Glial cells= supporting cells, includes astrocytes (fibres), oligodendrocytes (myelination- prevent cross connection), microglia= macrophages Multiple sclerosis: bodys own cells cross react and destroy myelination 3rd and 4th ventricles: ependymal cells meninges: meningothelial tumour 01940- hydrocephalus; dilated ventricles with accumulation of CSF constant leak of CSF from choroid plexus (lateral ventricles) CSF- clear, acts as a cushion for the brain, also contains nutrients for the brain Choroid plexus lateral 3rd 4th ducts to subarachnoid surface reabsorbed by arachnoid vessels OBSTRUCTIVE- Inflammation with exudate = block, CSF accumulate in ventricles and dilates the brain NON OBSTRUCTIVE- poor reabsorption by arachnoid vessels Why is it worrying?: skull cavity has limited space to expand only way to accommodate is by atrophy and compression of brain parenchyma neurological deficits; conditions leading to hydrocephalus will still persist : edema, raised ICP Treat: SubQ route from ventricle to peritoneal cavities Huge space in the centre- massively dilated ventricles 00005- Subdural hematoma Brownish in color Not meningioma (uniform, whitish in colour) Trauma that disrupts the bridging veins that cross subdural space Same complications as above; herniation? 01896- Epidural hematoma 04389- Subarachnoid hemorrhage most common cause is rupture of berry aneurysm - why not TB? 1) COLOR: greyish - beneath thin flimsy membrane (pia mater) - Complication: Cranial deficits 03299- Circle of Willis Berry Aneurysm At junction of posterior and middle cerebral artery
Dilation due weakening
Cause: usually congenital, deficient artery wall If thoracic- most common cause is atherosclerosis 03570- Intra-cerebral Hemorrhage Replacement of parenchyma with hemorrhage, which has leaked into the ventricles 6cm in maximum dimension POI: Infarction most common in the brain H/w for hemorrhage, due prolonged weakening of vessels due HTN, DM, atherosclerosis Stroke! - differentiate whether you should be using TPA or not 00013- Cystic change secondary due to infarct and consequent liquefactive necrosis Disruption in tissue v.s. coagulative: cell structure still preserved Causes of cerebral infarct: Obstruction of vascular lumen- either venous or arterial infarct Thromboemboli, atherosclerosis Cystic change within brain parenchyma 00024- Inflammatory exudate in the meninges Brain Tuberculous Meningitis (hard to differentiate grossly) - do a spinal tap - almost acellular normally - must ensure doesnt have raised ICP, may have cerebral herniation, the low pressure shunt will drag the cerebrum down : herniation! Meningitis: neck stiffness, photophobia 00016-Brain Purulent Meningitis surface of brain covered by thick exudate; seems like purulent pus to be confirmed by culture and CSF examination Recall : encephalitis mostly in viral infection; 00020- Abscess (Intra-cerebral) or Tuberculoma 0000- Tumour 1) Secondaries most common, followed by 2) Meningeal tumours asymptomatic, slow growing, incidentally found
Nicely circumscribed pressure atrophy on parenchyma due to the
meningioma Not invading into the brain; easy to remove Meningioma- benign, but you can have a malignant meningioma 03886- Meningioma that has invaded into brain tissue Fibrous, looks different from brain parenchyma 00668- Mets to brainCoronal section of brain, multiple lesions of various sizes scattered across both hemispheres 00045- Medulloblastoma From a 5 year old child Cerebellum and the child is suffering from medulloblastoma Also seen in children: pilocytic astrocytoma also most commonly in cerebellum 02931- Pituitary adenoma Most commonly present with visual disturbances Excessive hormone production Use keyhole surgery 03740 Tumour looks of the same consistency as the brain parenchyma Thus, a glioma Most likely to be grade 4! Glioblastoma multiforme Histologic differentiation due to different behaviours and responses to chemotherapy
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