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Neurpathology
| Question | Answer |
|---|---|
| List 4 tumor types that make up 75% of brain tumors. List 2 additional tumors to account for 85% of brain tumors. | Glioblastoma Meningioma Metastatic Brain Tumor Astrocytoma Pituitary Adenoma Acoustic Neuroma |
| Based on recent discoveries which led to altering the original concept of brain tumor origin, what cell type gives rise to astrocytomas? | Neuroectoderm -> glial cells -> astrocytes |
| What general factors does a neurosurgeon consider when determining how much tissue to remove? | The diagram illustrate the difficulty of removing a tumor within brain structures. It is difficult to determine the how much tumor remains when removing it and also the underlying result of it is loss of brain tissues that can result in permanent damage |
| List 4 types of astrocytomas and associate each with a decade of life. correlation between age and degree of malignancy in these astrocytomas. Of the 4 types, which type is least malignant? most? If a tumor is necrotic, how is it classified? | Pilocytic Astrocytoma - least malignant - low grade - peak between 10-12 Low-grade Astrocytoma - low grade - 4th decade Anaplastic Astrocytoma - high grade - 5th decade Glioblastoma (GMB) - most malignant = necrosis - high grade - 6th decade |
| List 2 examples of sites where a meningioma would be dangerous to excise because of its site and the structures involved. | Wraps around the internal carotid and optic nerve - increase ICP |
| What are the consequences of a meningioma growing out of the inner sphenoid ridge? | Press on optic nerve causeing ipsilateral optic atrophy and contralateral papilledema - increase ICP |
| List the most common brain tumor seen after the age of 50. | Metastatic tumor |
| List the 5 most common sites of primary tumors that metastasize to the brain. Which one is most common? | Lung (1) Breast Malignant melanoma Renal cell carcinoma GI cancer |
| Why are 30% of pituitary tumors undiagnosed until they are fairly large? In these cases, what is a presenting finding? | Non-functioning adenomas - do not cause endocrine manifestations. Presenting signs = endocrine problems |
| What is the terminology when there is bleeding into a pituitary tumor? | Pituitary Apoplexy |
| List a benign tumor that arises from the acoustic nerve in the cerebello-pontine angle. | Acoustic Neuroma Meningioma Choriod plexus papilloma Epidermoid cyst ependymoma |
| Briefly define the term, “phakomatoses”. | group of hereditary diseases of neuroectoderm characterized by cutaneous manifestations |
| List findings associated with Neurofibromatosis I and NF II. | NF I Optic gliomas. Plexiform neurofibromas, café au-lait spots, lisch nodules in iris, spinal astrocytomas NF2 Bilateral aoucstic schwanomas, meningioma, spinal ependymoma |
| List 4 main categories of causes of acute and chronic increase in ICP. | Brain water Increase (cerebral edema) Blood increase CSF increase Abnormal Tissue |
| What is the earliest sign of raised ICP? If a patient is awake, alert and oriented, is there an increase in ICP? | Earliest sign of ICP = Level of Consciousness (LOC) There may be without the sign |
| List functions of the Reticular Formation. | Alertness and control of LOC Control respiration, hear, pain |
| Progression can continue to the medullary stage; list these clinical findings. | Deep coma pupils dilated and fixed Ataxic respiration Limbs flaccid |
| Briefly describe rostral-caudal deterioration. Although you do not need to know features of each stage, realize that level of consciousness is affected at the diencephalic stage. | Diencephalon -> midbrain -> pons -> medulla |
| What breathing pattern indicates involvement of the medullary respiratory center and that the patient is about to expire? | Ataxic respiration |
| Briefly discuss why tonsillar herniation can occur without alteration in LOC. | Reticular Activation System is above the level of herniation in the medulla. |
| List the most important risk factor for lacunar strokes. | DM Smoking hyperlipidemia |
| List the location of lacunar infarcts (starting with most frequent location) | Putamen caudate thalamus int. capsule |
| Describe classic lacunar syndromes: Pure motor hemiparesis; where is the site of the lesion? | Whole contralateral side affected. No sensory, speech or visual deficit Most common syndrome Site of lesion Internal capsule Posterior limb Basis pontis |
| Pure sensory; where is the site of the lesion? | Whole contralateral side All sensory modalities gone Site of lesion Ventral posterior nucleus of thalamus |
| Ataxic hemiparesis | Weakness and pyramidal signs + cerebellar type ataxia on the same side Site of lesion Contralater internal capsule posterior limb Basis pontis lesion Red nucleus lesion |
| Dysarthria-clumsy hand syndrome | Upper motor facial palsy, dysarthria, dysphagia + hand paresis and clumsiness Site of lesion Basis pontis at junction of upper and lower pons Bigenu of internal capsule |
| Atheroma plaques are a leading cause of cerebral infarction; list 4 sites where they occur. Of these, what is the most common site? List a general area where it is rare to find plaques. | Carotid bifurcation* Vertebral artery Vertebral-Basilar Junction stem or main bifurcation of middle cerebral artery Rare to find plaques beyond first major branching of cerebral arteries |
