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NEUROLOGY > Neuropathology > Flashcards

Neuropathology Flashcards

1
Q

Describe the two types of microglia cells; M1 and M2

A 
M1 = pro- inflammatory, chronic 
M2= anti-inflammatory, phagocytic, acute
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2
Q

What is gliosis?

A

An indicator of CNS injury

Astrocyte hyperplasia and hypertrophy

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3
Q

What is chromatolysis?

A

Margination and loss of Nissl granules

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4
Q

What is wallerian degeneration?

A

Degeneration of the axon and myelin sheath distal to the site of injury

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5
Q

The brain receives what % of CO?

A

The brain receives 15% of CO and uses 20% of the total body oxygen consumption

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6
Q

What is meant by ‘excitotoxicity’?

A

Energy failure in the cell

Pathological process by which nerve cells are damaged or killed by excessive stimulation by neurotransmitters

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7
Q

Describe cytotoxic oedema and its causes

A

More water in the cell (ICP is not raised)

Intoxication/ severe hypothermia

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8
Q

Describe ionic oedema and its causes

A

AKA osmotic oedema

Hyponatraemia/ excess water intake/ SIADH

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9
Q

Causes of vasogenic oedema

A

Trauma/ tumours/ inflammation/ infection/ hypertension/ encephalopathy

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10
Q

Infarcts in the brain most commonly affect which artery territory?

A

MCA (middle cerebral artery)

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11
Q

What are ‘watershed areas’ and why are these particularly sensitive to infarcts?

A

Watershed areas are the zones between two arterial territories

They are sensitive to infarcts as they are distant from the heart and therefore not very well supplied

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12
Q

Some neurones are more sensitive than others to infarction. Give two examples.

A

Neurons in the neocortex and hippocampus

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13
Q

Describe the differences between global and focal infarctions

A

Global infarctions involve a generalised reduction in blood flow/ oxygenation. Examples include severe hypotension and cardiac arrests.

Focal infarctions involve restriction to blood flow in a localised area of the brain due to vascular obstruction.

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14
Q

What would the brain look like 12-24 hours after a stroke?

A

Pale, soft and swollen
Red neurons
Oedema
Neutrophils

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15
Q

What would the brain look like months after a stroke?

A

Liquified
Cavities form which are lined by dark grey tissue
Gliotic scar formation

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16
Q

What are the two mechanisms for haemorrhage?

A

Disruption of the BBB

Haemorrhagic conversion

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17
Q

Neglect syndrome indicates damage to which side of the brain?

A

Right side

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18
Q

Aphasia/dysphasia indicates damage to which side of the brain?

A

Left side

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19
Q

How would a vascular lesion in the middle cerebral artery present?

A

Weakness of the contralateral face and arm

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20
Q

How would a vascular lesion in the anterior cerebral artery present?

A

Weakness and sensory loss in the contralateral leg

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21
Q

How would a vascular lesion in the vertebra-basilar artery system present?

A

Vertigo, ataxia, dysarthria and dysphagia

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22
Q

What are lacunae?

A

Lacunar infarcts

  • Small infarcts in deep parts of the brain
  • many are incidental findings (not that significant)
  • multiple lacunar infarcts can contribute to multiple infarct dementia
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23
Q

What is a charcot-bouchard aneurysm?

A

These are micro-aneurysms occurring in small vessels

Occur mostly in the MCA branches in the basal ganglia

Rupture causes intracerebral haemorrhage

24
Q

What is amyloid angiopathy and when does this occur?

A

Amyloid angiopathy involves the deposition of amyloid in vessels, causing them to become less compliant

