Neuropathology Flashcards

1
Q

What is Gliosis?

A

Astrocytes hypertrophy (upregulation of astrocytic activity) and increase GFAP immunoreactivity in response to both acute and chronic insults.
-Infiltration neoplasm, ischaemia, infection
Gliotic tissue is firm and appears grey.

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2
Q

What is normal intracranial pressure?

A
  • Within the intact skull, there are 3 major components of intracranial pressure: the brain, the CSF and blood.
  • Any increase in volume of one of these 3 components will produce an increase in ICP, unless a compensatory reduction in one of the other components occurs
  • Normal upper limit of ICP is 2.7kPa (reduce CSF, collapse venous sinuses)
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3
Q

What are the common causes of raised ICP?

A
  • Intracranial expanding lesions – tumour, haematoma, abscess
  • Hydrocephalus (excessive CSF= ventricular dilatation)
  • Cerebral oedema – an increase in the water content of the brain, due to dysfunction of the blood-brain barrier. This can be localised (eg around tumours) or generalised(eg following severe head injury or in hypoxic brain damage)
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4
Q

What is the normal cerebral blood flow?

A
Human cerebral blood flow
=Overall- 50 ml/100g per minute
=Grey matter- >80 ml/100g per minute
=White matter- 20-25ml/100g per minute
-The cerebral metabolic rate is higher for infants (and also in other species with small brains)
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5
Q

Examples of cerebrovascular disease

A
  • Strokes can be thrombo-embolic or haemorrhagic (20%).
  • In thrombo-embolic disease symptoms are determined by the vessel involved.
  • When there is hypotension watershed infarcts can develop.
  • Cardiac arrest results in global brain injury (hypoxic-ischaemic encephalopathy HIE)
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6
Q

What is Subfalcine herniation?

A

-Medial direction/ midline shift of the ipsilateral cingulate gyrus beneath the free edge of the falx cerebri due to raised intracranial pressure.

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7
Q

What is axial displacement?

A

Diencephalic structures pushed downwards by brain swelling

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8
Q

Where are primary hypertensive haematomas usually found in the brain?

A

Basal ganglia

Brainstem and cerebellum

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9
Q

What occurs at a microscopic level in the brain vessels in hypertension?

A

Lipohyalinosis/ small vessel disease accounts for defects in vessel resulting in parenchymal haemorrhage
-Large vessel occluded by degenerative features caused by long-standing chronic hypertension

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10
Q

What are the causes of parenchymal brain haemorrhage?

A
  • Hypertension
  • Vascular malformation
  • Neoplasia (metastatic, primary gliomas like oligodendrocyte)
  • Trauma (more superficial)
  • Cerebral amyloid angiopathy (older patients, consequence of proteins associated with Alzheimer’s- lobar haematomas)
  • Iatrogenic, other blood dyscrasias (anticoagulants)
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11
Q

What are Border zone infarcts?

A
  • Border zone infarct develop at interface between anterior, middle and posterior cerebral artery territories
  • Consequence of hypertension
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12
Q

What are the areas of Selective Vulnerability to lack of blood flow?

A
  • Hippocampus- sector CA1 is most vulnerable, sector CA2 least so.
  • Cerebral cortex- neurones of layers 3, 5 and 6 are most vulnerable. Damage is most pronounced within the depths of sulci and posteriorly within the cerebral hemispheres (triple watershed zone).
  • Basal ganglia (including thalamus)- variable.
  • Cerebellum- Purkinje cells.
  • Brainstem- Brainstem nuclei tend to be relatively preserved in adults, but when they are affected sensory nuclei are more susceptible than motor nuclei
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13
Q

What are the consequences of cardiac arrest and global cerebral ischaemia?

A
  • Cessation of blood to brain= irreversible neuronal damage
  • Lack of blood and oxygen to neurones (cytoplasm red in red cell change)
  • Build up lactic acid around neurones usually removed by blood from perineuronal environment
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14
Q

What are the causes of subarachnoid haemorrhage?

A
  • Ruptured aneurysms

- Trauma

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15
Q

What is a cerebral aneurysm?

A
  • Swelling of artery at a junction

- Can rupture and cause intracerebral or subarachnoid haemorrhage (aneurysm of MCA)

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16
Q

What organisms target the NS for infection?

A
-Viruses 
eg herpes, CMV, measles, rabies, HIV
-Bacteria
eg meningococcus, listeria, m. tuberculosis
-Protozoa
eg amoeba, toxoplasma, pl. falciparum (malaria)
-Metazoa
eg echinococcus (hydatid cyst)
-Fungi
eg aspergillus, candida
-Prions
17
Q

What are the modes of transmission of infection to the NS?

