Cerebral Pathology Flashcards
Describe cerebral infarction. What are the risk factors?
An area of tissue death due to lack of oxygen. This accounts for 70-80 percent of all strokes and is most commonly caused by atherosclerosis.
Risk factors include smoking, diabetes, hypertension, family history, oral contraceptive, alcohol and hyperviscosity disorders.
What is the epidemiology, symptoms, vascular territories, investigations and management of stroke?
Stroke is defined as an ischaemia which results in a constellation of symptoms that last for longer than 24 hours.
Epidemiology:
- 100,000 new strokes every year
Symptoms:
- Depends on territory of assault
- Sudden onset, facial drooping, slurred speech, muscle weakness
- Numbness, loss of vision, dysphagia
Vascular territories:
- Commonly the MCA
- Can be any
Investigations:
- CT/MRI
- Investigation of vascular risk: FBC, ESR, BP, glucose, lipids, CXR, ECG, doppler
Management:
- Aspirin and dipyridamole
- Thrombolytics (if <3 hours)
- Carotid endartectomy
- Long term: HTN management, reduce lipids, anticoagulation
What is the epidemiology, symptoms, vascular territories, investigations and management of a transient ischaemic attack?
TIA is defined as an ischaemia which results in a constellation of symptoms that last for less than 24 hours.
Epidemiology:
- 0.4/1000 every year
- 1/3 will go on to develop stroke
Symptoms:
- Last less than 24 hours, usually <5 minutes
- ‘funny turn’
- Depends on territory of assault
- Sudden onset, facial drooping, slurred speech, muscle weakness
- Numbness, loss of vision, dysphagia
Vascular territories:
- Can be any
- Characteristically emboli travel to ophthalmic branch of internal carotid (visual symptoms)
Investigations:
- CT/MRI
- Investigation of vascular risk: FBC, ESR, BP, glucose, lipids, CXR, ECG, doppler
Management:
- Aspirin and dipyridamole
- Carotid endartectomy
- Long term: HTN management, reduce lipids, anticoagulation
Describe the causes of non-traumatic haemorrhage
Intraparenchymal haemorrhage:
- Half will be due to hypertension
- Abrupt onset, headache, LOC, focal signs
- Common at basal ganglia
Subarachnoid haemorrhage
- 85 percent from ruptured berry aneurysms
- Mostly at internal carotid bifurcation, females more at risk
- Highest risk of rupture when aneurysm at 6-10mm
- Thunderclap headache at back of head, vomiting, LOC
- Increased in Ehler’s Danlos, PKD
Describe causes of traumatic haemorrhage
Leading cause of death <45 years
Extradural haemorrhage
- Skull fracture
- Ruptured meningeal artery
- Rapid arterial bleed
- Lucid interval then LOC
Subdural haemorrhage
- History of trauma
- Elderly or alcoholic
- Brain atrophy and fluctuating consciousness
Describe causes of traumatic parenchymal injury
Missile: war zones
Non-missile: more common in civilian areas
- Rapid acceleration and deceleration
- Falls, assaults, RTC
- Rotations
- Fractures
Fractures:
- can be down to base of the skull
- CSF leak through ears or nose
- Infection risk
Concussion:
- Transient LOC
- Recovery in days or hours
- Predisposes to degeneration
Diffuse axonal injury:
- Number one cause of coma
- Prognostic factor of recover
Contusions:
- In areas where brain by bone (temporal)
Describe causes of oedema in the brain
Vasogenic:
- Caused by leaky capillaries
Cytotoxic:
- Caused by leakage from cells
Describe hydrocephalus
It is a build up of CSF, which can be communicating or non-communicating.
Communicating:
- Reduced CSF absorption
Non-communicating:
- Blockage (usually of aqueduct)
- In children: choroid plexus blocks aqueduct
Normal pressure:
- Reversible cause
Describe the normal intra-cranial pressure and causes for it to be raised and the consequences
Normal:
- 7-15mmHg for supine adult
Causes of raised ICP:
- Space occupying lesion
- Oedema
- Hydrocephalus
Consequences:
- Headache
- Herniation
Describe the different types of herniation
- Subfalcine
- Transtentorial
- Tonsillar (this is cerebellar tissue, not cerebral)
