Cerebral Edema, Hydrocephalus, Increased Intracranial Trauma

Question 1

Type of cerebral edema caused by increased vascular permeability:
-fluid shifts into intERcellular spaces in brain

Answer 1

Vasogenic

Question 2

Cerebral edema caused by cell membrane injury

• increased intRAcellular fluid
• typically seen with hypoxia or metabolic damage

Answer 2

Cytotoxic

Question 3

Treatment for vasogenic cerebral edema (2):

Answer 3

Dexamethasone

Mannitol

Question 4

Mechanism of action for dexamethasone CE treatment:

Answer 4

reduces water permeability of tight junctions

Question 5

Mech of action for Mannitol treatment of CE:

Answer 5

Osmotic diuretic

• increased number of particles in blood draws water in lumen of vessels
• small sugar, does not cross BBB

Question 6

Treatment for cytotoxic CE:

Answer 6

NONE

Question 7

Accumulation of excessive CSF within the ventricle system:

Answer 7

Hydrocephalus

Question 8

Five kinds of hydrocephalus:

Answer 8

1. Communicating
2. Non-communicating
3. Ex vacuo
4. Increased CSF production
5. Normal pressure

Question 9

Hydrocephalus where only part of the ventricular sys is enlarged due to a blockage in the system:
ie. tumor, abcess, hematoma, congenital malformation

Answer 9

Noncommunicating

Question 10

Hydrocephalus where entire ventricular sys is enlarged:

Causes?

Answer 10

Communicating

• blockage in subarachnoid space
• resolving meningitis
• subarachnoid hemorrhage
• dural sinus thrombosis

Question 11

Ventricular sys is enlarged due to brain atrophy (with compensatory increase in CSF)
-ie. Alzheimer, Pick disease

Answer 11

Ex Vacuo

Question 12

Uncommon hydrocephalus due to increased CSF production:

ie. choroid plexus papilloma

Answer 12

Hydrocephalus due to increased CSF…duh

Question 13

Large ventricles with no cortical atrophy, possibly from previous communicating hydrocephalus
-elderly patient with:
"MAGNETIC" gait
urinary incontinence
dementia

-may be reversible

Answer 13

Normal Pressure Hydrocephalus

Question 14

Two treatments for hydrocephalus:

Answer 14

1. Surgery to get fluid out (usually a shunt)

2. Decrease CSF production

Question 15

Two drugs to decrease CSF production:

How do they work?

Answer 15

Acetazolamide: carbonic anhydrase inhibitor
-prevents production of HCO3

Furosamide: NKCC transporter inhibitor (Lasix)
-keeps Na, K, and Cl out of CSF making it hypotonic and sending water back into ependymal cells and then to blood

Question 16

Most common causes of increased intracranial pressure:

Answer 16

Mass effect

• Edema
• tumor
• hematoma

Question 17

Feared outcome of increased intracranial pressure:

Answer 17

Herniation which leads to ischemia (decreased/loss of blod supply)