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Neurology > Pathology of the Brain > Flashcards

Pathology of the Brain Flashcards

1
Q

What may cause an increase in ICP ?

A
  • Tumour
  • Infection - Abscess
  • Trauma
  • Haemorrhage
  • Hydrocephalus
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2
Q

What is a space occupying lesion ?

A

Intracranial space occupying lesions are tumours or abscesses present within the cranium or skull. These lesions put pressure on the adjacent brain tissue causing its damage.

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3
Q

What is the name given to the herniation of the cerebellum through the foramen magnum ?

A

Coning

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4
Q

What is it called when the cerebrum passing below the tentorium cerebelli ?

A

Uncal herniation

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5
Q

What is the name given to the herniation of one half of the cerebrum under the falx ?

A

Cingulate/subfalcine herniation

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6
Q

Where are the common sites of brain metastases ?

A

Colon, breast and lung

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7
Q

What is the rule regarding location of adult and childhood brain tumours ?

A

Adult brain tumours usually arise above the tentorium and childhood tumours below the tentorium

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8
Q

What are the features of a Glioma ?

A
  • Diffuse edges - not encapsulated
  • Malignant
  • Growth time dependent on type
  • Multiple nuclei common
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9
Q

What are the two types of Gliomas ?

A
  1. Glioblastoma multiforme - aggressive high grade forming a large tumour with necrosis.
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10
Q

What is a medulloblastoma ?

A

Seen commonly in children its origin is the embryonic neural crest cells. Sheet of small undifferentiated cells can be seen. Usually in the brainstem.

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11
Q

What is a meningioma ?

A

Benign lesion of the meninges, formed from arachnocytes. They are slow growing and often resectable.

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12
Q

What is the calcification called seen with meningioma ?

A

Psammoma

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13
Q

What is a Schwannoma ?

A

Nerve sheath tumour. Can be both within the skull and outside. An example is an acoustic neuroma which is found between the pons and cerebellum. Benign lesion but often hard to access.

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14
Q

What is a pituitary adenoma ?

A

Benign tumour of the pituitary gland which secretes hormones. Visual signs are common if the optic chiasma is compressed.

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15
Q

What is a CNS lymphoma ?

A

High grade neoplasm, B cells. Hard to treat due to the BBB but generally doesn’t spread outside the CNS.

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16
Q

What are the features of a Haemangioblastoma ?

A

Blood vessel tumour, may bleed. Common in the cerebellum.

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17
Q

What are most secondary tumours of the brain classed as ?

A

Carcinomas

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18
Q

What is central venous thrombosis ?

A

Due to infection of the sinuses or orbit. Most common in young people due to the OCP

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19
Q

How does central venous thrombosis present ?

A
  • Headaches
  • Nausea
  • Decreased consciousness
  • Seizures
  • Visual signs
  • Papilloedema
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20
Q

What is the treatment for central vein thrombosis ?

A

Anticoagulation

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21
Q

What is the foramina targeted in trigeminal nerve anaesthesia ?

A

Foramen ovale

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22
Q

How does normal pressure Hydrocephalus present (3) ?

A
  • Thinking and reasoning problems
  • Loss of bladder control
  • Difficulty walking
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23
Q

Definition of coma

A

A state of unconsciousness from which a person cannot be aroused

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24
Q

What is the typical GCS of a coma patient ?

A

< 8

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25
Q

How must be working in order to maintain consciousness ?

A
  • Reticular activating system (Arousal)

- Cerebral cortex (Awareness)

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26
Q

What is copiousness ?

A

Being alert and aware

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27
Q

Definition of a persisting negative state

A

Patient is unresponsive to all stimulus and displays no signs of higher brain function. Being kept alive by medical intervention.

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28
Q

What may cause a decreased GCS ?

A
  • Seizures
  • Hypoxia
  • Hypoglycaemia
  • Alcohol/drug intoxication
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29
Q

How do you access a patient in a coma ?

A

Follow ABC

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30
Q

What causes an increase in breathing rate ?

A
  • Hypoxia
  • Hypercapnia
  • Drug overdose
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31
Q

What decreases breathing rate ?

A
  • Hypoglycaemia
  • Tumour
  • Drug overdose
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32
Q

What can you do to monitor a patient in a coma ?

A
  • BP
  • Pulse
  • Take bloods (blood gas, toxicology and glucose)
  • Insert a wide bore cannula
  • Temperature
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33
Q

How do you access disability in coma (3) ?

A
  1. Reflexes
  2. GCS
  3. Fundal examination
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34
Q

If a patient doesn’t have Meningism or a focal brain injury what are the possible causes ?

A
  • Drug overdose

- Hypoglycaemia

35
Q

If a patient has Meningism but no focal brain injury what are the possible causes ?

A
  • Meningitis

- Encephalitis

36
Q

If a patient has/hasn’t got Meningism and a focal brain injury what are the possible causes ?

A
  • Tumour
  • Abscess
  • Haemorrhage
37
Q

If a patient doesn’t have Meningism or a focal brain injury what investigations would you do ?

A
  • Bloods
  • BP
  • Toxicology
38
Q

If a patient has Meningism but no focal brain injury what investigations would you do ?

A
  • CT scan
  • LP
  • Bloods
39
Q

If a patient does/doesn’t have Meningism but does have a focal brain injury what investigations would you do ?

A
  • CT/MRI scan
  • Blood cultures/cells counts
  • CT angiography
  • LP
40
Q

What is ‘Locked in’ syndrome ?

