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Pathology - Year 2 AC > Week 10 - Pathology Of The CNS > Flashcards

Week 10 - Pathology Of The CNS Flashcards

1
Q

Name the different lobes of the brain

A

Frontal, parietal, occipital, temporal

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2
Q

What does the brain consist of?

A
  • cerebral hemispheres (grey matter, white matter, basal ganglia, ventricular system)
  • brain stem
  • cerebellum
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3
Q

What are the meninges?

A
  • membranous coverings of the central NS
  • protective function and important in production of cerebrospinal fluid

-dura mater –> arachnoid mater –> pia mater

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4
Q

Explain the blood supply to the brain

A
  • the cerebral arteries supply a defined territory within the cerebral cortex
  • if blood supply to a particular part of the brain is interrupted - symptoms developed due to lack of blood supplied to that part of the brain by that vessel

-circle of Willis - arteries supplying brain

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5
Q

Explain the venous drainage of the brain

A

Veins covering the brain to ensure venous drainage

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6
Q

What is the skull and what can occur because of it?

A
  • bony box which can’t expand
  • if the volume of tissue fluid inside the skull increases, the intracranial pressure rises
  • results in herniation where a part of the brain moves from one compartment of the skull to another
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7
Q

What is herniation and what does it present with?

A

where a part of the brain moves from one compartment of the skull to another

  • brain herniation frequently presents with abnormal posturing (characteristic positioning of the limbs indicative of severe brain damage)
  • lowered level of consciousness - GCS score of 3-5
  • one or both pupils dilated - fail to restrict in response to light
  • vomiting can also occur due to compression of the vomiting centre in the medulla oblongata
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8
Q

What is the function of the spinal cord?

A

-communication of motor and sensory functions between brain and peripheral nervous system

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9
Q

Name the regions of the spine and how many nerve pairs it has

A

Cervical - 8 nerve pairs

Thoracic - 12 nerve pairs

Lumbar - 5 nerve pairs

Sacrum - 5 nerve pairs

1 coccygeal nerve

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10
Q

What surrounds the spinal cord?

A

Meninges

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11
Q

What is the basic neuroanatomy of the peripheral nervous system?

A
  • spinal and cranial nerves
  • branches of above linking CNS to peripheral sensory receptors and effector organs (muscles and glands)
  • autonomic and somatic nervous systems
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12
Q

What are the cells of the nervous systems?

A

Neurons - the processors

Glial cells - supporting functions
- Schwann cells, astrocytes and oligodendrocytes

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13
Q

Where are the sensory and motor cortex located?

A

Sensory = post-central gyrus

Motor = pre-central gyrus

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14
Q

Which areas are responsible for speech and language production?

A

Broca’s area:

  • frontal lobe, anterior to pre-motor cortex
  • predominantly responsible for speech production

Wernicke’s area:

  • temporal lobe, posterior to auditory cortex
  • speech processing and comprehension of written and spoken language
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15
Q

What is the frontal lobe responsible for?

A
  • complex executive functions involved in decision making
  • emotional reactions
  • formation of some types of memory
  • motor cortex
  • olfactory function
  • generation of fluent speech
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16
Q

What is the parietal lobe responsible for?

A
  • sensory cortex

- processing of sensory information

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17
Q

What is the temporal lobe responsible for?

A
  • language functions (auditory cortex and comprehension of written and spoken words)
  • memory
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18
Q

What is the occipital lobe responsible for?

A

-visual cortex

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19
Q

What is the brain stem responsible for?

A
  • conduction of major motor and sensory pathways
  • control of cardiorespiratory function
  • consciousness
  • cranial nerve roots
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20
Q

What is the cerebellum responsible for?

A
  • precise motor control

- ? Others - language, attention (not yet well defined)

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21
Q

What is the basic functional anatomy of spinal cord nerves/roots in the CNS?

A

Spinal cord nerve roots:

  • specific spinal nerves innervate defined motor functions and sensory territories
  • damage to spinal cord at a specific level will cause loss of function of spinal nerves below that level
  • sensory dermatomes
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22
Q

What is a sensory dermatome?

