Neuropathology Flashcards
What part of the CNS is most vulnerable to hypoxic damage?
Neurones
What damage to CNS is described here - activation of glutamate receptors results in uncontrolled calcium entry into cell, neurones cant use anaerobic glyclysis?
Hypoxic damage
What is the term for a reaction within the cell body that is associated with axonal injury?
Axonal reaction
What is the most important histopathological indicator of CNS injury regardless of cause?
Gliosis
What happens to astrocytes in gliosis?
Undergo hyperplasia and hypertrophy
Disruption to what cells often associates with a local proliferation of sub-ependymal astrocytes to produce small irregularities on the ventricular surfaces termed ependymal granulations?
Ependymal cells
How much cardiac output does the brain recieve?
15%
How much oxygen does brain consume?
20% of body oxygen
Blood is supplied to the brain via what two arteries?
Branches of internal carotid and vertebral arteries
What artery is affected with frontal lobe dysfunction, contralateral sesnory loss in foot and leg, paresis of arm and foot relative sparing of thigh and face?
Anterior cerebral artery
What artery is affected with hemiparesis, hemisensory loss, aphasia/dysphasia and apraxia?
Middle cerebral artery
What does vertebrobasilar - posterior supply (three things)?
Brainstem
Cerebellum
Occipital lob
Where does Webers syndrome affect?
Midbrain
Where does medial and lateral inferior pontine sundromes afect?
Pons
Where does lateral medullary syndrome affect?
Medulla
Where is affected to cause homonymous hemianopia with macular sparing?
Occipital lobe
Where is affected to cause ataxia,. nystagmous, intention tremor and pendular reflexes?
Cerebellum
Below systolic BP of what are autoregulatory mechanisms inadequate to compensate leading to parenchymal injury?
50 mmHg
What are watershed areas (hypoxic ischaemic damage)?
Junctions of arterial territories which are first to be deprived of blood
What is the term for sudden disturbance of cerebral function of vascular origin that causes death or lasts over 24 hours?
Stroke
What is the most common type of stroke?
Infarction - thrombotic
Most common cause of spontaneous subarachnoid haemorrhage?
Berry aneurysm rupture 90& in internal carotid artery territory
What is associated with severe headache, vomiting and loss of consciousness?
Subarachnoid haemorrhage
What is associated with lacunes - small cavities found in basal ganglia, thalami and pons of elderly?
Hypertension
Lucunar infarcts?
Hypertension and the brain
What disease has primary demyelination?
Multiple Sclerosis
What three toxins can cause demyelination?
Cyanide, CO, solvents
What type of demyelination are central pontine myelinosis, progressive multifocal leucoencephalopathy, subacute sclerosing panencephalitis, AIDS and axonal degeneration?
Secondary
What is the most common demyelinating disease?
Multiple Sclerosis
What sort of episodes does multiple sclerosis cause?
Relapsing and remitting flare up episodes
What is the morphology like in multiple sclerosis?
External appearance of brain and spinal cord usually normal, cut surface shows multiple areas of demyelination termed plaques
What matter does MS affect?
White matter
well-demarcated plaques in white matter?
MS
What CN is MS commonly seen in?
Optic nerve
What type of MS has yellow/brown demyelinated plaques with an ill-defined edge which blends into surrounding white matter?
Acute MS
What type of MS has plaques that are well demarcated, grey/brown lesions in white matter and classically sit around lateral ventricles?
Chronic MS
What patholkogical condition can huntingtons disease and picks disease cause?
Dementia (primary)
In Alzheimers disease what happens to the macroscopic pathology of the brain?
Decreased size and weight - cortical atrophy
In Alzheimers disease what happens to the macroscopic pathology of sulci?
Widening
In Alzheimers disease what happens to the macroscopic pathology of gyri?
Narrowing
What lobes are affected in Alzheimers?
Frontal
Temporal
Parietal
What happens to brainstem and cerebellum in alzheimers?
Normal
What disease has intracytoplasmic neurofibrillary tangles, Amyloid plaques (extracellular senile or neuritic plaques), amyloid angiopathy and extensive neuronal loss with astrocytosis?
Alzheimers disease
What protein is affected with neurofibrillary tangles in Alzheimrs?
Tau protein
What colour does perivascular amyloid stain in Alzheimers?
Congo red
What are the hallmarks of dementia with Lewy bodies?
Hallucinations and fluctuating levels of attention
What is degenerated in dementia with Lewy bodies - same as PD?
Substantia nigra
Name a neuropsychiatric disorder, onset common between 35-50 but can occur anytime?
Huntington’s disease
What is the hungtintons disease triad?
- Emotional disturbance
- Cognitive disturbance
- Motor disturbance
Chorea, myoclonus, clumsiness, slurred speech, depression, irritability and apathy?
Hungtintons disease - develop dementia later
What disease has teh microscopic appearance of loss of neurons in caudate nucleus and cerebral cortex accompanied by reactive fibrillary gliosis?
Hungtintons disease
A progressive dementia commencing in middle life (usually between 50 and 60 years) characterised by slowly progressing changes in character and social deterioration leading to impairment of intellect, memory and language
Pick’s disease
What two lobes suffer extreme atrophy in picks disease?
Frontal and temporal
What are the histological hallmarks of Pick’s disease?
Pick’s cells (swollen neurons)
Pick’s bodies (intracytoplasmic filamentous inclusions
What disease gives personality and behavioural changes, speech and communication problems, changes in eating habits and reduced attention span?
Pick’s disease
What four things seperate multiinfarct dementia from Alzheimers?
- Abrupt onset
- Stepwise progression
- History of hypertension/stroke
- Evidence of stroke seen on CT or MRI
What is hydrocephalus?
Accumulation of excessive CSF within the ventricular system of the brain
What is the normal volume of CSF?
120 to 150ml
Where is CSF produced?
In choroid plexus in lateral and fourth ventricles of brain
What absorbs CSF?
Arachnoid granulations
What foramina does CSF travel through to get to the cisterna magna?
Foramina of Luschka
Foramina of Magendie
Where does non-communicating hydrocephalus occur?
Within ventricular system
Where does communicating hydrocephalus occur?
Outside ventricular system e.g. in SA space or at arachnoid granulations
What are the four most common herniation routes due to an increase in ICP?
- subfalcine
- Tentorial
- Tonsillar
- Transcalvarium
What are the most primary intracerebral tumours?
Gliomas - most commonly astrocytoma
What arteries are usually ruptured in extra dural haemorrahges - usually associated with skull fractures?
Meningeal arteries
