Neuropathology

Question 1

How can infections get into the brain?

Answer 1

Direct Spread (Otitis Media)
Blood (Septicaemia)
Iatrogenically (LP)

Question 2

What can infections in the brain cause?

Answer 2

Meningitis
Encephalitis
Abcess
Chronic Meningitis

Question 3

What are the Pathogens for different types of Encephalitis?

Answer 3

Spinal Cord - Polio
Temporal Lobe - Herpes
Brainstem - Rabies

Question 4

What is Encephalitis?

Answer 4

Infection and inflammation of the neuronal cell bodies.

Can lead to cell death and formation of inclusion bodies

Question 5

What is “chronic” meningitis?

Answer 5

Different Pathogen

Causes Granulomatous disease, fibrosis, nerve entrapment

Question 6

How can you get an abcess in the brain?

Answer 6

Via inner ear infection –> Internal auditory meatus –> temporal lobe

Question 7

What are some consequences of meningitis?

Answer 7

Systemic --> Sepsis
Subdural Empyema
Herniation due to raised ICP --> death
Infarction
Abcess
Epilepsy

Question 8

What is Prion Disease?

Answer 8

Accumilation of mutated prion proteins which damage cell bodies.
This creates holes in the grey matter.

Question 9

How do you get Prion Disease?

Answer 9

Exposure to Prions themselves from food, sporadic mutation, or can be familial

Question 10

What is a spongiform encephalopathy?

What do you get it in?

Answer 10

Prion Disease

Question 11

What can Prion Disease Cause?

Answer 11

Creutzfeldt Jakob Disease

Question 12

What symptoms do you get with CJD?

Answer 12

Memory Lapses
Mood Changes
Hypertonia
Loss of Interest
Incontinence
Clumsiness

Question 13

What is Dementia?

Answer 13

An acquired global impairment of brain function, that does not cause a loss of consciousness

Question 14

What is Lewy Body Dementia?

Answer 14

Caused by accumilation of misfolded proteins which aggregate and form Lewy Bodies.
Leads to loss of attention and alertness

Question 15

What are the types of dementia?

Answer 15

Alzheimers
Lewy Body
Vascular Dementia
Picks Disease

Question 16

What is Alzheimers?

Answer 16

Dementia caused by neuronal damage (forming Tangles and Plaques) and loss of neurotransmitters.
This leads to atrophy of brain tissue

Question 17

What is a plaque?

Answer 17

Aggregation of amyloid with enlarged axons, dendrites and synaptic terminals

Question 18

What is a tangle?

Answer 18

Tau proteins are hyper phosphorylated and twist together

Question 19

What is the survival rate of Alzheimers

Answer 19

7 to 10 years

Question 20

Early signs of AD?

Answer 20

Forgetfulness

Question 21

Later signs of AD?

Answer 21

Confusion

Agitation

Question 22

Can we treat AD?

Answer 22

We can limit early symptoms and delay progression with AChE inhibitors

Question 23

What is Vascular Dementia?

Answer 23

Dementia caused by a loss or problem with the blood supply to the brain
It can be multi-infarct, post-stroke, subcortical or mixed with AD

Question 24

What are the signs of vascular dementia?

Answer 24

CVS risk factors
Memory is less affected early on
Problems with following instructions/cognition

Question 25

Can we treat V Dementia?

Answer 25

We can manage the CVS risk factors to prevent progression

Question 26

What is Picks Disease?

Answer 26

Fronto-temporal dementia caused by a build up of abnormal proteins It has no treatment

Question 27

What are the symptoms of Picks Disease

Answer 27

Get behavioural and personality changes (loss of inhibition) and speech difficulties

Question 28

What is a raised intracranial pressure?

Answer 28

Sustained over 20mmHg

Question 29

What can cause a raised ICP?

Answer 29

``` An abcess Hydrocephalus SOL Tumour Haemorrhage Infection ```

Question 30

What can happen in an enlarging SOL?

Answer 30

Increasing ICP leading to Herniation

Question 31

What are the types of herniation?

Answer 31

Subfalcine Tentorial/Uncal Tonsillar

Question 32

What are the benign tumours of the brain?

Answer 32

Meningioma

Question 33

What are some malignant brain tumours?

Answer 33

``` Astrocytoma Neurofibroma Ependymyoma Metastasis (most common) Lymphoma ```

Question 34

Describe a subfalcine herniation

Answer 34

There is a SOL on the same side, the cingulate gyrus is forced underneath the falx cerebri to the other side of the brain This can compress the ACA and lead to ischaemia of the brain

Question 35

Describe a uncal/tentorial herniation

Answer 35

The parahippocampal gyrus is forced underneath the tentorial notch by a lesion above it. This can compress CNIII, the PCA and the SCerebellarAs

Question 36

Describe a tonsillar herniation

Answer 36

Raised ICP leads to the cerebellar tonsils herniating through the foramen magnum of the skull and compressing the brainstem Leads to death

Question 37

What is tonsillar herniation also known as?

Answer 37

Coning

Question 38

What can happen secondary to a tentorial herniation?

Answer 38

A duret herniation into the brainstem

Question 39

What is a lacunar infarct?

Answer 39

Less than 1cm Commonly in the Basal Ganglia Associated with Hypertension

Question 40

What is a regional infarct?

Answer 40

An infarct in a cerebral or carotid artery