A

A dermatome is an area of skin supplied by sensory neurons that arise from a spinal nerve ganglion

-symptoms that follow a dermatome (e.g. Like pain or a rash) may indicate a pathology that involves the related nerve root

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23
Q

What are focal neurological signs?

A

Set of symptoms or signs in which causation can be localised to an automatic site in the CNS

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24
Q

What is generalised neurological abnormality?

A

Essentially an alteration in level of consciousness

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25
Q

What focal neurological signs may arise from the frontal lobe?

A
  • anosmia (lack of sense of smell)
  • inappropriate emotions
  • expressive dysphasia (language disorder marked by deficiency in the generation of speech)
  • motor impairment
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26
Q

What focal neurological signs may arise from the parietal lobe?

A
  • receptive dysphasia

- sensory impairment

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27
Q

What focal neurological signs may arise from the temporal lobe?

A
  • cortical deafness

- receptive dysphasia

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28
Q

How are spinal cord lesions examined?

A
  • physical examination - helps to identify the level of injury in spinal cord lesions
  • signs limited to a single dermatome or nerve root suggest either a focal nerve root injury or injury to a peripheral nerve
  • signs affecting several nerve roots below a certain level e.g. complete paralysis of the body and legs with maintained head and neck movement is caused by injuries to the cervical spine
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29
Q

What may a diffuse neurological injury present as?

A
  • usually manifest as impairment of consciousness
  • most often due to increased intracranial pressure (ICP)
  • may occur as a primary process or as a secondary to response of to a focal injury
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30
Q

What may be the causes of reduced consciousness?

A
  • may be obvious on external examination (e.g. trauma) or easily identified on basic observations (e.g. hypoxia, hypothermia)
  • may require additional bedside tests or more clinical history (e.g. hypo/hyperglycaemia, post-ictal state in an epileptic patient)
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31
Q

How is consciousness assessed?

A

Basic - assess responsiveness

  • A = alert
  • V = voice
  • P = pain
  • U = unresponsive

More complex - Glasgow coma scale (GCS)

  • best response = 15
  • comatose client = 8 or less
  • totally unresponsive = 3
32
Q

What are the functions of the nervous system?

A

Basic: sensory –> motor
(mediated by central and peripheral NS, autonomic and somatic)

Higher:
(consciousness, complex and learned motor skills, memory and planning, communication and language)

33
Q

What does cerebrovascular disease incorporate?

A
  • strokes
  • TIAs
  • intracerebral haemorrhage
34
Q

What are the 2 main pathological processes in cerebrovascular disease?

A
  • hypoxia, ischaemia and infarction due to impaired blood supply/oxygenation
  • haemorrhage from CNS vessels
35
Q

What does the brain require a constant supply of?

A

Glucose and oxygen

36
Q

Why is cerebral blood flow autoregulated?

A

-maintain adequate perfusion over a wide range of blood pressure and intra-cranial pressure (ICP)

37
Q

What affects the severity of cerebral vascular disease?

A

Blood flow reduced to a portion of the brain, tissue survival depends on:

  • collateral circulation
  • duration of ischaemia
  • magnitude and rapidity of flow reduction

-blood flow reduced to the whole brain e.g. global hypoperfusion (e.g. hypotension, cardiac arrest) can result in generalised neuronal dysfunction

38
Q

What is a TIA and what is its symptoms?

A
  • transient ischaemic attack
  • characterised by temporary loss of function that resolves itself within 24 hours
  • ‘mini-stroke’
  • symptoms similar to that of a full stroke but recovery is rapid
39
Q

How is a TIA treated?

A
  • 10% chance of having a full stroke within 4 weeks if left untreated
  • anti-platelet therapy: aspirin or clopidogrel
  • control BP
  • lower cholesterol
40
Q

What is a stroke?