| Epidural hematoma: classic presentation (“talk & die”); trauma?; most commonly affects what artery? (high or low pressure bleed?) | Skullfracture and dura Middle meningeal arteries -> high pressure bleed |
| - ASDH with underlying brain damage: trauma? other findings? See image on page 7, bottom left – with marked midline shift of brain, is surgery indicated? | Severe head trauma and Diffuse axonal injury Cortical contusions, brain swelling |
| ASDH without brain damage: trauma?; age group; management | Minor trauma in older age group with brain atrophy Observe -If clot is solid = craniotomy -If clot liquefies = Burr hole surgery |
| · Chronic subdural hematoma: age group; trauma?; presentation; risk factors | Trivial trauma Older age group HA, confusion, decrease memory, minor neuro deficit, speech difficulty, TIA like symptoms or rarely seizure Risk factors Older age with cerebral atrophy Falls CVA, dementia, alcohol abuse, seizures, CSF shunts, parkins |
| main causes of intra-cerebral hemorrhage | Berry aneurysm Cerebral amyloid angiopathy Vascular tumor Mycotic aneurysm - septic embolus Lipohyalinosis Charcot-Bouchard Aneurysm |
| Subarachnoid hemorrhage (SAH): most common cause of spontaneous SAH, symptoms (including textbook description). | Headache - sudden and severe Faintness, diaphoresis, lethary |
| SAH: Pupillary involvement indicates an aneurysm of what artery? | damage to PCOM artery |
| List complications. Is surgery effective in removing blood from the subarachnoid space? | Rebleeding Vasospasm - reduction in cerebral blood flow. Poor outcome. Surgery is done to occlude the aneurysm to prevent rerupture |
| Describe the sequence of events with ischemia. | Ischemia -> loss of neuronal elec. Activity and hypoxemia -> cellular ATP depletion -> membrane potential failure -> cell depolarization -> Glutamate release -> activation of NMDA and other receptors -> Na and Ca H2O ions IN -> cytotoxic edema |
| Describe the characteristics of transient ischemic attack (TIA). What is the pattern of a TIA believed to be caused by embolism? Thrombosis? | Embolism - 1 single episode >1 or multiple episodes in different vascular areas Thrombosis - episodes of the same pattern. Precedes a stroke - almost always |
| What are the symptoms of TIA with involvement of the carotid territory? | Contralateral weakness or clumsiness and/or hypersthesia or paresthesia Dysphasia if dominant side Ipsilateral monocular blindness, contralateral homonologous demianopia |
| What is the most common cause of stroke? Source of embolus? List the most frequently involved artery. | Embolic Infarction Source is heart Middle cerebral Superior Division is the most frequent artery involved |
| List examples of noncardiac emboli. | Atheroma of aorta carotid vertebrobasilar arteriers (thrombus or plaque) |
| List the most common site of atheroma plaque. | Dissection Fibromuscular dysplasia |
| List 3 ways that an atheroma can initiate cerebral thrombosis. | Plaque ulceration or fissuring macro- or microscopic Hemorrhage into plaque Stenosis causing turbulence |
| List the pattern of symptoms when the TIA is caused by thrombosis vs embolism | thrombosis -TIA -> Main stroke -Usually 10 mins to 1 hour -Stuttering or intermittent progression to completion. HA rare Embolism -Very rare to have warning signs -TIA >1 hr = main stroke -Sudden and complete onset - improve HA+ |
| Describe how prions are ‘infectious’. | Prions can enter the brain by infection or may arise from a mutation in the gene. They multiply by inducing the normal protein to misfold like them |
| List the fatal neurodegenerative condition occurring in humans and animals. | Fatal neurodegenerative condition in humans and animals are Subacute Spongiform Encephalopathy (SSE) |
| Creutzfeldt-Jakob disease: Sporadic Disease | Sporadic - normal prion spontaneously convert to abnormal prions. Prion gene is normal |
| Creutzfeldt-Jakob disease: Iatrogenic Disease | Iatrogenic - transmission by corneal transplant, cadaveric dural graft, contaminated brain electrodes, neurosurg. Operating room, human growth hormone. |
| Creutzfeldt-Jakob disease: Inherited Disease | Inherited - prion gene abnormal and transmitted as a autosomal dominant |
| What is the consequence of rupture of a brain abscess? | increase ICP |
| List 3 general categories of causes of brain abscess. | Infections of the head Distant infections Immunosuppressed host |
| List the symptoms of brain abscess; can it occur in absence of fever? | Fever (can occur without fever) Seizure Neuro deficit Lethargy - common |
| List examples of infections of the head that can cause brain abscess. | Sinusitis, otitis media, mastoditis, apical dental abscess, septic phlebitis, penetrating head wounds, post neurosurgery |
| Discuss characteristics of the blood-brain barrier | Capillary wall are endothelial cells Cell membrane = lipid bilayer with ion channels Sugar and amino acid carriers Ion pumps Ion channels Enzymes bound to wall |
| Vasogenic edema | Blood-brain barrier is broken and fluid builds up at intracellular and extracellular area of the brain Result from a trauma, tumor or stroke, meningitis, encephalitis |
| Cytotoxic Edema | Due to cells' inability to maintain a proper osmotic gradient, i.e. ischemia leading to energy debt leading to poorly functioning ion pumps. Cells swell with water - increased intracellular osmolality |
Created by:
prinny916
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