Can lead to rupture causing intracerebral haemorrhage

This is an age-related process and occurs in alzheimer’s

25
Describe arteriovenous malformations
These are abnormal torturous vessels which involve shunting from artery to vein The vein undergoes smooth muscle hypertrophy, becomes less compliant and ruptures easily Most AVMs occur in the MCA territory They are the most common congenital vascular malformation
26
Describe the two following primary demyelinating disorders; Acute disseminated encephalomyelitis (ADEM) Acute haemorrhage leukoencephalitis (AHL)
ADEM - self limiting - low mortality - occurs in children - autoimmune AHL - fatal - high mortality - occurs in adults - high mortality
27
Give some examples of primary demyelinating disorders
MS ADEM AHL
28
Give some examples of secondary demyelinating disorders
(PML) Progressive multifocal leukoencephalopathy - (Viral disease) Central pontine myelinosis (over rapid correction of hyponatraemia) Toxic insults e.g with cyanide or CO
29
Is MS a white matter or grey matter disease?
MS is a white matter disease as this is the part of the brain which is myelinated
30
Describe the appearance of the plaques which you get in MS
Well circumscribed, well demarcated plaques with a glassy/ translucent appearance
31
Describe the differences between active and inactive plaques in MS
Active plaques - ongoing demyelination - microglial cells - plaques are yellow/brown with an ill defined edge (blends into the white matter) Inactive plaques - glosis predominates - well demarcated grey/brown lesions in the white matter - classically located in the lateral ventricles
32
Which neurodegenerative diseases are associated with the basal ganglia and brainstem?
Parkinson's and Huntington's
33
Which condition is most associated with cortical atrophy?
Dementia
34
What are some of the pathological features of alzheimer's?
Amyloid angiopathy Atrophy - compensatory widening of the ventricles (2ndry hydrocephalus) Neuronal loss Neurofibrillary tangles Neuritic plaques
35
What are some of the pathological features of Lewy body dementia?
Loss of pigmented lesions causes pallor in the substantial nigra Reactive gliosis Lewy bodies
36
What are some of the pathological features of huntington's?
Atrophy of the basal ganglia Reduction in the size of the caudate nucleus Cortical atrophy
37
What are some of the pathological features of front-temporal dementia?
Extreme atrophy of the frontal lobe Pick's cells
38
Where is CSF produced and absorbed?
CSF is produced by the choroid plexus in the lateral and fourth ventricles CSF is absorbed by the arachnoid granulations
39
What are some of the causes of raised ICP?
Increased CSF SOL Oedema Increased venous volume
40
What are some of the effects of raised ICP on the brain?
Intracranial shifts and herniations "cloning" Midline shift Pressure on cranial nerves Impaired blood flow
41
What are some of the clinical signs of raised ICP?
Papilloedema Headache Neck stiffness N&V
42
Describe a sulfalcine herniation
Expansion of the cerebral hemisphere displaces the cingulate gyrus under the falx cerebri
43
Describe a tectorial herniation
Medial aspect of the temporal lobe herniates over the tentorium cerebelli
44
Describe a cerebellar herniation
Displacement of the cerebellar tonsils through the foramen magnum
45
What are the 3 causes of hydrocephalus?
Obstruction to CSF flow Decreased reabsorption of CSF Overproduction of CSF
46
What is the difference between communicating and non-communicating (obstructive) hydrocephalus?
Obstructive (non-communicating) - Due to a structural pathology outwith the ventricular system blocking the flow of CSF - Dilatation of the ventricular system is seen superior to site of obstruction - Causes include: tumours, haemorrhage, aqueduct stenosis and arnold chiari malformations Non-obstructive (communicating) - Due to an imbalance of CSF production and absorption (referred to as communicating as it is a problem within the ventricular system) - E.g chord plexus tumours cause increased CSF production (v.rare) - E.g meningitis or post-haemorrhage cause failure of reabsorption at the arachnoid granulations
47
What is meant by the term 'Hydrocephalus Ex Vacuo'?
Occurs when there is damage to the brain caused by stroke or injury, causing a shrinkage of the brain Although there is more CSF than usual, the CSF pressure itself is normal.
48
Give examples of space occupying lesions
Tumours Abscesses Haematomas Localised brain swelling
49
What is the most common type of brain tumour in children?
Medullobastoma
50
Where do most tumours arise in relation to the tentorium cerebelli in children vs adults?
Most tumours arise below the tentorium cerebelli in children and above the tentorium cerebelli in adults
51
What is the most common cause of brain tumours?
Metastasis (much more common than primary bone tumours) Mets from; breast, lung, kidney, thyroid and colon
52
What is the most common type of tumour in adults?
Astrocytoma
53
What are some possible causes of abscesses in the brain?
Local extension e.g from mastoiditis Direct implantation of infectious agents e.g from skull fractures and penetrating injuries Haematogenous spread from infections elsewhere
54
How would a brain abscess be investigated and managed?
Diagnosis; CT/ MRI +aspiration for culture Management; aspiration and antibiotics
55
Why are the frontal and temporal lobes at greater risk of contusions?
The undersurface of the lobes have sharp bony prominences causing them to be at increased risk of contusions and lacerations
56
What is meant by coup and contracoup?
Coup are surface contusions/ lacerations occurring at the point of impact Contracoup occur at the opposite side from the point of impact and are often worse than coup injuries

NEUROLOGY (18 decks)

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