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Flashcards in SOLs Deck (58)
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1
Q

SIGNS of RAISED ICP? (4)

A

Papilloedema, Headache, N.V, Stiff Neck

2
Q

Name the dif. forms of herniation? (4)

A

Subfalcine, Tentorial, Cerebellar, TransCalvarial

3
Q

Where is Hydrocephalus Ex Vacuo seen?

A

Alzheimer’s Disease

4
Q

Name 4 kinds of SOLs

A

Tumors/Abscess/Hematomas/Localized brain swelling (EDEMA around infarct)

5
Q

70% of childhood brain tumors arise from ________

A

BELOW the tentorium cerebelli

—WHILST 70% OF ADULT CNS tumors= ABOVE

6
Q

Where do brain tumors usually metastasize from?

A

breast, bronchus, kidney, thyroid, colon carcinomas and MALIGNANT melanoma

7
Q

Most common malignant primary intracranial tumors in KIDS and ADULTS

A

ASTROCYTOMA (45-50%) and oligodendroglioma (1-6% incidence)

8
Q

Why do high grade tumors cause edema?

A
  • they interfere with the integrity of the BBB, causing vasogenic edema
9
Q

Name a grade 1 Astrocytoma. Can this become malignant?

A

Pilocytic Astrocytoma —no remains benign

10
Q

Name a distinct histological ft of High grade tumors.

A

neo-angiogenesis- so very vascular tumors

11
Q

Name 3 fts of a Medulloblastoma

A
  1. radiosensitive
  2. arises Midline of cerebellum
  3. poorly differentiated cells (EMBRYONAL cells)
12
Q

Best management of Medulloblastoma

A

75%, 5 year survival with RESECTION and RADIOTHERAPY

13
Q

Causes of Single Abscesses

A
  1. Local Extension (mastoiditis)

2. Direct Implantation (skull #)

14
Q

Name 2 conditions which may cause Multiple Abscess formation

A

HEMATOGENOUS spread:

  1. Bronchopneumonia
  2. Bacterial Endocarditis
    - —also seen at the boundary of G-W matter
15
Q

How to manage brain abscesses?

A
  • CT/ MRI to confirm
  • aspiration for CULTURE and rx
  • weeks of antibiotics
16
Q

What organism usually causes ear abscesses?

A

B.Fragilis

17
Q

What usually causes peripheral abscesses and deep abscesses?

A

peripheral- Bacterial

deep (basal ganglia)- Toxoplasma

18
Q

How does meningitis cause raised ICP?

A

Becauses it causes edema and arachnoiditis–> lack of CSF absorption and therefore hydrocephalus

19
Q

Gram +ve Cocci cause of bacterial meningitis in older adults/ children

A

Strep. Pneumoniae

20
Q

Gram - rods cause of Meningitis

A

E.coli

21
Q

Gram -ve cocco bacilli that causes bact. meningitis in KIDS

A

H.influenzae

22
Q

What gram - diplococci commonly infects young children and aldolescents?

A

Neisseria Meningitidis

23
Q

How does high vs low velocity missile injury differ?

A

High velocity penetrating wound, causes FAR MORE DAMAGE to the surrounding tissue than a low velocity wound; the SMALLER the contact time THE LARGER the force

24
Q

Name the 3 types of skull fracture

A
  1. Linear - straight sharp #; but NO movement of bone
  2. Compound- full thickness scalp lacerations
  3. Depressed
25
Q

What risk does a Linear Fracture hold?

A

Risk of potentially RUPTURING the Middle Meningeal Artery

26
Q

Where does DIFFUSE AXONAL INJURY usually occur?

A

in central areas of the brain, at moment of injury

27
Q

Main difference between Epidural and Subdural Hematoma?

A

Epidural - accumulation of ARTERIAL blood

Subdural is accumulation of venous blood

28
Q

Common Extradural hematoma

A

fracture of the pterion bone on the tempero-parietal region causing the rupture of the Middle Meningeal Artery

29
Q

What occurs if you leave an extradural hematoma untreated?

A
  • compression, midline shift and herniation

- mortality of 10-20%

30
Q

Subdural hemorrhage involves what blood vessels?

A

It involves the disruption of the BRIDGING veins which extend from the brain surface into the subdural space…between dura mater and arachnoid mater

31
Q

What is different about an Acute Subdural hematoma and a Chronic one?

