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Neuro > Neuropathology > Flashcards

Neuropathology Flashcards

1
Q

What are the main types of neuropathology

A 
Infection 
Prion disease 
Raised intracranial pressure 
Tumour
Dementia 
Stroke
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3
Q

What are the modes of spread of CNS infections

A

Direct
Blood-borne
Iatrogenic

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4
Q

Give examples of direct spread in CNS infections

A

Middle ear infection

Basilar skull fracture

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5
Q

Give examples of blood-borne CNS infections

A 
Sepsis 
Infective endocarditis (septic emboli)
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6
Q

What are the main sites of infection in CNS

A

Meningitis: infection of leptomeninges (pia + subarachnoid mater)

Encephalitis: infection of neural parenchyma

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7
Q

What are the causative organisms of meningitis (by age group)

A

Neonates: E. Coli
2-5: H. Influenzae
5-30: Neisseria meningitides
>30: Strep. pneumoniae

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8
Q

What are the pathological features of meningitis

A

Meninges red + swollen

Pus around vessels

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9
Q

What is chronic meningitis

A

Slowly developing meningitis that lasts > 4 weeks

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10
Q

What organism causes chronic meningitis

A

M tuberculosis

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11
Q

What are pathological features of chronic meningitis

A

Granulomatous inflammation
Fibrosis of meninges
Nerve entrapment (involves brainstem)

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12
Q

What are clinical features of chronic meningitis

A

Insidious onset of: headache, neck stiffness, fever

Focal cranial nerve palsies - nerve entrapment in brainstem due to meningeal fibrosis

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13
Q

What are the complications of meningitis

A 
Death - raised ICP 
Cerebral abscess 
Cerebral infarction 
Subdural empyema 
Epilepsy (neural damage and scarring) 
Sepsis
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14
Q

What are pathological features of encephalitis

A

Brain haemorrhagic and swollen

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15
Q

What are causative organisms of encephalitis

A 
Virus: 
Herpes simplex (temporal lobe) 
Cytomegalovirus
Polio (spinal cord motor neurones) 
Rabies (brainstem)
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16
Q

What are prion proteins

A

Proteins normally present in pre and post synaptic compartments of nervous system

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17
Q

What is prion disease

A

Group of progressive encephalopathies caused by accumulation of mutated prion proteins
NOT an infection

18
Q

What is the pathophysiology of prion disease

A
  1. Presence of mutated prion protein: sporadic, familial, ingested
  2. Accumulation of mutated PrP: abnormal PrP bind to normal PrP to cause post-translational conformational change
  3. Neural cell death: aggregated PrP v stable, accumulate and cause local cell damage
  4. Spongiform encephalopathy: holes in grey matter
19
Q

What are the types of prion disease

A

Variant Creutzfeld-Jacob disease: in humans

Bovine spongiform encephalopathy: in cattle

20
Q

What is normal intracranial pressure

A

0-10mmHg

21
Q

What are the compensatory mechanisms to maintain normal ICP

When are these mechanisms effective

A

Reduced CSF production
Reduced cerebral blood volume
Brain atrophy

In gradual rise in ICP
Up to 60mmHg, otherwise blood flow compromised

22
Q

What are the causes of raised intracranial pressure

A 
Haemorrhage
Tumour
Infarction (inflammation + swelling)
Abscess 
Generalised inflammation (meningitis, encephalitis)
23
Q

Raised ICP is a cause of neuropathology. What types of neuropathology does it cause?

A

Atrophy around lesion
Displacement of midline
Herniation

24
Q

What are the types of brain herniation

A

Subfalcine
Tentorial
Tonsillar

25
Q

What is subfalcine herniation

What are the consequences

A

Protrusion of cingulate gyrus under free edge of falx cerebri
Compression of ACA - infarction of medial parts of frontal + parietal lobes

26
Q

What is tentorial herniation

What are the consequences

A

Protrusion of uncus of temporal lobe through tentorium cerebelli

Occlusion of PCA + superior cerebellar arteries - infarction, oculomotor nerve palsy
Duret haemorrhage + death: downward displacement of brainstem -> tearing of perforating pontine arteries + haemorrhage into brainstem

27
Q

What is tonsillar herniation

What are it’s consequences

A

Protrusion of cerebellar tonsils through foramen magnum
Compression of brainstem + death:
Cvs + Resp depression
RAS compression - coma

28
Q

What type of brain tumours are more common

Why

A

Secondary

Primary tumours are rare bc neural cells do not proliferate frequently

29
Q

What are the types of primary tumours

Where do they spread

A

Benign:
Meningioma

Malignant:
Astrocytoma
Neurofibroma
Ependyonoma

Spinal cord; do not metastasise outside CNS

30
Q

What cancers metastasis to brain

A

Lung
Breast
Kidneys

31
Q

Give examples of iatrogenic spread in CNS infections

A

Lumbar puncture
Ventricular-peritoneal shunt
Surgery

Neuro (18 decks)

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