14. Nervous System II - Pathologies Flashcards
Raised Intercranial Pressure: definition
Increase in pressure within the cranial cavity
Raised Intercranial Pressure: pathophysiology
Compression of blood vessels leads to reduced oxygen delivery to the brain
Raised Intercranial Pressure: aetiology
Tumours - gliomas, metastases
Haemorrhage - subdural, subarachnoid
Hydrocephalus - excess cerebrospinal fluid
Meningitis - inflammation of meninges
Encephalitis - inflammation of brain tissue
Intracranial abscess
Raised Intercranial Pressure: signs and symptoms
Headache - worse on awakening, when coughing or moving head
Vomiting - often without nausea
Visual disturbance - if damage to optic nerve
Pupil fixed/dilated in one eye
Impaired mental state
Altered speech
Papilloedema - bulging of the optic nerve
Elevated blood pressure, slow irregular pulse, slow breathing
Hydrocephalus: definition
Abnormal accumulation of CSF in the cerebral ventricles and subarachnoid space
Hydrocephalus: pathophysiology
Impaired absorption or excessive secretion
Results in ventricular dilation
CSF permeates through the ependymal lining into the surrounding white matter
Hydrocephalus: aetiology - young children
Infection or congenital malformation
Hydrocephalus: aetiology - older children/adults
Tumour
Trauma
Meningitis
Hydrocephalus: signs and symptoms
Headache - worse on awakening - CSF doesn’t drain well whilst lying down
Infants - increase in head circumference and dliated scalp veins
Vomiting, nausea
Blurred or double vision
Neck pain
Hydrocephalus: allopathic treatment
Diuretics - inhibit CSF secretion
Shunt, ventricular drain, lumbar puncture
Emergency - to prevent white matter scarring/brain damage/death
Meningitis: definition
Infection or inflammation of the meninges
Meningitis: aetiology
Viral meningitis (herpes simplex) - most common cause (90%). Less severe
Bacterial infection - more serious
Fungal/parasitic micro-organisms
Non-infective - brain tumour
Meningitis: signs and symptoms
Fever Sudden onset of severe headache Neck stiffness Photophobia Vomiting
Petechiae - small purple/red spots on skin as result of tiny haemorrhages that don’t disappear under pressure
Kerning’s sign - pain resistance to knee extension when lying with the hips fully flexed
Brudzinski sign - neck flexion causes flexion of hip and knee
Meningitis: diagnostics
Lumbar puncture - withdraw CSF between L4-L5
Meningitis: complications
Swelling
Raised ICP
Septicaemia
Seizures
Meningitis: allopathic treatment
Antibiotics, antivirals, corticosteroids
Analgesics, antipyretics
Intravenous fluids
Concussion: definition
Temporary loss of neuronal function
Concussion: aetiology
Significant blow to the head
Concussion: signs and symptoms
Loss of consciousness
Memory loss of events surrounding the injury
Headache
Disorientation
Concussion: allopathic treatment
Rest
If any consciousness lost, avoid any vigorous activity for 3 months
Cerebral Contusion: definition
Traumatic brain injury that causes bruising of the brain with ruptured blood vessels and oedema
Cerebral Contusion: aetiology
Blunt blow to the head
Cerebral Contusion: signs and symptoms
Headache Confusion Dizziness Loss of consciousness Nausea Vomiting Seizures Difficulty with co-ordination/movement Impaired memory, vision, speech, hearing
Cerebral Contusion: allopathic treatment
Medical emergency
Coup injury: definition
Injury to the site of primary impact
Contrecoup injury: definition
Damage to the brain at a site contra-lateral to the site of trauma
The skull acts to stop acceleration of the brain away from the site of impact, causing damage to the opposite side
Headaches: aetiology
Dehydration Cervicogenic (from the neck) Temporomandibular joint - jaw headache Congested sinuses Hypoglycaemia Medication - e.g. paracetamol Intra-cranial - e.g. brain tumour, haemorrhage Organ referral
Cervicogenic headache:
location, duration, severity, pain character
Occipital to frontal/temporal
1 hr to weeks
Moderate to severe
Non-throbbing pain
Tension headache:
location, duration, severity, pain character
Diffuse (bilateral)
Hours to days
Mild to moderate
Dull pain
Migraine headache:
location, duration, severity, pain character
Retro-orbital (behind eyes)
4-72 hrs
Moderate to severe
Throbbing, pulsating
Cervicogenic headache: aetiology
Neck movement, sustained postures
Cervicogenic headache: signs and symptoms
Reduced neck range of movement
Cervicogenic headache: allopathic treatment
Stretching
Supporting neck
Massage
Tension headache: aetiology
Stress
Muscle tension
Tension headache: signs and symptoms
Reduced appetite
Photophobia
Tension headache: allopathic treatment
Rest
Massage
Relaxation
Migraine headache: definition
Neurological condition that results in recurrent, severe headaches
Migraine headache: aetiology
Strong links with genetics - more common in women
Food allergies
Food additives - tyramine, nitrates, MSG, aspartame, histamine, alcohol
Emotions - stress
Hormonal changes
Poor sleep
Low levels of serotonin
Complex series of intracranial vascular changes - vasoconstriction (aura) and subsequent vasodilation (headache)
Induced by cerebral depolarisation - this secretes vasodilators and pain mediators