Neuropathology 3

Question 1

Normal ICP value

Answer 1

5-13 mmHg

Question 2

Physiological causes of raised ICP

Answer 2

Hypoxia, hypercapnia, low cerebral perfusion pressure, exaggerated hypertension

Question 3

“Accumulation of excessive CSF within the ventricular system of the brain”

Answer 3

Hydrocephalus

Question 4

Normal CSF volume

Answer 4

120-150ml (500ml per day becuase of turnover 3-5 times per day)

Question 5

Where is CSF produced?

Answer 5

Produced by the choroid plexus in the lateral and fourth ventricles of the brain

Question 6

Normal volume of CSF

Answer 6

120-150mls

Question 7

How much CSF produced per day?

Answer 7

500mls I think (turnover 3-5 times per day)

Question 8

What absorbs CSF?

Answer 8

Arachnoid granulations

Question 9

Normal level of lymphocytes

Answer 9

Less than 4 mm3

Question 10

Normal level of protein

Answer 10

less than 0.4 g/l

Question 11

Normal glucose level

Answer 11

> 2.2 mmol/l

Question 12

What is non-communicating hydrocephalus?

Answer 12

Obstruction to flow of CSF occurs within the ventricular system

Question 13

What is communicating hydrocephalus?

Answer 13

Obstruction to flow of CSF outside of the ventricular system (e.g. in subarachnoid space or at the arachnoid granulations)

Question 14

Subfalcine herniation is often associated with what?

Answer 14

With compression of the anterior cerebral artery, manifest by weakness and/or sensory loss in leg

Question 15

Signs of tentorial herniation?

Answer 15

Results in compression of IPSILATERAL 3rd cranial nerve and its parasympathetic fibres, pupillary dilation and impairment of ocular movements on the side of the lesion

Question 16

Signs of tonsillar herniation

Answer 16

Life threatening as it causes brainstem compression and compromises vital respiratory centres in the medulla oblongata
Neurological features associated with progressive elevation of intracranial pressure

Question 17

Signs of transcalvarium herniation?

Answer 17

Reduction in level of consciousness
Dilatation of pupil on the same side as mass lesion
Bradycardia
Increase in pulse pressure and increase in mean arterial pressure
Cheyne-stokes respiration

Question 18

What are Cheyne-stokes respiration and which type of herniation are they associated with?

Answer 18

Cycles of deeper and then shallower breathing

Seen in transcalvarium herniation

Question 19

Which cancers can metastasise to the brain?

Answer 19

Lung
Breast
Kidney
Thyroid
Melanoma
Gut
Prostate

Question 20

Grade 1 pilocytic astrocytoma survival

Answer 20

95% alive at 10 years

Question 21

Grade 2 diffuse astrocytoma survival

Answer 21

7-8 years

Question 22

Grade 3 anaplastic astrocytoma survival

Answer 22

2-3 years

Question 23

Gade 4 glioblastoma survival

Answer 23

median survival 10 months

Question 24

Serum marker for glioblastoma

Answer 24

GFAP

Question 25

Common causes of single abscesses

Answer 25

Focal cause e.g. otitis media, sinusitis, nasal, facial and dental infections, skull fractures, penetrating injury, neurosurgical procedures

Question 26

Causes of multiple abscesses

Answer 26

Usually result from septicaemia, acute bacterial endocarditis, bronchiectasis and lung abscess, cyanotic heart disease, IV drug abuse

Question 27

What is vasogenic cerebral oedema?

Answer 27

Defect in blood-brain barrier - water, sodium and protein leach out into extracellular space

Question 28

Cause of cytotoxic cerebral oedema?

Answer 28

-commonest type due to ischemia

Question 29

What is hydrostatic oedema?

Answer 29

Passage of protein-poor fluid into the extracellular space is followed by a sudden increase in the intravascular pressure, which forcibly dilates capillary bed

Question 30

What is hypo-osmotic cerebral oedema?

Answer 30

Swelling occurs as a result of a large reduction in serum osmolality