A

Loss of function lasting greater than 24hrs

2 main types

  • ischaemic
  • haemorrhagic
41
Q

What are the risk factors of a stroke?

A
  • hypertension
  • diabetes mellitus
  • heart disease - ischaemic, AF
  • previous TIAs
  • hyperlipidaemia
42
Q

What are the causes of a stroke?

A

Hypoxia of brain

  • blockage of blood vessel by atheroma
  • blockage of blood vessel by embolus

Bleed into the brain

  • hypertension related
  • berry aneurysm
43
Q

How are strokes managed?

A

Depending on type

  • thrombolysis
  • aspirin/clopidogrel
  • physio
  • occupational health
  • SALT
  • supportive treatment
44
Q

What can cause haemorrhagic events?

A
  • hypertension
  • vascular malformation
  • berry aneurysm
  • neoplasia
  • trauma
  • drug abuse
  • iatrogenic (relating to illness caused by medical examination or treatment - e.g. side effects of drugs)
45
Q

What are the different types of haemorrhage in the brain?

A
  • intracerebral
  • subarachnoid
  • subdural
  • extradural
46
Q

What is an intracerebral haemorrhage?

A
  • ‘haemorrhagic stroke’
  • presents as headache with rapid or gradual decrease in conscious level - localises depending on site of bleed
  • usually arterial in origin
  • show mass effect
  • in 80% cases with hypertension the bleed is ‘capsular haemorrhage’
  • few survive
47
Q

What is a subarachnoid haemorrhage?

A
  • spontaneous
  • often catastrophic
  • 80% rupture of saccular aneurysms
  • thunderclap headache
  • ‘meningitis like’ signs
  • requires neurosurgical input
48
Q

What is a subdural haemorrhage?

A
  • fluctuant conscious level
  • often on anticoagulants
  • bleeding from bridging veins between cortex and venous sinuses
  • blood between dura and arachnoid
  • often minor trauma in the elderly
49
Q

What is an extradural haemorrhage?

A
  • post head injury, slowly falling conscious level, possibility with lucid period
  • often with fractured temporal of parietal bone
  • typically the middle meningeal artery
50
Q

What is dementia?

A
  • progressive and largely irreversible clinical syndrome with widespread impairment of mental function
  • complex needs and high levels of dependency and morbidity
51
Q

What are the risks/signs of dementia?

A
  • > 65 years old increased risk
  • memory loss
  • speed of thought
  • language
  • understanding/judgement
  • disinterest in usual activities
  • difficulties in controlling emotions
52
Q

What types of dementia are there and how prevalent is each type?

A
  • Alzheimer’s disease (70%)
  • vascular dementia - recurrent small strokes (15%)
  • Lewy body dementia (15%)
  • along with some rare causes - e.g. Syphilis
53
Q

If the frontal lobe is affected by dementia, what dysfunction may occur?

A
  • behaviour disorders
  • mood
  • motivation
  • judgement
  • planning
  • reasoning
  • appetite and continence
  • disinhibition
54
Q

If the temporal lobe is affected by dementia, what dysfunction may occur?

A

Memory dysfunction

55
Q

If the parietal lobe is affected by dementia, what dysfunction may occur?

A

Dysphasia - language disorder marked by deficiency in the generation of speech

Dyspraxia - difficulties in activities requiring coordination and movement

56
Q

If the subcortical area of the brain is affected by dementia, what dysfunction may occur?

A

-slowness of thought processes

57
Q

What assessments can be done for people with dementia?

A
  • TSH - ensure thyroid function is normal
  • CT scan (not all cases) - to check for intracranial pathology
  • vitamin B12, thiamine - alcoholism
58
Q

What is the cause of Alzheimer’s disease and what does it lead to?

A
  • due to and accumulation of AB amyloid, Tau-neurofibrillary tangles and plaques, and loss of neurones and synapses
  • leads to defects of visual-spatial skill (gets lost), memory loss, decreasing cognition, ansognosia (lack of awareness)
59
Q

How is dementia treated?

