Pathology

Question 0

Definition of epilepsy?

Answer 0

Sudden synchronous discharge of cerebral neurons causing signs & symptoms apparent to patient or observer.

Question 1

Definition of Seizure?

Answer 1

Abnormal electrical discharge of brain that causes involuntary & unpredictable, repetitive, paroxysmal neural activity.

Question 2

Causes of epilepsy?

Answer 2

• primary generalised epilepsy (PGE)
• hippocampus sclerosis
• vascular disorders
• brain tumours or lesions
• neuro degenerative disorders
• alcohol withdrawal
• metabolic abnormalities

Question 3

What is PGE?

Answer 3

Primary generalised epilepsy. Polygenic together with a complex inheritance. Abnormalities of ion channels influences neuronal firing, abnormality of neurotransmitter release. Hence, epilepsy occurs

Question 4

What is hippocampus sclerosis?

Answer 4

Major cause of epilepsy. The sclerosis is visible on MRI, and a common cause of refractory epilepsy. It’s the main cause of temporal lobe epilepsy and localization related epilepsy.

Question 5

Classification of epilepsy?

Answer 5

Generalized - consists of absence(petit mal), tonic-clonic(grand mal), myoclonic, tonic & atonic.

Partial - consists of simple partial and complex partial, also partial with secondary generalization.

Question 6

Explain about petit mal?

Answer 6

It causes a 3 Hz spike-and-wave. Loss of awareness occurs in kes tuhan. 10 seconds, then patient returns to normal consciousness. Patinets dos bot realize they’re having an attack.

Question 7

What is grand mal?

Answer 7

It’s another name for the tonic-clonic epilepsy. Consists of four phase.

• prodrome (aura prior to secondary generalized seizure)
• tonic (stiffening of the muscles)
• clonic (synchronous jerking of the limbs. Patient may utter an initial cry and fall. Eyes remained open and tongue is usually bitten)
• postictal (period of flaccid unresponsiveness, followed by gradual awareness return with confusion & drowsiness. Headache is common)

Question 8

Elaborate types of skull fracture

Answer 8

Displaced skull fracture - fracture in which bone is displaced into the cranial cavity by a distance greater than the thickness of the bone itself

Basal skull fracture - fracture of the base of the skull, involving temporal bone, occipital bone, sphenoid bone & ethmoid bone.

Diastatic fracture - fracture which crosses suture

Question 9

Types of head injury

Answer 9

1. Skull fracture
2. Traumatic parenchymal injuries
3. Vascular injury

Question 10

List down types of traumatic parenchymal injury

Answer 10

1. Contusion
2. Penetration of the brain
3. Diffuse axonal injury
4. Concussion

Question 11

Define contusion

Answer 11

An injury of a part of the brain without the break of the skin (general)

Coup - collision of the brain with skull at the site of the impact

Contrecoup - blow on one side of the head with damage on the cerebral hemisphere of the opposite side, by transmitted force

Question 12

Define concussion

Answer 12

Loss of consciousness, transient or prolonged due to a blow to the head; there may be transient amnesia, temporary respiratory arrest and loss of reflexes

Question 13

What is cerebral contusion?

Answer 13

Bruising of the brain caused by rapid tissue displacement, disruption of vascular channels, and subsequent haemorrhage, tissue injury and edema

Question 14

What causes penetration of the brain?

Answer 14

By a projectile, such as bullet or skull fragment from a fracture causes laceration. Tissue tearing, vascular disruption and haemorrhage occurs.

Question 15

What’s diffuse axonal injury?

Answer 15

Movement of one region of brain relative to another that leads to the disruption of axonal integrity and function.

Question 16

What’s traumatic vascular injury and list the sites of haemorrhage

Answer 16

Direct trauma and disruption of the vessel walls, leading to haemorrhage

E - Epidural
S - Subdural
S - Subarachnoid
I - Intraparenchymal

Question 17

Explain about epidural haemorrhage and hematoma.

Answer 17

It is due to the rupture of vessels that runs along the dura, mainly middle meningeal artery during skull fracture. Once torn, accumulation of blood under arterial pressure causes separation of the dura from the inner surface of the skull, and the expanding hematoma that forms compresses the brain. It’s a neurosurgical emergency that requires prompt drainage.

Question 18

What’s subdural haemorrhage and hematoma.

Answer 18

Rapid movement of the brain that tears the bridging veins that extends from the cerebral hemisphere through subarachnoid and subdural space to empty into dural sinuses. The disruption leads to bleeding into subdural space.

Question 19

Who are susceptible to subdural haemorrhage?

Answer 19

Elders - atrophy of brain makes the veins to be stretched out and that the brain has space for movement

Infants - due to thin walled vessels

Question 20

Clinical manifestations of subdural haemorrhage

Answer 20

Headache, confusion and focal neurological signs

Question 21

Outcomes of traumatic head injury

Answer 21

1. Post traumatic epilepsy (most common)
2. Persistent vegetative state (severely neurological impaired)
3. Post traumatic dementia (due to neuronal loss and axonal damage)

Question 22

Types of spinal cord injury?

Answer 22

Open injury - direct trauma to spinal cord and nerve root

Closed injury - fracture/dislocation of vertebral column

Question 23

List the types of intracranial haemorrhage

Answer 23

1. Intraparenchymal/cerebral haemorrhage
2. Subarachnoid haemorrhage
3. Epidural and subdural haemorrhage
4. Mixed type

Question 24

What causes Intraparenchymal haemorrhage?

Answer 24

Caused by rupture of small Intraparenchymal vessels which is a consequence of hypertension. *HT is the main cause

Question 25

Where does hypertensive Intraparenchymal haemorrhage occurs and what are the abnormalities of blood vessels caused by H/T?

Answer 25

Typically it occurs at : basal ganglia, thalamus, pons, cerebellum Abnormalities caused : speeds up atherosclerosis in large arteries, hyaline arteriolosclerosis in small vessels, proliferative and necrosis of arteriole in severe cases

Question 26

Morphology of Intraparenchymal haemorrhage

Answer 26

Gross Acute haemorrhage - blood extravasation with adjacent parenchyma compression Old haemorrhage - cavitary destruction of brain with a rim of brownish discoloration Microscopic Early - central core of clotted blood surrounded by rim of brain tissue showing anoxic neuronal & glial changes, and edema Edema resolves eventually, pigment and lipid laden macrophages appear and reactive astrocyte proliferation are seen at the periphery

Question 27

What's the clinical features of Intraparenchymal haemorrhage?

Answer 27

S/s of increased ICP : severe headache, vomiting, papilloedema, rapid loss of consciousness Evidence of brain stem compression : deep coma, irregular respiration with apnoea, dilated non responsive pupil with spasticity

Question 28

What causes subarachnoid haemorrhage and the consequences?

Answer 28

Rupture of saccule aneurysm is the most common cause, followed by tumour trauma, vascular malformation and hematological disorders. When rupture occurs, blood is forced into subarachnoid space. Individuals have sudden excruciating headache and loses consciousness rapidly.

Question 29

Forum principle types of vascular malformation

Answer 29

1. Arteriovenous malformation 2. Cavernous angiomas 3. Capillary talengiectasias 4. Venous angiomas