A

Patient is in total paralysis from the 3rd never nuclei downwards, they can only elevate and depress eyes.

41
Q

What is seen on MRI in a person with ‘Locked in’ syndrome ?

A

Pontine infarction

42
Q

How can we care for patients in a coma ?

A
  • Attend to bladder and bowel incontinence/problems
  • Turn and place on flow mattress to prevent pressure sores
  • DVT prophylaxis
  • Maintain vital functions e.g. ventilation and PEG tube
43
Q

What common things result from head injury ?

A
  • Diffuse axonal injury
  • Contusion
  • SAH
  • EDH
  • SDH
44
Q

How do you access a patient with a head injury ?

A
  • ABC
  • Ventilation if GCS <8
  • Stabilise the spine
  • CT scan
45
Q

How do you manage a patient with a head injury ?

A
  • Maintain PO2 and PCO2 levels
  • Raise head
  • Emergency surgery
  • Mannitol
  • Analgesics
46
Q

Which scale is used to access stroke patients ?

A

ROSIER scale

47
Q

What predicts a stroke on the ROSIER scale ?

A

Score > 0. Scale runs from -2 to +5.

48
Q

What is the emergency skull surgery called to relieve ICP pressure ?

A

Hemicraniectomy

49
Q

Definition of stroke

A

A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures).

50
Q

What percentage of strokes are caused by ischaemia ?

A

85 %

51
Q

What are the modifiable risk factors of a stroke ?

A
  • Diet
  • Lack of exercise
  • Obesity
  • Hypertension
  • Diabetes
  • Smoking
52
Q

What are the non-modifiable risk factors for a stroke ?

A
  • Male
  • Age
  • FH
  • Previous stroke
53
Q

Do anticoagulants or antiplatlets have any affect on prevention of strokes ?

A

Anticoagulants e.g. warfarin and DOAC’s reduce risk but antiplatlets e.g. aspirin and clopidogrel do not.

54
Q

What is the benefit of DOAC’s over warfarin ?

A

Less chance of bleeding

55
Q

If the ACA is occluded which areas of the body will it affect most ?

A

Legs more than arms

56
Q

If the MCA is occluded which areas of the body will it affect most ?

A

Face and arms more than legs

57
Q

What system is used to classify strokes ?

A

Oxford community stroke classification project (OCSP)

58
Q

What are the 4 subtypes of strokes ?

A

TACS - Total anterior circulating stroke
PACS - Partial anterior circulating stroke
POCS - Posterior stroke
LACS - Lacunar stroke

59
Q

Which vessel is affected in a TACS ?

A

Main artery supplying one hemisphere of brain

60
Q

Which vessel is affected in a PACS ?

A

Branch of a main artery

61
Q

Which vessel is affected in POCS ?

A

Any posterior artery

62
Q

Which vessels are affected in LACS ?

A

Small perforating arteries

63
Q

What must be present in a patient with TACS ?

A

Hemianopia + neglect/dysphagia

64
Q

How many or hemianopia/neglect/dysphagia are seen in PACS ?

A

One

65
Q

In which stroke classification can you see cerebellar or brainstem signs ?

A

POCS

66
Q

What is Agnosia ?

A

In ability to use senses to recognise things

67
Q

What is Hemiplegia ?

A

Paralysis of one side of the body

68
Q

What is Prosopagnosia ?

A

Inability to recognise faces

69
Q

What is Anosagnosia ?

A

Denial or Hemiplegia

70
Q

What cerebellar or brainstem signs would you seen in a patient with a POCS stroke ?

A
  • Diplopia
  • Ataxia
  • Vertigo
  • Vision loss
71
Q

What is Hoover’s sign ?

A

Involuntary extension of the “normal” leg occurs when flexing the contralateral leg against resistance. Marks a functional disorder.

72
Q

What is the treatment for a stroke ?

A
  • Thrombolysis (TPA) < 4.5 hours
  • Thrombectomy
  • Stroke units
  • Anticoagulants
  • Statins
  • Beta blockers
73
Q

What are the regulations for using TPA ?

A
  • Must be within 4.5 hours of first symptoms
  • Must have symptoms for >60 minutes
  • Must have some disabling neurological deficit
74
Q

What are the contraindications of TPA usage ?

A
  • Clotting disorder
  • Recent bleeding event
  • Recent surgery
75
Q

How do you investigate a stroke ?

A
  • CT/MRI
  • Bloods
  • ECG
  • Carotid doppler ultrasound
76
Q

What type of cells do Gliomas arise from ?

A

Astrocytes

77
Q

How do we grade Gliomas ?

A

Grade 1-4

78
Q

How do patients with tumours present ?

A
  • Papilloedema
  • N/V
  • Altered consciousness in late stages
  • Seizures
  • Headaches
79
Q

How are brain tumours diagnosed ?

A
  • CT/MRI

- Biopsy

80
Q

What scan is used to look for Metastases ?

A
  • X-Ray of chest, abdomen and pelvis

- Mammography

81
Q

What is the name of a very aggressive Glioma ?

A

Glioblastoma Multiforme

82
Q

Where do brain metastases to the brain usually come from ? (4)

A
  • Lung
  • Breast
  • Colon
  • Melanoma
83
Q

What is the management of tumours ?

A
  • Surgery
  • Chemotherpay/radiotherapy
  • Corticosteroids
  • Anti-convulsants if epilepsy
  • Analgesics
84
Q

How do WHO classify brain tumours ? (2)

A
  • Origin

- How they behave

Neurology (16 decks)

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