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Semester 5 - Neuro > 11 - Herniation + Dementias > Flashcards

11 - Herniation + Dementias Flashcards

1
Q

What is the normal ICP range?

A

0 - 10 mmHg

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2
Q

What are the compensatory mechanisms to reduce RICP?

A
  • Reduce blood volume
  • Reduce CSF volume
  • Brain atrophy
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3
Q

What are the 3 types of brain herniation?

A
  • Subfalcine
  • Tentorial
  • Tonsillar
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4
Q

What is the most common type of brain herniation? Describe it:

A

Subfalcine

Cingulate gyrus is pouched under the free edge of the fall cerebri

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5
Q

Which blood vessel is most at risk during a subfalcine herniation? This results in infarction of which areas?

A

ACA

Medial frontal + parietal lobes + corpus callosum

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6
Q

What are the main MRI findings in a subfalcine herniation?

A
  • Ipsilateral loss of lateral ventricle

- Contralateral dilatation of lateral ventricle

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7
Q

Describe a tectorial herniation:

A

Uncus/medial part of parahippocampal gyrus herniates through tectorial notch

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8
Q

Which nerve(s) and vessel(s) are most at risk in a tectorial herniation?

A

CN III

PCA + superior cerebellar artery

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9
Q

Which type of herniation involves the uncus?

A

Tentorial herniation

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10
Q

Describe a tonsillar herniation:

A

Cerebellar tonsils pushed into foramen magnum = compresses brainstem

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11
Q

Which type of brain herniation is associated with a Duret haemorrhage? What is a duet haemorrhage?

A

Tentorial herniation

Haemorrhage in midbrain and upper pons

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12
Q

Which type of brain herniation involves the foramen magnum?

A

Tonsillar herniation

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13
Q

From which layer of the meninges does a meningioma arise?

A

Arachnoid mater

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14
Q

Brain metastases usually arise from which primary cancers?

A
  • Breast
  • Lung
  • Colon
  • Kidney
  • Skin
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15
Q

List some causes of reversible dementia:

A
  • Intracranial tumour
  • Chronic subdural haematoma
  • Alcohol
  • Trauma
  • Cushing’s syndrome
  • Hypothyroidism
  • Vitamin deficiencies: B12, folic acid, thiamine, nicotinic acid
  • Normal pressure hydrocephalus
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16
Q

Apart from neurodegenerative diseases, what are some other causes of irreversible dementia?

A
  • Infection - HIV, encephalitis, syphilis, CJD
  • Drugs - Benz’s, barbiturates
  • Alcohol
  • CVD = vascular dementia
  • Trauma
17
Q

Tau protein tangles and β-amyloid plaques are associated with what type of dementia?

A

Alzheimer’s disease

18
Q

What is the normal time span from onset of Alzheimer’s disease to death?

19
Q

Which type of dementia exhibits a continuous progressive cognitive decline?

A

Alzheimer’s disease

20
Q

Which type of dementia exhibits a step-wise cognitive decline?

A

Vascular dementia

21
Q

Which type of dementia exhibits a random, fluctuating cognitive decline?

A

Dementia with Lewy-bodies

22
Q

Which which type of dementia is it common to experience recurrent visual hallucinations?

A

Dementia with Lewy-bodies

23
Q

Antipsychotics are contraindicated in which type of dementia?

A

Dementia with Lewy-bodies

24
Q

What type of dementia is Pick’s disease?

A

Fronto-temporal dementia

25
Q

In which type of dementia is memory initially preserved, but insight and speech are lost early?

A

Fronto-temporal dementia

26
Q

In which type of dementia may you find signs of CVS disease elsewhere?

A

Vascular dementia

27
Q

In which type of dementia do people have memory lapses, become disorientated, have trouble planning and organising things?

A

Alzheimer’s disease

- Impaired cognitive and executive functions

28
Q

Name the types of cortical dementias:

A
  • Alzheimer’s
  • Vascular (mixed)
  • Fronto-temporal
29
Q

Name the type of subcortical dementias:

A
  • Vascular (mixed)

- Dementia with Lewy-bodies

30
Q

How is dementia classified in the ICD-10?

A
  • Decline in memory
  • Decline in other cognitive abilities
  • Decline in emotional control/motivation ie labile/irritable/apathetic/coarsening of social behaviour
  • Present for >6months
31
Q

What are some differential diagnoses of dementia?

A
  • Normal ageing
  • Delirium
  • Trauma
  • Stroke
  • Depression
  • Late-onset schizophrenia
  • Amnesia
  • Learning disability
  • Substance misuse
  • Drugs: Opiates, benzo’s
32
Q

What are the 1st line drug treatments for Alzheimer’s disease?

A

AchE inhibitors:

  • Donepezil
  • Galantamine
  • Rivastigmine
33
Q

What is the mechanism of action of Memantine?

A

NMDA antagonist

34
Q

What is the initial management of a patient with dementia (before drugs):

A
  • Information + education
  • Advance planning
  • Contact DVLA
  • Social support ie Alzheimer’s society
  • Community services ie day care, meals-on-wheels, befriending services
  • Aromatherapy, massage, music/art therapy
  • Home nursing and personal care
35
Q

If a patient with dementia is suffering insomnia, what should be prescribed 1st line?

Semester 5 - Neuro (14 decks)

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