Neuropathology module tutorial

Question 1

What is the shape of an extradural haematoma?

Answer 1

Concave

Question 2

What is an intradural haemorrhage?

Answer 2

Subdural - but between the two layers of dura mater (endosteal and meningeal)

Question 3

What happens if there is only mild/moderate lysis within 1 week?

Answer 3

Scarring and organisation into a scar after 1 to 3 months

Question 4

What is a chronic subdural haematoma?

Answer 4

Owing to re bleeding especially 1-3 months after initial bleed

Question 5

What does a subfalcine herniation cause?

Answer 5

Compression of the anterior cerebral artery

Question 6

What does transtentorial herniation cause?

Answer 6

Oculomotor nerve compression and blown pupils

Question 7

What does tonsillar herniation cause?

Answer 7

Compression of vital respiratory and cardiac centres in the medulla oblongata

Question 8

What secondary brainstem trauma results from a tonsillar herniation?

Answer 8

Duret haemorrhages

Question 9

Which conditions increase the risk of berry aneurysm formation?

Answer 9

Adult polycystic kidney disease
Ehlers danlos
NF1
Marfans

Question 10

What two things are predisposing factors for rupture?

Answer 10

Hypertension

Smoking

Question 11

What does rupture of a berry aneurysm cause?

Answer 11

Subarachnoid haemorrhage

Question 12

Where is a subarachnoid haemorrhage usually centred?

Answer 12

Base of brain but may occur over the top too

Question 13

When is the risk of a subarachnoid haemorrhage common?

Answer 13

When lesions are greater than 10mm

Question 14

What is rupture of a berry aneurysm associated with?

Answer 14

High peaks in BP (exertion and cocaine)

Question 15

What is the mortality rate of a subarachnoid haemorrhage caused by rupture of a berry aneurysm?

Answer 15

50%

Rebleeding is common

Question 16

Name an acute complication of rupture of a berry aneurysm

Answer 16

Vasospasm leading to focal/global ischaemia

Question 17

Name a later complication of rupture of a berry aneurysm

Answer 17

Hydrocephalus owing to scarring and CSF flow obstruction

Question 18

Describe some treatment options available for berry aneurysms

Answer 18

Coiling - interventional radiology involves clotting the blood and eventual scarring

Clipping - clips the base of the aneurysm and hence requires craniotomy. Controversial if this is beneficial for survival because of complication rates

Control of blood pressure

Question 19

During autopsy what is the importance in measuring heart weight?

Answer 19

Indicates hypertension

Question 20

List people high at risk of intracerebral haemorrhage

Answer 20

Age > 60
History of hypertension
System coagulopathy (surgery and neoplasm)
Vascular malformation
Cerebral amyloid angiopathy 
Vasculitis

Question 21

What is the most common bacteria causing a spinal abscess?

Answer 21

Staphylococcus aureus

Question 22

What risk factors of a spinal abscess are there?

Answer 22

Skin abscess
Septicaemia
Bacteremia
Back injury
Trauma
TB
Lumbar puncture
Surgery
Myeloma
Primary bone tumor
Metastasis (breast or prostate)
Osteoporotic fracture 
Slipped disc

Question 23

What may also be found in the CSF in case of spinal abscess?

Answer 23

Blood
Fungi
TB

Question 24

What are the clinical signs of meningitis?

Answer 24

Photophobia
Nuchal stiffness
Neck stiffness
Non blanching skin rash

Question 25

What clinical investigations would you do if you suspect meningitis?

Answer 25

CT/MRI to determine raised intracranial pressure
Lumbar puncture to obtain CSF for lab
If in doubt start antibiotics

Question 26

Which bacteria are the most common cause of meningitis in newborns?

Answer 26

E coli

Group B streptococcus

Question 27

Which bacteria are the most common cause of meningitis in children?

Answer 27

Meningococcus, streptococcus pneumoniae, haemophilus

Question 28

Which bacteria are the most common cause of meningitis in adults?

Answer 28

Meningococcus

Streptococcus pneumoniae

Question 29

Which bacteria are the most common cause of meningitis in old age?

Answer 29

Meningococcus
Streptococcus pneumoniae
Listeria monocytogenes

Question 30

Which bacteria are the most common cause of meningitis in old age?

Answer 30

Meningococcus
Streptococcus pneumoniae
Listeria monocytogenes

Question 31

What are some viral causes of meningitis?

Answer 31

HSV. VZV, HIV, CMV, enterovirus

Question 32

What are some fungal causes of meningitis?

Answer 32

Cryptococcus neoformans, histoplasma, candida

Question 33

What are some parasitic causes of meningitis?

Answer 33

Angiostrongylus 
Gnathostoma
Schistosoma 
Cysticercosis
Toxocariasis

Question 34

What are some non infectious causes of meningitis?

Answer 34

Malignant or metastatic meningitis
Drug reaction (NSAID, antibiotics, immunoglobulins)
Sarcoidosis
Lupus erythematosus
Vasculitis

Question 35

What are the risk factors of meningitis?

Answer 35

Skull trauma to allow nasal cavity bacteria to enter the CSF space
Cochlear implants
Cerebral shunts
Developmental abnormality

Question 36

Where does a meningioma arise from?

Answer 36

Arachnoid cap cells associated with the dura mater and choroid plexus

Question 37

What are the 3 grades of meningioma?

Answer 37

Benign
Likely to recur
Malignant

Question 38

What are the treatment options of a meningioma?

Answer 38

Observation
Resection
Radiotherapy and post op radiotherapy

Question 39

Where can meningiomas occur?

Answer 39

Anywhere associated with the dura or within the ventricular system