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Jonathan's Neuroscience > Pathology > Flashcards

Pathology Flashcards

1
Q

Which structures of the brain can suffer traumatic damage? What kind of damage is common?

A

scalp, skull, meninges and brain/cord

scalp - laceration
skull - fractures
meninges - vascular injury, laceration

brain - contusion, laceration, diffuse axonal injury, diffuse vascular injury

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2
Q

what kind of fractures can occur at the skull

A

linear fracture

depressed fracture

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3
Q

what is contusion?

A

bruising and haemorrhagic necrosis of the brain

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4
Q

how can the brain tissue be lacerated?

A

from a depressed fracture, where bone gets pushed in and tears the tissue

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5
Q

What is a concussion?

A

a clinical consequence of head injury, involving instantaneous loss of consciousness, temporary resp arrest, and loss of reflexes

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6
Q

What is a concussion caused by?

A

a sudden change in the momentum of the head and the brain develops areas of undetectable injuries

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7
Q

What does a glasgow coma scale do?

A

It helps assess severity of brain injury

the lower the score, the higher the chance of severe brain injury

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8
Q

How is the brain and cord protected?

A

they are enclosed in protective bony cases, and a lot of energy will be needed to breach the bony layer

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9
Q

What is the downside of having bony protection around the brain?

A

Penetrating injury and closed injury can occur

Penetrating = direct disruption of tissue (depressed fracture)
Closed = movement and compression of neurovascularture within confined space
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10
Q

What is secondary traumatic injury?

A

further damage to the brain following primary injury in certain circumstances

can be delayed or immediate

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11
Q

List 5 possible secondary injuries

A

ischaemia, hypoxia (generally acute)

raised ICP, infection, epilepsy (delayed)

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12
Q

T/F skull fracture tends to damage only the point of impact

A

False, skull fractures are able to radiate from primary site of impact

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13
Q

What is the term given to skull fracture with splinter

A

comminuted fracture

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14
Q

Why is a skull fracture “open”

A

If the fracture communicates with the surface (bone can be seen superficially)

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15
Q

What can result from a basal fracture?

A

blood and CSF come out from the nose and/or ear. This is a bad sign

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16
Q

Why is it important to diagnose bone fracture (think how a bone injury occurs) ?

A

bone fractures are a result of high energy transfer injury and may have severe secondary effects

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17
Q

The tearing of which artery can lead to epi-dural haematoma?

A

middle meningeal artery

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18
Q

Why is epi-dural haematoma less common for older people

A

because the dura mater adheres more tightly to the skull with increasing age

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19
Q

What is the cause of subdural haematoma?

A

tearing of sub-dural vein or sinuses

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20
Q

Why does subdural haematoma happen more frequently in older people?

A

shrinking of the brain + increased tension on veins

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21
Q

Contusions can occur at two locations upon traumatic injury, what is the name given for the 1) impact site 2) opposite to impact site

A

1) coup

2) countercoup

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22
Q

When can a contusion occur at the countercoup?

A

When the brain is not immobilised at the time of injury, so the sudden change of momentum freely moves the brain, causing injury on both sides

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23
Q

Why do contusions occur usually at the base of brain?

A

because of the irregular lining on the skull floor

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24
Q

what are two stereotypical locations for contusion?

A

inferior frontal lobe

inferolateral temporal lobe

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25
Q

What is the consequence of injuring the olfactory bulb?

A

anosmia, loss of smell

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26
Q

If the patient survives traumatic injury, and the contusion heals, why does the injured site look like?

A

brain has an area of scarring which is yellowish in appearance. The injured area tends to be compressed as well

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27
Q

How does a bullet cause damage to the brain?

A

direct penetration of the tissue
shockwave effect - damage diameter greater than actual bullet
bullet can break into fragments to cause further injury

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28
Q

How does a diffuse axonal injury present?

A

brain may appear as normal

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29
Q

How do we visualise axonal damage?

A

use silver stain, and axons will appear as black lines

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30
Q

on a silver stained image, how does an injured axon appear?

A

axonal spheroids present - area of axon swelling because the axon cannot function due to injury, but because the soma doesn’t stop producing axonal proteins, the swelling occurs

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31
Q

What are the three presentations of long term brain atrophy

A

thin corpus callosum, enlarged ventricles, thin white matter

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32
Q

T/F acute compressive injury of the spinal cord only affects the cord at the site of injury

A

False, because the cord is soft tissue, the injury is not confined. Compression may extend proximally and distally

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33
Q

How much blood and CSF are in the cranium

A

150 ml of each

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34
Q

what is the initial response of raised ICP

A

expulsion of as much CSF and venous blood as possible, so the ventricles will decrease in size

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35
Q

Give two severe consequence of raised ICP?