A

Chronic subdural hematoma results in prodn of a yellow fluid called Neomembrane

32
Q

What occurs in Cerebellar Tonsil Herniation?

A

Caused by increased pressure in the POSTERIOR fossa forcing cerebellar tonsils out through the foramen magnum.

33
Q

What is the presentation of a Cerebellar Tonsil Herniation?

A

Ataxia/ VI CN palsy/
+Babinski’s>loss of consciousness
-apneoa/ irregular breathing

34
Q

Subfalcian herniation is caused by a _______

A

Frontal Mass—the cingulate gyrus is forced under the rigid falx cerebri…..SILENT until anterior cerebral artery is compressed and causes STROKE (==> c/l LEG weakness and abulia)

35
Q

Why does hydrocephalus develop secondary to Alzheimer’s disease?

A
  • d.t LOSS of brain parenchyma in AD

- –> dilatation of the VS and compensatory INCR. in CSF volume

36
Q

What are the effects of RAISED ICP?

A
  • intracranial SHIFTS and HERNIATIONS- CONING
  • midline SHIFT
  • PRESSURE on CRANIAL nerves and vital neurological centres
  • impaired blood flow (CPP= MAP- ICP)
  • Reduced level of consciousness
37
Q

What are the common fts of brain tumors?

A
  1. focal symptoms (70%)
  2. HEADACHE (50%)
  3. seizures (30%)
  4. vomiting
  5. visual disturbances
    —-PAPILLOEDEMA
    and focal deficit
38
Q

Name 2 fts of metastatic brain tumors.

A
  1. multiple

2. often seen in the BOUNDARIES between grey and white matter

39
Q

What is the grading of prmary brain tumors based on?

A
  1. Mitoses
  2. Neovascularisation
  3. Necrosis
  4. Atypia
40
Q

Name the most common benign adult brain tumor?

A
  • Meningioma and Pituitary adenoma
41
Q

Most common benign children tumor?

A

craniopharyngioma

42
Q

List the 4 genetic mutations that predispose a person to v. agressive brain tumors?

A
  • IDH1
  • P53
  • PDGFRA
  • PI3KCA
43
Q

Histologically, palisading of the cells is commonly seen in which brain tumor?

A
  • Glioblastoma
44
Q

2nd most common tumor in children AFTER pilocytic astrocytomas.

A
  • medulloblastoma

20% of pediatric CNS neoplasms

45
Q

What is seen morphologically in brain abscesses?

A
  • central necrosis
  • edema
  • fibrous capsule
46
Q

What are the symptoms of abscesses?

A
  • fever

- raised ICP

47
Q

What is seen in the CSF in bact. meningitis?

A
  • abundant polymorphs

- decr. glucose

48
Q

Causal organism for bacterial meningitis in NEONATES?

A
  • E-COLI
49
Q

Possible, gram +ve rod, causal pathogen for bacterial meningitis in an older person?

A

Listeria Monocytogenes

50
Q

What is the relation between time of force of contact in blunt injuries of the brain?

A
  • the SMALLER the contact time; the LARGER the force
  • —-so the brain moves within the cranial cavity and makes contact with the inner table of the cranium and BONY protrusions
51
Q

What is primary injury?

A
  • the direct impact that has occurred TO the NEURONES

- —irreversible

52
Q

Examples of primary injuries to the brain>

A
  • diffuse axonal injury
  • diffuse VASCULAR injury
  • surface contusions/ lacerations
  • petechial hemorrhage
53
Q

How is a linear # managed?

A
  • no interventions needed
  • pts pbserved for a while
  • back to normal activities
54
Q

What is diastatic #?

A
  • when the # occurs ALONG the suture lines of the skull

-

55
Q

Name the most SERIOUS skull #?

A
  • basillar skull #
56
Q

What is coup and contracoup?

A
  • coup : occurs to the brain on the SIDE of the IMPACT

- contracoup: diamtrically OPP. point of impact

57
Q

Why are contracoup injuries worse?

A
  1. theory: denser CSF moves to coup side 1st –FORCING brain to contra-coup side
  2. Cavitation theory—- low pressure at side of contr-coup creates CAVITATION bubbles ==> damaged parenchyma
58
Q

What may occur post DAI?

A

-as many as 50% develop COMA after trauma
- to be d.t white matter damage and DAI
- reduced consciousness
> vegetative state