Pathology, Coning, Hydrocephalus & Trauma

Question 1

what is a red neuron

Answer 1

dying neuron after acute neuronal injury

Question 2

what part of a neruon is lost in chromatolysis

Answer 2

Nissl body

Question 3

what is chromatolysis also referred to as

Answer 3

axonal reaciton

Question 4

what is gliosis

Answer 4

reactive hyperplasia or hypertrophy of astrocytes in response to damage/injury

Question 5

what cell type in the brain proliferates in response to injury and aggregates around necrosis/damage?

Answer 5

microglia

Question 6

which type of microglia are pro-inflammatory and which are anti-inflammatory

Answer 6

M1 pro-inflam, M2 anti-inflam

Question 7

what is the term that describes a glutamate storm in the brain in response to hypoglycaemia or hypoxia and leads to apoptosis

Answer 7

excitotoxicity

Question 8

what are the causes of global hypoxic brain damage

Answer 8

cardiac arrest, hypotension, shock

Question 9

oedema occurs secondary to hypoxic brain damage. T or F

Answer 9

T

Question 10

how is malignant HTN defined

Answer 10

a BP so high it causes end organ damage

Question 11

what type of brain oedema occurs in hypothermia and intoxication and is often pre-morbid

Answer 11

cytotoxic oedema

Question 12

what type of brain oedema occurs in hyponatraemia and SIADH due to BBB dysfunction

Answer 12

ionic/osmotic

Question 13

what type of brain oedema occurs in trauma, tumour, inflam, infection and hypertensive encephalopathy

Answer 13

vasogenic oedema

Question 14

what is the commonest cause of congenital hydrocephalus

Answer 14

aqueduct stenosis

Question 15

what is communicating hydrocephalus

Answer 15

problem with CSF reabsorption

Question 16

what is non-communicating hydrocephalus

Answer 16

obstruction within ventricular system

Question 17

name a cause of communicating hydrocephalus

Answer 17

post-meningitis

Question 18

what is hydrocephalus ex vacuo

Answer 18

compensatory after parenchyma loss

Question 19

presentation of hydrocephalus

Answer 19

headache, vomiting, papilledema, gait disturbance

Question 20

what additional signs are present in congenital hydrocephalus

Answer 20

big head
shiny scalp 
visible scalp veins
sun setting
downward eyes
bulging eyes
trouble feeding
irritable
sleep
muscle stiffness

Question 21

imaging choice in acute hydrocephalus

Answer 21

CT

Question 22

imaging choice in non-acute hydrocephalus

Answer 22

MRI

Question 23

acute management of hydrocephalus

Answer 23

IV mannitol

Question 24

mechanism of acetazolamide

Answer 24

decreases CSF production

Question 25

complications of hydrocephalus

Answer 25

brain herniation/coning, VI palsy

Question 26

management of congenital hydrocephalus

Answer 26

LP lumboperitoneal shunt

Question 27

an adult with a headache, N+V, absent upgase, blurred vision and a PMH of hydrocephalus is likely...

Answer 27

blocked shunt

Question 28

age range normal pressure hydrocephalus occurs in

Answer 28

elderly

Question 29

signs of normal pressure hydrocephalus

Answer 29

broad shuffling gate, reversible dementia, bladder incontinent

Question 30

what brain structure is enlarged in normal pressure hydrocephalus

Answer 30

ventricles

Question 31

investigations for normal pressure hydrocephalus

Answer 31

CT, CSF tap test

Question 32

management of normal pressure hydrocephalus

Answer 32

shunt

Question 33

signs of raised ICP

Answer 33

HA worse lying down/ coughing, N+V, mental change, seizure, stiff neck also potential signs of complications eg. III palsy

Question 34

cushing's triad can occur in raised ICP. what is cushing's triad

Answer 34

Raised BP Bradycardia Irregular breathing

Question 35

does brain herniation occur in rapid or insidious changes in ICP

Answer 35

rapid

Question 36

what is coning

Answer 36

type of brain herniation where cerebellar tonsils are displaced through the foramen magnum

Question 37

complication of central herniations

Answer 37

VI palsy; diplopia

Question 38

what is the pattern in subfalcine herniations?

Answer 38

cingulate gyrus of frontal lobe herniates under falx cerebri

Question 39

what structure can be compressed in subfalcine aka cingulate herniations? and how does this present?

Answer 39

anterior cerebral artery weakness/sensory leg problem

Question 40

what is the pattern in tentorial uncal herniations

Answer 40

medial temporal lobe herniates over tentorium cerebelli

Question 41

what is the 1st presentation of tentorial uncal herniations?

Answer 41

ipsilateral CN III palsy; unreactive pupil

Question 42

what is a later presentation of tentorial uncal herniations?

Answer 42

pyramidal compression; contralateral hemiparesis

Question 43

what is the pattern in tonsillar herniations?

Answer 43

cerebellar tonsils herniate through foramen magnum

Question 44

aetiology of tonsillar herniations

Answer 44

Arnold Chiari malformation or posterior fossa lesion

Question 45

how do tonsillar herniations present

Answer 45

stiff neck, decreased RR, decreased HR, increased BP lecture may say cheyne stokes respiration but not sure if true

Question 46

what is the major cause of mortality in tonsillar herniations?

Answer 46

compress medullary resp centre which arrests respiration

Question 47

what is a transcalvarial herniation

Answer 47

herniation through defect in dura/skull

Question 48

do morphologic changes to the cns occur in chronic pain?

Answer 48

yes

Question 49

what type of pain is defined as 'an appropriate physiologic response to painful stimuli via an intact nervous system'

Answer 49

nociceptive pain

Question 50

what type of pain is an inappropriate response due to nervous system dysfunction?

Answer 50

neuropathic pain

Question 51

what is allodynia?

Answer 51

pain elicited by a stimulus that wouldn't normally cause pain

Question 52

what infection is linked to neuropathic pain?

Answer 52

HSV; post herpetic neuralgia

Question 53

what are the patterns of skull fractures

Answer 53

linear depressed compound/open

Question 54

what is the name of the injury that occurs at the time of trauma

Answer 54

primary impact

Question 55

is primary impact injury to neurons reversible?

Answer 55

no

Question 56

in primary impact brain injury, coup and contracoup are types of what?

Answer 56

contusion

Question 57

is secondary injury in brain trauma reversible?

Answer 57

potentially

Question 58

what is the name of the type of brain injury that can cause death or a vegetative state?

Answer 58

diffuse axonal injury

Question 59

a coma is a GCS of less than what

Answer 59

8

Question 60

is a coma due to brainstem or cortex dysfunction

Answer 60

brainstem

Question 61

what are the 2 patterns of rigidity in coma / brainstem dysfunction?

Answer 61

decorticate rigidity | decerebrate rigidity

Question 62

what type of rigidity in coma / brainstem dysfunction is more severe?

Answer 62

decerebrate rigidity

Question 63

where does damage occur in decerebrate rigidity

Answer 63

below red nucleus of the midbrain

Question 64

arms flexed, hands clenched, legs extended, feet inward - does describe decorticate rigidity or decerebrate rigidity?

Answer 64

decorticate rigidity

Question 65

head arched back, limbs extended - does describe decorticate rigidity or decerebrate rigidity?

Answer 65

decerebrate rigidity