosses corpus callosum - Butterfly lesion

59
Q

Describe meningioma

A

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
Q

Describe schwannoma

A

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
Q

Describe oligodendroglioma

A

malignant tumour of oligodendrocytes

calcified tumour in white matter of frontal lobe

may present with seizures

fried egg appearance of cells on biopsy

62
Q

Describe pilocytic astrocytoma

A

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
Q

Describe medulloblastoma

A

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
Q

Describe ependymoma

A

malignant tumour of ependymal cells

usually seen in children

arises in 4th ventricle + may present with hydrocephalus

perivascular pseudo-rosettes on microscopy

65
Q

Describe craniopharyngioma

A

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
Q
A

Neurology (30 decks)

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