Neuropathology

Question 1

Define malacia

Answer 1

softening and necrosis of the nervous tissue with complete loss of architecture and cells.
grossly, cavitation and haemorrhage
histo, cavitation, loss of architecture and pallor

Question 2

Define fibrosis of the brain

Answer 2

fibrogenic cells are restricted to the meninges and perivascular areas meaning only these areas can show fibrosis

Question 3

What does a symmetrical lesion suggest ?

Answer 3

metabolic, endocrine or toxic disease

Question 4

What does a focal lesion suggest ?

Answer 4

infectious (parasitic cysts) or tumour

Question 5

What do multifocal lesions suggest ?

Answer 5

vascular (in line with BVs?) or embolic

Question 6

White matter prefix

Answer 6

leuko -

Question 7

Grey matter prefix

Answer 7

polio -

Question 8

Name the 5 major macroscopic lesion patterns

Answer 8

1. deviation of normal anatomy (malformations, swelling or atrophy)
2. space-occupying mass (neoplasms or abscesses)
3. malacia (infarct, metabolic, toxic or degenerative)
4. white matter pallor (dysmyslination, leukodystrophy, demyelination)
5. haemorrhage (trauma, vascular issues, infection, inflammation and deficiency)

Question 9

Name the 7 major microscopic lesion patterns

Answer 9

1. malacia
2. perivascular cuffing
3. spongy state (caused by oedema, spongy degeneration, spongiform changes, demyelination, axon loss or an artifact)
4. hypercellularity
5. accumulation of intracellular material
6. selective loss of neurons
7. selective loss of myelin / axons

Question 10

Name the most common causes of TBI

Answer 10

road traffic collisions
falls
blunt force trauma
bites
penetrating wounds
iatrogenic wounds

Question 11

Define contusion of the spinal cord

Answer 11

damage to the microvasculature following impact, see haemorrhage and myelomalacia

Question 12

Define compression of the spinal cord

Answer 12

spinal cord narrowing (e.g. protruding disc)

Question 13

Define a cerebral oedema and give the 2 patterns they may take

Answer 13

an increase in the water content of the brain

localised - less clinical effect. neoplasia, inflammation, trauma, haemorrhage
generalised - more clinically significant

Question 14

Name and describe the 4 types of oedema

Answer 14

vasogenic –> injury to the vascular endothelium causes a breakdown of the BBB leading to increased permeability and leakage

cytotoxic –> swelling of the cytoplasm of astrocytes, neurons and endothelial cells

hydrostatic –> accumulation of fluid in interstitial space, commonly around ventricles

hypo-osmotic –> over consumption of water leading to dilution of plasma

Question 15

Define hypoxia

Answer 15

reduced oxygen supply, causes cytotoxic oedema and eventually infarction (necrosis)

Question 16

Define anoxia

Answer 16

complete lack of oxygen

Question 17

Define a cerebral infarct

Answer 17

consequences of vascular obstruction.
wedge-shaped lesions of liquefactive necrosis and malacia

Question 18

Name some causes of cerebral infarction

Answer 18

thromboembolism
metastasis of a neoplasm
cerebral trauma
atherosclerosis
vasculitis

Question 19

Define fibrocartilagenous embolic myelopathy (FEM)

Answer 19

herniation of fibrocartilage from the intervertebral disc into the vasculature, forming occlusive emboli