A

herniation of brain tissue through dural openings

hypoxia because the ICP opposes arterial pressure

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36
Q

What are the two main sub-types of cerebral oedema and what are the individual causes?

A

vasogenic - BBB disruption and increased permeability

cytotoxic - cell membrane damage and increase of intracellular fluid

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37
Q

Which sub-type of cerebral oedema can be treated? What are the three treatments?

A

vasogenic

Steroids, isotonic pressure manipulation, hypocarbia inducing therapy

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38
Q

Which cerebral oedema is primarily a result of a stroke?

A

cytotoxic oedema

39
Q

What are the two ways of causing hydrocephalus?

A

obstruction along the draining pathway

absorptive problem, only in normal pressure hydrocephalus

40
Q

What is medial herniation?

A

when the medial temporal lobe herniates through the tentorial opening (also called transtentorial herniation)

41
Q

What is duret brainstem haemorrhage?

A

When there is herniation of the brainstem, the brain tissue can move, but the vessels are fixed, so there can be tearing of small blood vessels, causing haemorrhage

This is a secondary effect of ICP

42
Q

Most cases of meningitis occur in _______, but there is higher ______ in older individual. The case fatality is 47%, and those who survive are likely to have _________

A

younger children
mortality
neurological sequelae

43
Q

T/F bacterial meningitis is most serious

A

True, viral causes are generally self-limiting

44
Q

What is aseptic meningitis

A

might be bacterial cause, but you can’t culture the bacteria

45
Q

What are some non-infectious causes of meningitis

A

malignancy, drugs, inflammatory conditions

46
Q

What is the most common cause of meningitis?

A

viral, usually caused by entero-virus, which is generally self-limiting

47
Q

What are the three common bacterial causative agents of meningitis?

A

Strep pneumonia
Type A Neisseria
Haemophilus influenzae

48
Q

Why are the three bacteria common in meningitis?

A

they are encapsulated, so are able to evade compliment fixation and avoid phagocytosis

They are also commensals of the nasalpharynx

49
Q

Which three other bacteria also cause meningitis in children under 3 months?

A

E Coli
Group B strep
Listeria

50
Q

Describe the pathogenesis of bacterial meningitis

A

normal flora enters the bloodstream, and if not killed, they can enter the BBB to increase permeability of BBB and increase ICP. The resulting inflammation damages the meninges

51
Q

What are the specific clinical features of meningitis?

A

stiff neck, altered mental state, photophobia, seizures

52
Q

What is the definitive diagnosis of meningitus?

A

composition of CSF, or PCR in the 16s region

53
Q

T/F the abnormal composition of CSF can tell you whether the cause of meningitus is bacterial or viral

A

False, the CSF composition can fall into the reference range, but there are always exceptions

54
Q

What are the normal values of CSF?

A

Pressure < 150mmHg
Clear appearance
protein < 0.4g/L
Glucose > 60% in blood

55
Q

What is the change of CSF composition in bacterial meningitis?

A

raised pressure, cloudy appearance with neutrophils, raised proteins, decreased glucose, positive gram stain

56
Q

What is the change of CSF composition in TB meningitis?

A

ZN positive with lymphocytes
raised pressure, very high protein, very low glucose

basically an extreme version of bacterial meningitis

57
Q

T/F you can determine the appearance of CSF macroscopically

A

False, you need a lot of cells to make the appearance cloudy

need microscope

58
Q

T/F CSF result is inaccurate if the analysis is not done immediately

A

True, white cells drop by 20% over 4 hours, so it requires immediate analysis

59
Q

What is the change of CSF composition in viral meningitis?

A

clear appearance, normal pressure, reduced protein, increased glucose

60
Q

What is the sequence of treatment for meningitis?

A

life support
fluid/antibiotics/steroids
IV cephalosporin (add penicillin and gentamicin in infants under three months)

61
Q

What is the most common sequelae of meningitis?

A

hearing loss

62
Q

What is the most important cause of encephalitis?

A

HSV

63
Q

What’s the differential clinical sign of encephalitis?

A

altered consciousness

64
Q

What is the drug of choice for meningoencephalitis

A

add in acyclovir for suspicion of encephalitis

65
Q

Define “stroke”

A

stroke is the neurological deficit following a vascular event

66
Q

What is a TIA?

A

a stroke-like episode that resolved completely

67
Q

What are the three main processes of stroke?

