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202: Theme 1, Fundamental neuroscience and the brain > Neuropathology > Flashcards

Neuropathology Flashcards

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1
Q

Role of CSF

A

Transport of metabolites

Cushions the brain and spinal cord

Immune regulation and defence

Auto regulation of blood flow to the brain

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2
Q

Circulation of CSF

A

[500ml a day circulates]

Lateral ventricle-[Foramen of Monro]—> Third ventricle
[Cerebral aqueduct]

Fourth ventricle–[Foramen of Luschka/ Magendie]–> Cisterna magna

Ascends over cerebellum and cerebral hemispher–[arachnoid granulation]–> Superior sagittal sinus

Ascends ventral subarachnoid space—> Over cerebral hemisphere—> arachnoid granulation…

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3
Q

Hydrocephalus Ex vacuo

A

Enlargement of ventricles and subarachnoid space due to shrinking of brain tissue.

Occurs in dementia

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4
Q

Raised intracranial pressure

  • Definition
  • Causes
A

CSF pressure above 200mm H2O

Causes:

  • Hydrocephalus
  • Intracranial space occupying lesion [neoplasm, bleed, abscess]
  • Cerebral oedema [e.g in hypoxia, injury, trauma]

Consequence= herniation

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5
Q

Herniations

- Different types

A

Subfalcine
- Cingulate gyrus dispace under the free edge of the falx cerebri

Central/ transtentorial
- Cerebral hemisphere tissue pushed through tentorium cerebelli

Tonsillar/ cerebellar

  • Cerebellar tissue pushed through foramen magnum
  • Can compress the medulla and cause breathing and cardiac impairments.
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6
Q

Duret haemorrhages

A

Small linear bleeds in the midbrain and upper pons.

- Caused by tonsillar herniation—> compression in medulla oblongata

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7
Q

Examples of space occupying lesions

A

Haemorrhages:

  • Extradural
  • Subdural
  • Subarachnoid
  • Intracerebral

Oedema + haemorrhage [from ischemic infarct]

Neoplasm
Abscess

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8
Q

Vascular brain injury causes [include vessels involved]

  • Extradural
  • Subdural
  • Subarachnoid
  • Intraparenchymal
A

Extradural bleed

  • Severe trauma with arterial laceration
  • Middle meningeal artery

Subdural

  • Trauma minor in atrophy
  • Caused by ruptured vein [bridging vein]
  • Seen in old age

Subarachnoid
- Rupture of saccular aneurysm in circle of willis

Intraparenchymal

  • Bleeding into the brain, from BV inside the brain.
  • Hypertension
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9
Q

Saccular aneurysm

A

Known as ‘berry aneurysm’
- Most common type of intracranial aneurysm

Can lead to subarachnoid haemorrhage if it ruptures

Vessels affected:

  • Anterior communicating [40%, most common]
  • Middle cerebral
  • Internal carotid
  • Tip of basilar
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10
Q

Cerebral oedema

- Causes

A

Vasogenic
- Increased vascular permeability

Cytotoxic
- Neuronal, glial/ endothelial cell damage

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11
Q

Global vs focal ischemia

A

Global- Includes wide range of brain tissue

  • Hypoxia [low O2 in blood]
  • Can still preserve brain if kept cold

Focal

  • Localised to brain tissue
  • Obstruction of blood flow
  • More dangerous
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12
Q

Hemorrhagic vs ischemic cerebral infarction

A

Haemorrhagic

  • Red blood cell in infarcted tissue
  • Caused by emboli
  • Petechial (small bleeds) lesions [ from bone marrow emboli]

Ischemic

  • Lack of blood flow= infarction
  • Caused by thrombosis
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13
Q

Histology of ischemic infarcts

A

ACUTE NEURONAL INJURY

Pyknosis [irreversible condensation of chromatin] in nucleus of neurones

Red neurones

Shrunken cell bodies

Loss of nucleoli

Eosinophilia [increased eosinophils] of cytoplasm

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14
Q

Glioma examples

A

Glioma- neoplasm of glial cells

Examples

  • Astrocytoma
  • Oligodendroglioma
  • Glioblastoma [very malignant]
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15
Q