A
  • multidisciplinary team

- new treatments include cholinesterase inhibitors e.g. rivastigmine (use closely controlled - NICE)

60
Q

What is epilepsy?

A

A recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the the brain, manifest as seizures

  • seizures can take many forms (focal twitching, trance-like, convulsions)
  • usually no identified cause
  • for example, can be due to - space occupying lesions, stroke, alcohol withdrawal
61
Q

How is epilepsy diagnosed?

A
  • good history taking
  • exclude structural abnormality
  • EEG - electroencephalogram - test that measures and records the electrical activity of your brain
  • any triggers e.g. TV?
62
Q

How is epilepsy managed?

A
  • compliance very important
  • depending on seizure type
  • have serious side effects (teratogenic)
  • examples = sodium valproate (epilim), carbamazepine, phenytoin, lamotragine
63
Q

What types of infections can occur in the brain?

A

Diffuse infection
-e.g. Meningitis

Focal infection
-e.g. Abscess

64
Q

What types of meningitis can you get?

A

Bacterial

  • neisseria meningitidis
  • pneumococcus
  • meningococcus

Viral

Fungal (rare - HIV etc.)

65
Q

What is the presentation of meningitis?

A

Early

  • headache
  • cold hands and feet
  • pyrexial

Late

  • neck stiffness
  • photophobia
  • Kernig’s sign (pain and resistance on passive knee extension with hip fully flexed)
  • non-blanching rash
  • seizures
66
Q

What is a brain abscess, how does it spread and what are the effects?

A
  • focal infection
  • can lead to focal brain damage or mass effect
  • can present with headache, seizures, temperature
  • radiologically a ‘ring enhancing lesion’ - differential diagnosis is a glioblastoma
  • can spread via blood e.g. Embolus from bacterial endocarditis, IV drug users at risk
  • can spread directly e.g. from an infected inner ear
67
Q

What is Parkinson’s disease?

A
  • movement disorder
  • sporadic or familial
  • can be drug induced

-associated with the degeneration of the basal ganglia of the brain and a deficiency of the neurotransmitter dopamine

68
Q

What are the clinical signs of Parkinson’s disease?

A
  • rigidity
  • bradykinesis (slowness of movement)
  • resting tumour
  • postural instability
69
Q

How is Parkinson’s disease treated?

A
  • multidisciplinary team approach
  • L-DOPA e.g. madopar
  • anticholinergic drugs e.g. orphenadrine
  • drug induce Parkinson’s (e.g. Haloperidol) can be helped by procyclidine
  • surgery?
70
Q

What types of tumours can affect the brain and why?

A
  • benign and malignant
  • benign tumours can cause problems depending on location and mass effects
  • can affect the skull, the meninges or the brain itself
71
Q

What are the symptoms/presentation of a brain tumour?

A
  • headaches
  • seizures
  • cognitive or behavioural change
  • vomiting
  • altered consciousness
72
Q

Can metastasis occur in the brain?

A

Yes

  • cancers elsewhere in the body can metastasise in the brain
  • must be included when tumours are found on CT and MRI scans - e.g. Breast and small cell lung cancer
73
Q

What is the most common benign tumour to arise in the brain?

A

Meningiomas

  • benign
  • generally well circumscribed, slow growing
  • derived from meningothelial cells
  • enlarge slowly, don’t often infiltrate the brain and can be often removed surgically
  • can be found incidentally on brain imaging scans
74
Q

What malignant tumours are commonly known to arise in the brain?

A

Astrocytomas

  • range from WHO grade I-IV
  • grade I generally good outcome but grade 4 usually fatal

Glioblastoma

75
Q

Explain about pituitary tumours

A
  • cause compression symptoms (e.g. of the optic nerve)
  • can be hormonally active (classified based on hormone produced, e.g. Prolactinoma)
  • surgically removed transphenoidally (brain surgery where an endoscope and/or surgical instruments are inserted in to part of the brain by going through the nose and the sphenoid bone)

Pathology - Year 2 AC (19 decks)

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