Neuropathology module tutorial Flashcards
What is the shape of an extradural haematoma?
Concave
What is an intradural haemorrhage?
Subdural - but between the two layers of dura mater (endosteal and meningeal)
What happens if there is only mild/moderate lysis within 1 week?
Scarring and organisation into a scar after 1 to 3 months
What is a chronic subdural haematoma?
Owing to re bleeding especially 1-3 months after initial bleed
What does a subfalcine herniation cause?
Compression of the anterior cerebral artery
What does transtentorial herniation cause?
Oculomotor nerve compression and blown pupils
What does tonsillar herniation cause?
Compression of vital respiratory and cardiac centres in the medulla oblongata
What secondary brainstem trauma results from a tonsillar herniation?
Duret haemorrhages
Which conditions increase the risk of berry aneurysm formation?
Adult polycystic kidney disease
Ehlers danlos
NF1
Marfans
What two things are predisposing factors for rupture?
Hypertension
Smoking
What does rupture of a berry aneurysm cause?
Subarachnoid haemorrhage
Where is a subarachnoid haemorrhage usually centred?
Base of brain but may occur over the top too
When is the risk of a subarachnoid haemorrhage common?
When lesions are greater than 10mm
What is rupture of a berry aneurysm associated with?
High peaks in BP (exertion and cocaine)
What is the mortality rate of a subarachnoid haemorrhage caused by rupture of a berry aneurysm?
50%
Rebleeding is common
Name an acute complication of rupture of a berry aneurysm
Vasospasm leading to focal/global ischaemia
Name a later complication of rupture of a berry aneurysm
Hydrocephalus owing to scarring and CSF flow obstruction
Describe some treatment options available for berry aneurysms
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
During autopsy what is the importance in measuring heart weight?
Indicates hypertension
List people high at risk of intracerebral haemorrhage
Age > 60 History of hypertension System coagulopathy (surgery and neoplasm) Vascular malformation Cerebral amyloid angiopathy Vasculitis
What is the most common bacteria causing a spinal abscess?
Staphylococcus aureus
What risk factors of a spinal abscess are there?
Skin abscess Septicaemia Bacteremia Back injury Trauma TB Lumbar puncture Surgery Myeloma Primary bone tumor Metastasis (breast or prostate) Osteoporotic fracture Slipped disc
What may also be found in the CSF in case of spinal abscess?
Blood
Fungi
TB
What are the clinical signs of meningitis?
Photophobia
Nuchal stiffness
Neck stiffness
Non blanching skin rash
What clinical investigations would you do if you suspect meningitis?
CT/MRI to determine raised intracranial pressure
Lumbar puncture to obtain CSF for lab
If in doubt start antibiotics
Which bacteria are the most common cause of meningitis in newborns?
E coli
Group B streptococcus
Which bacteria are the most common cause of meningitis in children?
Meningococcus, streptococcus pneumoniae, haemophilus
Which bacteria are the most common cause of meningitis in adults?
Meningococcus
Streptococcus pneumoniae
Which bacteria are the most common cause of meningitis in old age?
Meningococcus
Streptococcus pneumoniae
Listeria monocytogenes
Which bacteria are the most common cause of meningitis in old age?
Meningococcus
Streptococcus pneumoniae
Listeria monocytogenes
What are some viral causes of meningitis?
HSV. VZV, HIV, CMV, enterovirus
What are some fungal causes of meningitis?
Cryptococcus neoformans, histoplasma, candida
What are some parasitic causes of meningitis?
Angiostrongylus Gnathostoma Schistosoma Cysticercosis Toxocariasis
What are some non infectious causes of meningitis?
Malignant or metastatic meningitis Drug reaction (NSAID, antibiotics, immunoglobulins) Sarcoidosis Lupus erythematosus Vasculitis
What are the risk factors of meningitis?
Skull trauma to allow nasal cavity bacteria to enter the CSF space
Cochlear implants
Cerebral shunts
Developmental abnormality
Where does a meningioma arise from?
Arachnoid cap cells associated with the dura mater and choroid plexus
What are the 3 grades of meningioma?
Benign
Likely to recur
Malignant
What are the treatment options of a meningioma?
Observation
Resection
Radiotherapy and post op radiotherapy
Where can meningiomas occur?
Anywhere associated with the dura or within the ventricular system