Neoplasm of the brain example

A

[25% are metastatic]

Gliomas

Ganglion cell tumours- neural tumours

Meningiomas

Medulloblastoma [poorly differentiated]

Primary CNS lymphona

Peripheral nerve tumours

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16
Q

Peripheral nerve tumours example

A

Schwanoma - Schwann cells

Neurofibroma [nerve cell tumour]

MPNST [malignant peripheral sheath tumour]

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17
Q

Encephalitis

A

Inflammation of the brain

Viral causes:

  • Herpes simplex
  • CMV
  • HIV
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18
Q

Examples of parasitic infection of the brain

A

Toxoplasmosis

Cyscticerosis

-Localised infections

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19
Q

Spinocerebellar degenerative diseases

  • Definition
  • Symptoms
A

Accumulation of protein aggregates—> loss of cellular then CNS function

Symptoms:

  • Dementia
  • Personality changes
  • Language disturbance
  • Paralysis
  • Movement distrubance
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20
Q

Prion disease

A

Progressive neurodegenerative condition

Example:
CJD [Creutzfeldt-Jakob]

21
Q

Consequences of head trauma

A

Skull fracture

Contusion [bruise]
Laceration
Diffuse axonal injury [widespread lesion in white matter]

Vascular injury

22
Q

Coup and contrecoup head injury

A

Coup- Injury of the brain occurs under the site of impact
- stationary head striking moving object.

Contrecoup

  • Injury occurs in the opposite site of where head was hit.
  • e.g moving head hitting a stationary object
23
Q

Hydrocephalus

  • Causes
  • Clinical differences
A

Obstruction of CSF flow

Impaired arachnoid granulation absorption

Dementia- shrinking of brain tissue

Over production of CSF [rare]

Clinical classification

  • Communicating [or obstructive]
  • Non-communicating
24
Q

Concussion

A

Clinical term used to describe symptoms associated head trauma

25
Q

Spinal cord injury

A

C4 injury and above
- May paralyse the diaphragm [C3-5 innervation]

C4 injury below
- Quadriplegia

Thoracic spine injury
- Paraplegia

26
Q

Berry aneurysm risk factors

  • Lifestyle
  • Acquired conditions
  • Genetic
A

Lifestyle

  • Hypetension
  • Obesity
  • Smoking
  • Excessive alcohol

Acquired conditions

  • Head trauma
  • Infections

Genetics:

  • Marfan’s syndrome
  • Autosomal dominant polycystic kidney disease
  • Ehlers-Danlos syndrome
  • Inherited hemorrhagic telangiectasia
27
Q

Extradural bleed

A

Haemorrhage between the periosteum and periosteal dura mater.

Causes:

  • ARTERIAL laceration from severe head trauma
  • Most likely of middle meningeal artery
28
Q

Treatment of berry aneurysm

A

If ruptured

  • Decrease intracranial pressure [i.e craniotomy]
  • Restoration of respiration

Prevention of rupture

  • Surgical clipping [craniotomy required]
  • Endovascular coiling [endovascular approach, radiology]
29
Q

Subdural haemorrhage

A

Haemorrhage between the meningeal dura layer and arachnoid layer.

Causes:

  • Ruptured bridging vein
  • Head trauma minor in atrophy
  • Shaken baby syndrome

Risk factors:

  • Old age [more brittle veins and larger subdural space]
  • Infants [ larger subdural space]
  • Blood thinners
  • Dementia
  • Long-term alcohol use
30
Q

Subarachnoid bleed

A

Hematoma between the subarachnoid matter and pia mater [subarachnoid space]

Cause:
- Rupture of saccular aneurysm in the Circle of Willis

31
Q

Intraparenchymal bleed

  • Mechanism
  • Causes [9]
A

Haemorrhage into the neural parenchyma

  • Caused by rupture of small vessels within the brain
  • Can be accompanied with oedema

Causes:

