cerebrovascular disease

Question 1

Define and explain the types of cerebral oedema

Answer 1

Excess accumulation of fluid in the brain parenchyma

Vasogenic - due to disrupted BBB
Cytotoxic - secondary to to cellular injury e.g. hypoxia or ischemia

Question 2

What is the consequence of cerebral oedema?

Answer 2

Space occupying lesion so
Raised intracranial pressure

Receptors on the astrocyte end feet surround blood vessels. AQP4 receptors e.g. can let water through to blood vessels and vice versa

You loose differentiation of sulci and gyri due to the oedema

Question 3

What pumps out

Answer 3

Choroid plexus

Question 4

Define the types of hydrocephalus

Answer 4

Non communicating time - obstructs CSF flow
Communicating -no obstruction but problems with reabsorption of CSF into venus sinuses

CSF is produced by choroid and resorbed into the venus sinuses

Cerebral acqueduct - most common area of blockage as the choroid plexus gets caught here

Question 5

Raised ICP normal range

Answer 5

7-15mm Hg in a supine adult

Question 6

Why do we get herniations?

Answer 6

Subfalcine herniation - cortex is pushed under the falx cerebri since the

Transtentorial hernination - also called UNCAL herniation

Tonsillar herniation - when the brain comes through the foramen magnum?

Question 7

Stroke FAST acronym

Answer 7

Face
Armst
Speech
Time to call 999

Question 8

Define stroke

Answer 8

Rapid onset focal or global loss of cerebral function resulting in symptoms which last for over 24 hours, or result in death

Question 9

Define stroke

Answer 9

Rapid onset focal or global loss of cerebral function resulting in symptoms which last for over 24 hours, or result in death

Cerebral infarction, primary intracerebral haemorrhage, intraventricular haemorrhage and most cases of subarachnoid harmorrhage

Excludes subdural, epidural and intracerebral haemorrhage

Question 10

TIA

Answer 10

1/3 of those with a TIA get significant infarction within 5 years

Question 11

Haemorrhage main cause and where it’s most common

Answer 11

50 percent of bleeds

most common in basal ganglia

Question 12

AVM malformation

Answer 12

high pressure big bleeds
seizures
headaches
symtomatic between 20s and 50s

treatment - surgery, embolisation, radiosurgery

Question 13

AVM malformation

Answer 13

high pressure big bleeds caused by a malformation of the arteriovenous vessels
seizures
headaches
symptomatic between 20s and 50s

treatment - surgery, embolisation, radiosurgery

congential

Question 14

Cavernous angioma

Answer 14

congenital lesion / cavity

less bleeding

Question 15

Sub arachnoid

Answer 15

rupture of berry aneurysm

ppl are born with it
risk of rupture if it’s above a certain size
cthunder club headache

Question 16

Sub arachnoid haemorrhage - when is it found? w

Answer 16

Due to rupture of berry aneurysm

ppl are born with it
risk of rupture if it’s above a certain size
thunder clap headache

Found serendipitously and then later clipped
now they are filled with coiled platinum

Low risk of bleeding

Question 17

Infarction
how much

Answer 17

Tissue death due to ischemia

66 percent of glucose is used by the brain

Thromboembolic stroke
Atherosclerosis common cause

Focal cerebral ischemia - define vascular territory
Global cerebral ischemia - systemic circulation fails

Question 18

Where do you get infarctions most commonly? What else can cause

Answer 18

Often near carotid bifurcation

Air emboli
Middle cerebral artery branches

Question 19

Differential diagnosis for infarction vs haemorrhage

Answer 19

Haemorrahge - you can get some recovery
Infarction - you do not recover

Question 20

What is the most common cause of non-traumatic intraparenchymal haemorrhage?

Answer 20

Hypertension

Question 21

Head trauma classification

Answer 21

Missile vs non-missile

Non missile - acceleration/decleration of the brain within the skull or rotation around the midline

RTA, falls and assaults

focal or diffuse

Question 22

Fractures of the skull - presentation

Answer 22

CSF through ear or nose (otorrhoea or rhinorrea)
there is an infection risk

Battle sign - skull fracture classic sign
Panda eyes - periorbital haemorrhage

Question 23

What is cerebral contusion?

Answer 23

Cerebral CONTUSION = bruising when the the brain rubs against the skull during TRA

Coup injury - hits front of skull
Contrecoup injury - when teh brain hits the front of the skull

Question 24

Which cells are affected after d

Answer 24

Tearing of axonal cells due to shear and tensile forces

commenest cause of coma if there is no bleed

Rotational injury affects the falx

There is inflammation that is ongoing after the trauma

Long term

Chronic traumatic encephalopathy - post traumatic brain injury e.g. psych symptoms within a few years of retiring from