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Neuroscience > Neuropathology 2 > Flashcards

Neuropathology 2 Flashcards

1
Q

What are the types of focal lesions in trauma?

A 
=scalp lacerations
=skull fractures
=contusions (bruises on the brain)
=intracranial haemorrhages
=lesions secondary to raised intracranial pressure
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2
Q

What are the types of diffuse lesions in trauma?

A

=Global ischaemia
=Brain swelling
=Traumatic axonal injury

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3
Q

What are the causes of head injury?

A

=Road traffic accidents
=Falls
=Assault

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4
Q

What are the mechanisms of head injury?

A 
-Direct contact
=object striking head/ being struck by head
-acceleration/deceleration
=unrestricted movement of the head
-Penetrating
-Blast
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5
Q

Where are acute contusions usually seen?

A

Frontal and temporal regions

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6
Q

What are the types of intracranial haemorrhages?

A

-Extradural
=usually associated with squamous temporal bone fractures damaging the underlying middle meningeal artery
=concave deformation of brain (haematoma space occupying)
-Subdural
=extensive, associated with cortical contusions and torn bridging veins
-Subarachnoid
=rarely extensive, usually associated with contusions
-Intracerebral
=superficial associated with contusions
deeply seated often within the basal ganglia

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7
Q

What are the consequences in the brain from an extradural haemorrhage?

A
  • Subfalcine herniation
  • Tentorial herniation
  • Axial displacement
  • Tonsillar herniation
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8
Q

Describe diffuse traumatic axonal injury

A
  • Rotational injury
  • Corpus callosum and internal capsule involved, brainstem
  • T2 star MRI (black dot in corpus callosum)
  • Susceptibility Weighted Image (black dots are haemorrhage)
  • DAI
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9
Q

What is Penetrating Head Injury?

A
  • Brain parenchyma damaged by missile
  • In ballistic parenchymal damage there is a “blast wave” which can cause damage distant from the tract
  • Strength of wave determined by velocity of bullet
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10
Q

Describe the aetiology of brain tumours

A

-X-irradiation; meningiomas / sarcomas / gliomas associated with previous therapeutic irradiation (20-30 year delay).
-Occupational exposure to herbicides?
-Electrical and magnetic fields?
-Oncogenic virus SV40 (introduced via polio)?
-Hereditary tumour syndromes
=NF; meningiomas, schwannomas, gliomas
=VHL; haemangioblastomas
=Tuberous sclerosis; SEGA
=Li Fraumeni; gliomas, medulloblastomas

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11
Q

What are the general principles of CNS tumours?

A
  • Anatomical location
  • Local invasion
  • Angiogenesis
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12
Q

Why is it difficult to get complete resection of even low grade tumours?

A
  • Frontal lobectomy
  • Follow tumour into normal white matter (macroscopic resection)
  • Glioma cells diffusely infiltrate beyond macroscopic resection
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13
Q

What are the common brain tumour types?

A
  • Metastatic tumours
  • Gliomas (astrocytomas including glioblastoma, oligodendrogliomas etc)
  • Meningiomas (usually low grade)
  • In children, medulloblastoma (posterior fossa/ cerebellum)
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14
Q

What are the main categories of neurodegenerative disorders?

A
  • Tauopathies
  • Synucleinopathy
  • Trinucleotide repeat disorders (Huntington’s)
  • TDP43 proteinopathy (motor neurone disease)
  • Prion disorders
  • Motor neurone disorders
  • Others
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15
Q

How are these abnormal proteins formed?

A
  • Abnormal cleavage in Alzheimer’s

- Misfolding in prion disease (CJD)

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16
Q

What happens when disposal systems cannot cope?

A

In disease states where large amounts of abnormal protein may aggregate, these mechanisms are overwhelmed and ubiquitinated proteinaceous inclusions are formed

  • Ubiquitin Proteasome System= manage abnormal proteins
  • Ubiquitinated proteins when abnormal, taken off to proteasome to digest
17
Q

What is Dementia?

A
  • Defined as a loss of cognitive and other higher functions without loss of consciousness
  • Prevalence: 5%> 65 years, 15%>80 years F > M
  • The “silent epidemic”
18
Q

What are the causes of Dementia?

A 
=Alzheimer’s disease	 =(AD)	75%
-AD and vascular disease			=5-10%
-Lewy body disease (+/- AD)		=5-10%
-Vascular disease				=5-10%
-Others:						=1-3%
=Huntingdon’s disease
=Prion diseases
=Metabolic diseases
19
Q

What is the pathology of Alzheimer’s?

A
  • Cortical beta amyloid pathology in frontal cortex
  • Tauopathy
  • Deposits in parenchyma and blood vessels
  • Cerebral amyloid angiopathy
  • Spreads from Hippocampus to temporal/ frontal lobes then occipital/ parietal lobes
20
Q

Describe vascular dementia

A
  • Generally due to multiple infarcts (multi-infarct dementia)
  • Lacunar type infarcts= caused by blockage of striate arteries
  • Binswanger’s disease (probably end-stage of chronic hypertension)
21
Q

What are the movement disorders?

A
  • Parkinson’s disease
  • Other causes of parkinsonism
  • Ataxias
  • Disorders of the motor neuron
22
Q

Describe Parkinson’s

A
  • Commonest of the movement disorders
  • Due to loss of dopaminergic neurones in substantia nigra
  • Characterised by Lewy bodies (alpha synuclein protein)
23
Q

What are other causes of parkinsonism?

A
  • Multiple system atrophy
  • progressive supranuclear palsy (tauopathy)
  • Iatrogenic (anti-psychotics)
  • vascular
  • drug induced
24
Q

What are the types of motor neuron disorders?

A
  • Motor neuron disease (adults)
  • Spinal muscular atrophies (children)= degeneration of LMN, accumulation of TDP-43
  • Hereditary spastic paraparesis
25
Q

Describe demyelination

A

-Commonest cause is multiple sclerosis (MS).
-Other causes include;
=Infective
(Progressive multifocal leucoencephalopathy
Acute haemorrhagic leukoencephalitis)
=Developmental (dysmyelination)
=Post-vaccination

26
Q

Describe MS

A
  • Commonest cause of demyelination
  • Auto-immune condition with the response being directed against a protein found in only central nervous system myelin.
  • Common sites for plaques include periventricular region and optic tracts.
27
Q

What are the pathologies of the cornea?

A

-Inflammatory (keratitis)
=infective/non-infective
-Degenerations
=corneal dystrophies (epithelium, stroma, endothelium)
-Neoplasms
=very rare; epithelial/ melanocytic, squamous cell carcinoma

28
Q

What are the pathologies of the iris, ciliary body and choroid?

A 
-Inflammatory (uveitis)
=often non-infective (RA, Behcet's)
-Neoplasms
=melanocytic
=soft tissue
29
Q

What are the pathologies of the retina?

A 
-Inflammatory
=CMV, HSV, toxoplasma
-Degenerative
=retinitis pigmentosa 
=macular etc.
-Neoplastic
=retinoblastoma (childhood)
=lymphoid
=glial
30
Q

What are orbital lesions?

A

-Inflammatory
-Neoplastic
=soft tissue; rhabdomyosarcoma, osteosarcoma
=lymphoid

Neuroscience (33 decks)

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