  • Hypertension
  • Sickle cell disease
  • Arteriovenous malformation
  • Amyloid deposits
  • Intracranial neoplasm
  • Coagulopathy
  • Infection
  • Vasculitis
  • Trauma
32
Q

Cauda equina syndrome

  • Definition
  • Symptoms [7]
  • Causes [6]
A

Set of symptoms due to damage/compression of spinal cord below the cauda equina [end of spinal cord]

Symptoms:

  • Severe back pain
  • Saddle anesthesia
  • Bladder and bowel dysfunction—-> decreased tone of the urinary and anal sphincters.
  • Urinary retention—> Detrusor weaknesses
  • Weakness of the muscles of the lower legs (often paraplegia)
  • Sexual dysfunction
  • Absent anal reflex

Cause:

  • Disc herniation in the lower region of the back.
  • Spinal stenosis
  • Neoplasm
  • Epidural abscess
  • Epidural hematoma
  • Trauma
33
Q

Spine tumours

A

Primary
- Tumour originated in spinal tissue

Secondary

  • Metastatic
  • Originated from cancers, common to spread to bone
  • Breast, thyroid, prostate, lung [bronchi], myeloma

Can compress spinal cord or spinal nerves

34
Q

Spinal abscess

A

Caused by infection

  • Can be caused by IV drug use
  • Can destroy spinal disc

Bacterial

  • S. aureus
  • TB
  • Meningitis

Fungal

35
Q

Causative agent of meningitis in the elderly [4]

A

Streptococcus pneumoniae
Meningococcus
Listeria monocytogenes

36
Q

Causative agent of meningitis in newborns

A

Escherichia coli

Group B streptococci

37
Q

Causative agent of meningitis in children

A

Streptococcus pneumoniae

Meningococcus

Haemophilus

38
Q

Viral causative agents of meningitis

A

HIV

HSV VZV

CMV

Enterovirus

39
Q

Fungal causative agents of meningitis

A

Candida

Crytococcus neoformans

Histoplasma

40
Q

Parasitic causative agents of meningitis

A

Angiostrongylus

Schistosoma,

Toxocariasis

Schistosoma

Cysticerosis

41
Q

Signs and symptoms of meningitis

A

Stiff neck

Vomiting

Confusion

Photophobia

Butterfly rash- does not blanche under pressure.

42
Q

Investigations for meningitis

A

Lumbar puncture [except when intracranial pressure is high, due to tonsillar herniation risk]

  • Cloudy CSF
  • Increased protein levels [viral]
  • Increased WBC count [bacterial]
  • Decreased glucose levels

CT/MRI done before lumbar puncture to check ICP.

43
Q

Meningitis risk factors

A

IV drug use

Cerebral shunt

Cochlear implant

Young children- developmental abnormalities

Skull trauma, allowing nasal cavity bacteria to enter CSF space

44
Q

Non-infections causative agents of meningitis [5]

A

Drug interactions:

  • Antibiotics
  • Immunoglobulins
  • NSAIDs

Sarcoidosis

Malignant/metastatic

Lupus erythematosus

Vasculitis

45
Q

Bacterial causative agents of meningitis for adults

A

Meningococcus [N.meningitides]

Step. pneumoniae

46
Q

Causative agents for meningitis in the immunosuppressed

A

Meningococcus

Step. pneumoniae

Listeria monocytogenes

virus, TB, fungi

47
Q

Risk factors for spinal S.aureus abscess [5]

A

Skin abcess

Septicaemia/ bacteraemia

Back injury/ trauma

Lumbar puncture

Surgery

48
Q

Intraparenchymal haemorrhage risk factors [6]

A

Age, >60

Hypertension

System coagulopathies

Vuscular malformations

Vasculitis

Cerebral amyloid angiopathy

49
Q

Complications of subarachnoid haemorrhage

A

Acute:
- Vasospasm= focal/global ischaemia

Late:
- Hydrocephalus due to scarring and CSF obstruction.

202: Theme 1, Fundamental neuroscience and the brain (27 decks)

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