A
  • Blood borne: septicaemia, viraemia, infected blood cells (Trojan horse), embolisation (IV drug use, transfusion)
  • Direct spread: local source of infection (mastoid abscess, frontal sinus infection, maxillary sinus infection)
  • Trauma: breaching NS coverings (incl neurosurgery)
  • Transplants (immune suppressed)
  • Pregnancy-related vertical transmission
  • Original source of infection may include contact, inhalation, sexual transmission
18
Q

What are the foetal infections of CNS?

A
  • Rubella (deafness, blindness, microcephaly)
  • CMV (microcephaly)
  • Toxoplasma (microcephaly)
  • Syphilis (tertiary forms include GPI, tabes dorsalis and meningovascular syphilis)
  • (HIV)
19
Q

What organisms cause meningitis?

A

-Bacteria
=Infants: Group B Streptococcus, E. coli, Listeria
=0-4yrs: Haem. influenzae, Strep. pneumoniae, Myco. tuberculosis (in high prevalence countries)
=0-25 yrs: Neiss. meningitidis
=Older adults: Myco. tuberculosis (in low prevalence countries)
=IV drug abuse: Staph. aureus
-Viruses
=Children: Enteroviruses (Coxsackie, Echo)
=Adults: Herpes viruses, Mumps
-Immunosuppressed
=Cytomegalovirus, =cryptococcus

20
Q

What are the viral infections of the NS?

A

-Meningitis
eg echoviruses, coxsackie, herpes simplex, mumps
-Acute encephalitis
eg herpes simplex, CMV, varicella zoster virus, rabies (rubella in fetus)
-Subacute encephalitis
HIV
-Demyelination
JC virus (progressive multifocal leucoencephalopathy)
-Delayed, reactivated
Varicella zoster virus

21
Q

Describe Herpes Simplex Encephalitis

A

-Used to have high mortality
-Aciclovir= mortality dropped
=Early treatment vital
-Necrotising damage
-Hippocampus and medial temporal lobes affected
-Survivors have memory problems

22
Q

Describe Rabies

A

Enter body through bite wound
Crawls up peripheral NS to CNS
Fatal when in CNS
Affects neurons with Negri Body (viral protein)

23
Q

What are the common Protozoal and Metazoal infections?

A

Rare in UK
Toxoplasma (foetal/ neonatal/ immunosuppressant like HIV)
=cysts in ventricles
-Cerebral malaria
=plasmodium infection
=acute brain swelling and widespread haemorrhage

24
Q

What are the fungal infections of the CNS?

A
  • Candida
  • Aspergillus
  • Cryptococcus
25
Describe Prion infection
Perplexing transmissible and genetic disease of the =CNS =Sporadic CJD (Creutzfeldt Jacob Disease) =Familial CJD and GSS =Iatrogenic CJD =Variant CJD =Kuru (cannibalism in tribe)
26
What are the types of neurogenic muscle diseases?
- Disorders of motor neurones, e.g. motor neurone disease, spinal muscular atrophy - Disorders of spinal motor nerve roots, e.g. disc prolapse - Disorders of motor nerves - peripheral neuropathies
27
What are the types of primary muscle disorders (myopathies)?
- Inflammatory myopathies - Muscular dystrophies - Metabolic myopathies - Endocrine myopathies - Toxic and drug-related myopathies - Mitochondrial myopathies - Ion channel myopathies - Congenital myopathies
28
Describe muscular dystrophies
- These are genetically determined destructive myopathies. - They are usually progressive. - Dystroferlin most important protein
29
What are the types of muscular dystrophies?
-Duchenne Muscular Dystrophy (young boys at 5-6 age, death in early teens) -Becker Muscular Dystrophy (partial expression of Dystroferlin protein in later years) -Others =limb-girdle muscular dystrophies (50+) =congenital muscular dystrophies =Emery-Dreifus muscular dystrophy =myotonic dystrophy
30
Describe the normal structure of the peripheral NS
- Mixed, sensory or motor - Nerve trunks composed of a variable number of nerve fascicles surrounded by the epineurium - Individual fascicles surrounded by perineurium - Connective tissue within fascicles is the endoneurium
31
What are the cells of the peripheral NS?
- Intrafascicular; axons surrounded by Schwann cells. Capillaries also present - Perineurium; flattened perineurial cells connected by tight junctions and forming concentric layers separated by collagen - Epineurium; collagenous tissue with some adipose and elastic tissue. Larger vessels found in the epineurium
32
What are the peripheral nerve disorders?
-Trauma -Tumour- mostly benign (schwannoma= periphery of nerve to push to one side, neurofibroma= intrinsic to nerve so expand nerve from inside out) but may be malignant (MPNST) -Acquired neuropathies =Nutritional- diabetes =Neurotoxins- alcohol, drugs, industrial chemicals =Inflammatory- Guillain Barre syndrome (autoimmune reaction) =Infective- leprosy =systemic disorders- vasculitis, amyloidosis -Hereditary neuropathies =CMT(Charcot-Marie-Tooth) =Others