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Integrative Pathology > Week 8 - CNS > Flashcards

Week 8 - CNS Flashcards

1
Q

What functions is the frontal lobe responsible for?

A 
Movement
Intelligence
Reasoning
Behaviour
Memory
Personality
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2
Q

What functions is the temporal lobe responsible for?

A 
Speech
Behaviour
Memory
Hearing
Vision
Emotions
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3
Q

What functions is the parietal lobe responsible for?

A 
Intelligence
Reasoning
Telling right from left
Language
Sensation
Reading
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4
Q

What functions is the occipital lobe responsible for?

A

Vision

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5
Q

What functions is the cerebellum responsible for?

A

Balance
Coordination
Fine muscle control

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6
Q

What functions is the brain stem responsible for?

A

Breathing
Blood pressure
Heartbeat
Swallowing

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7
Q

What does compression of the III nerve cause?

A

Fixed dilated pupils

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8
Q

What are 5 types of brain herniation?

A 
Parahippocampal gyrus herniation
Sub-falcine herniation
Collapse of ventricle
Transtentorial herniation
Cerebellar tonsil hernation in foramen magnum
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9
Q

What happens in an Sub-falcine herniation?

A

The innermost part of the frontal lobe, called the cingulate gyrus, slips under the free edge of the falx cerebri into the opposite hemisphere. This can compress the anterior cerebral artery leading to an ischaemic stroke. Usually a forerunner to other types of supra-tentorial herniation.

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10
Q

What happens in an Collapse of ventricle herniation?

A

The inner most part of the temporal lobe slips below the cerebellar tentorium. This can lead to compression of the III nerve, ischemic stroke in the occipital lobe leading to lateral vision loss and compression of the brain stem leading to unilateral weakness.

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11
Q

What happens in an Collapse of ventricle herniation?

A

The diencephalon and parts of the temporal lobe slip under the free edge of the tentorium (falx cerebelli)

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12
Q

What happens in an Transtentorial herniation?

A

The inner most part of the temporal lobe slips below the cerebellar tentorium. This can lead to compression of the III nerve, ischemic stroke in the occipital lobe leading to lateral vision loss and compression of the brain stem leading to unilateral weakness.

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13
Q

What happens in a cerebellar tonsil herniation in the foramen magnum?

A

The cerebellum slips down through the foramen magnum compressing the brain stem and affecting neurons responsible for breathing and cardiac function.

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14
Q

Brain herniation is a result of ______ _________ _______.

A

Raised intracranial pressure.

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15
Q

What are the four types (causes) of ischaemic brain damage?

A

Large vessel disease
Small vessel disease
Venous infarction
Global ischaemia

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16
Q

What is the outcome of ischaemic brain damage by large vessel disease?

A

Regional infarction by thrombosis and embolism.

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17
Q

What is the outcome of ischaemic brain damage by small vessel disease?

A

Microinfarcts (lacunar) due to arteriosclerosis (damage to arterioles). Usually as a result of hypertension and diabetes.

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18
Q

What is the outcome of ischaemic brain damage by venous infarction?

A

Thrombosis (red infarct) in the main venous sinus. Usually due to dehydration, thrombophilia syndromes.

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19
Q

What is the outcome of ischaemic brain damage by Global ischaemia?

A

Cortical neuronal necrosis due to cardiorespiratory arrest or hypotension.

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20
Q

What is a common cause of cerebral infarction?

A

Complicated atheroma.

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21
Q

What are the risk factors for cerebral infarction?

A

Hypertension, diabetes, smoking, hyperlipidaemia, thrombosis of atheromatous artery, history of MI.

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22
Q

What are the common sites of cerebral infarction?

A

Cervical portion of the carotid artery, vertebral, cerebral, basilar arteries.

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23
Q

What are the symptoms of a cerebral infarction?

A

Rapid onset of symptoms which may persist >24 hrs
Hemiplegia
Confusion, aphasia
Seizures
Loss of consciousness with resulting paralysis

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24
Q

What is a TIA?

A

A short lived anoxic episode with minimal damage to CNS. It is a warning sign of an impending CVA within 6 months.

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25
Q

What are the symptoms of a TIA?

A 
Symptoms DO NOT persist >24hrs
Amaurosis fugax (transient loss of vision in 1 eye)
Hemiparesis (partial paralysis)
Paraesthesia
Vertigo
Diplopia (double vision)
Rarely LOC
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26
Q

Brain infarcts typically show __________ necrosis.

A

Colliquative

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27
Q

What are some tests used for the diagnosis of cerebral infarction?

A 
Clinical symptoms
History
CT scans
EEG
Cerebral angiography
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28
Q

What is the treatment for cerebral infarction?

A

Neurosurgery, vasodilators, increased does of corticosteriods, anticoagulants, preventative daily aspirin.

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29
Q

What is the prognosis for cerebral infarction?

A

70% 30 day survival
~10% survivors suffer another stroke in the same year
~20% survivors suffer another stroke withing 5 years of original stroke.

30
Q

What is the cellular response after an cerebral infarction?

A

Phagocytic cell response maximal 10-14 days
No neutrophils, many macrophages/microglia
Gliosis occurs from day 7-12
Gial scar around a central cystic space = apoplectic cyst

31
Q

What are the main causes of intracranial haemorrhages?

A

Malformation of blood vessels or trauma to the vessels.

32
Q

How are intracranial haemorrhages classified?

A

Classifed accoriding to the anatomical regions involved.

33
Q

What are the two classifications of intracranial haemorrhages?

A

Extra-axial and intra-axial.

