01008, 1009- Normal brain

Glial cells vs. neurons

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