A

Ischaemic cause, to infarction
Haemorrhage
Subarachnoid haemorrhage

68
Q

How can an infarction occur in the brain?

A

usually occlusion, but can also be caused by severe global hypoperfusion

69
Q

T/F only occlusions in the arteries can lead to brain infarction

A

False, a blockage in venous sinuses can lead to increased ICP, and eventually oppose the arterial pressure supplying the brain

70
Q

Large artery occlusions are usually a result of _______, while Small vessel occlusion is more likely caused by _______. Venous occlusion, on the other hand, can only be caused by _______.

A

embolus
thrombosis

thrombosis

71
Q

Can you ever get a brain infarct from deep vein thrombosis?

A

Yes, but not very common. 1/3 of the population has probe-patent interatrial septum, such that a thromboembolus can cross from right atrium directly into left atrium, if the pressure in RA is high enough. The embolus can enter the brain

72
Q

What are the four common sites of atherosclerosis in the brain arteries

A

bifurcation of common carotid
MCA
Vertebral artery
Basilar artery

73
Q

What is endarterectomy

A

strip the artery’s media and intima in order to prevent flow problem and embolus from occluding vessels downstream

74
Q

T/F Infarction is immediately visible macroscopically

A

False, you don’t see infarction immediately, hence CT and MRI are not very sensitive at this stage

75
Q

What does the brain look like after several hours of infarction?

A

cell membrane breaks down, tissue filled with fluid, vasogenic oedema, swelling

increased ICP can then cause herniation

76
Q

What does a dying neuron look like microscopically

A

The neuron will initially swell up, but gradually become hyper-eosinophilic and shrink down. The nucleus will shrink, and eventually disappear

77
Q

What does a brain look like weeks after an infarction

A

liquefactive necrosis - tissue breaks down, macrophages enter to clean up

There is sharp demarcation between healthy and necrotic tissues

78
Q

What is the end result of an infarction?

A

a cystic space filled with CSF. Functionally, the neurological impairment will depend on the location of the infarct

79
Q

What’s a secondary haemorrhagic infarct in the brain caused by?

A

First a primary occlusion causing ischaemia of distal vessels. The thromboemoli can resolve independently leading to reperfusion. However, the vessel can no longer sustain arterial pressure, there lead to haemorrhagic infarct

80
Q

What is the most common small vessel disease?

A

small vessel hyaline arteriolosclerosis

81
Q

How does small vessel hyaline arteriolosclerosis lead to haemorrahagic infarct

A

The vessel wall thick, but weak, so it can balloon out and cause local berry aneurysm that can rupture

82
Q

What is lacunar infarction caused by?

A

small vessel occlusion and small infarction

83
Q

T/F lacunar infarct can cause significant neurological deficit

A

True, if the infarct is at crucial areas like the internal capsule

84
Q

T/F cerebral infarction is commonly the cause of death

A

False, patients more commonly die from complications of the infarction or from the existing risk factors (CV disease)

85
Q

What structures are commonly involved in cerebral haemorrhages due to hypertension?

A

hypertension commonly leads to arteriolosclerosis, and affects generally small vessels and deep structures

basal ganglia, thalamus, lobar white matter, pons, cerebellum

86
Q

Why is cerebellum haemorrhage a surgical emergency?

A

there may be acute obstruction of the 4th ventricle, so CSF needs to be drained immediately to prevent raised ICP

87
Q

What is a slit haemorrhage?

A

a small haemorrhage not large enough to cause significant tissue destruction, which resolves slowly and form a slit-like scar

88
Q

What is the protein deposited in amyloid angiopathy? What is the significance of that?

A

a-beta-amyloid

It’s the same protein associated with Alzeimers

89
Q

T/F amyloid angiopathy typically cause occlusion

A

False, amyloid deposits in smaller vessels, so it is more likely to rupture and cause haemorrhagic infarct

90
Q

What is arteriovenous malformation caused by? What is the pathology involved?

A

congenital abnormality

artery and veins are connected without capillary bed so high pressure blood enters veins to cause rupture

91
Q

What pathology can lead to non-traumatic subarachnoid haemorrhage?

A

berry aneurysms in large vessels, particularly in the anterior vessel bifurcation

92
Q

What is the consequence of subarachnoid haemorrhage?

A

blood products can cause vasospasm
cerebral oedema, raised ICP
ventricular obstruction

93
Q

What is the treatment of large aneurysms?

A

clip the neck of aneurysm to prevent more blood from leaking and prevent vaso-spasm

Jonathan's Neuroscience (22 decks)

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