34
Q

What are the three types of extra-axial intracranial haemorrhages?

A

Epidural space haemorrhage
Subdural space haemorrhage
Subarachnoid space haemorrhage

35
Q

What is a type of intra-axial intracranial haemorrhage?

A

Intracerebral haemorrhage (brain parenchyma including ventricular spaces).

36
Q

What causes an epidural haemorrhage?

A

Trauma to the temporal region or a skull fracture resulting in rupture of the middle meningeal artery or one of its branches.

37
Q

What are the symptoms of an epidural haemorrhage?

A

After concussion there is LOC for a time. After regaining consciousness the patient becomes progressively comatose. Death results if untreated.

38
Q

What is the cause of an acute subdural haemorrhage?

A

Caused by a high speed acceleration/deceleration injury resulting in rupture of the cortical veins in the subdural space.

39
Q

What are the symptoms of an acute subdural haemorrhage?

A

Symptoms in-line with raised ICP leading to brain herniation, coma and death.

40
Q

What is the cause of a chronic subdural haemorrhage?

A

Caused by falls, birth trauma resulting in tearing of the bridging cerebral veins between the pia mater and dura mater.

41
Q

What are the symptoms of a chronic subdural haemorrhage?

A

Greatly delayed onset headache, increasing drowsiness, hemiparesis and seizures, deterioration of mental capacity. Brain herniation and death may occur.

42
Q

What is the cause of a subarachnoid haemorrhage?

A

Rarely due to head injuries, mostly due to pathology of the brain vasculature such as a brain infarction, aneurysms (berry aneurysms) or intracerebral haemorrhages.

43
Q

What are the symptoms of a subarachnoid haemorrhage?

A

Palsies of the cranial nerves, transient headache, neck stiffness.
Severe occipital headache with no warning.
Vomiting
LOC as ICP rises
Very poor prognosis.

44
Q

What is the causes of a intracerebral haemorrhage?

A

Ruprture of the lenticulostriate branch of the middle cerebral artery due to arterial disease, hypertensive crises, aneurysms, ateriovenous malformations, neoplasms, trauma.

45
Q

What are the symptoms of a intracerebral haemorrhage?

A

Intense headache
Vomiting
Hemiplegia
Rapid LOC

46
Q

What are some of the causes of a non-missile trauma to the brain?

A

Acceleration/deceleration forces to the head
Rotational and shearing forces on the brain
Shaken baby syndrome

47
Q

What are some of the causes of a missile trauma to the brain?

A

Penetration of the skull or brain by an external object e.g. a bullet.

48
Q

Brain pathology resulting from head trauma may be divided into two categories. What are these categories?

A

Primary brain damage = immediate injury

Secondary brain damage = delayed injury

49
Q

What are some examples of primary (immediate) damage to the brain?

A 
Scalp laceration
Skull fracture
Cerebral contusions
Cerebral laceratoins
Intracranial haemorrhage
Diffuse axonal injury
50
Q

What are some examples of secondary (delayed) damage to the brain?

A

Ischaemia
Hypoxia
Cerebral swelling
Infection

51
Q

What is a coup lesion?

A

When the brain is injured by violent contact with the skull or dural membranes adjacent to the site of impact.

52
Q

What is a contrecoup lesion?

A

When the brai nis injured on the diagonally opposite side of the impact.

53
Q

Coup and contrecoup lesions may lead to ____ brain injury of _____ brain injury.

A

Focal, diffuse.

54
Q

What is Cerebritis?

A

Inflammation of the the brain in a focal area.

55
Q

What is myelitis?

A

Diffuse inflammaiton of the spinal cord.

56
Q

What organisms can cause acute suppurative meningitis in neonates?

A

E. coli and other enteric bacteria

57
Q

What organisms can cause acute suppurative meningitis in children?

A

Neisseria meningitidis
S. pneumoniae
H. influenzae

58
Q

What organisms can cause acute suppurative meningitis in the immunocompromised?

A

S. pneumoniae
S. aureus
Candida albicans

59
Q

What happens at the cellular level in acute suppurative meningitis?

A

Purulent exudate acccumulates in the subarachnoid space. You see increased neutrophils.

60
Q

What are the symptoms of acute suppurative meningitis?

A

Sudden severe headache, fever, chills and neck stiffness.

61
Q

What is the treatment for acute suppurative meningitis?

A

Aggressive antibiotic therapy, relief of raised ICP.

62
Q

What are some examples of neurological impairment due to acute suppurative meningitis?

A

Seizures, hearing/vision loss, cranial nerve palsies.

63
Q

What organisms can cause chronic meningitis?

A

Cryptococcus neoformans

Mycobacterium tuberculosis

64
Q

What are the symptoms of chronic meningitis?

A

Slow onset of headaches, malaise, fatigue, low grade fever. Poor prognosis.

65
Q

What organisms can cause viral (aseptic) meningitis?

A 
Echovirus
Coxsackie virus
Mumps
Measles
Varicella
66
Q

What are the symptoms of viral meningitis?

A

Sudden headach, fever, neck stiffness. Usually self-limiting, full recovery within 1-2 weeks.

67
Q

What can you see at a cellular level in viral meningitis?

A

No bacteria but see increased numbers of lymphocytes.

68
Q

What are the causes of encephalitis?

A

Usually due to viruses such as herpes simplex virus, arbovirus, rubella, CMV.

69
Q

What are the symptoms of encephalitis?

A

Fever, variable neurological deficits, tremors, paralysis, convulsions.

70
Q

What disease is an example of a demyelinating disorder?

A

Multiple sclerosis.

Integrative Pathology (8 decks)

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