cerebrovascular disease Flashcards
Define and explain the types of cerebral oedema
Excess accumulation of fluid in the brain parenchyma
Vasogenic - due to disrupted BBB
Cytotoxic - secondary to to cellular injury e.g. hypoxia or ischemia
What is the consequence of cerebral oedema?
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
What pumps out
Choroid plexus
Define the types of hydrocephalus
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
Raised ICP normal range
7-15mm Hg in a supine adult
Why do we get herniations?
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?
Stroke FAST acronym
Face
Armst
Speech
Time to call 999
Define stroke
Rapid onset focal or global loss of cerebral function resulting in symptoms which last for over 24 hours, or result in death
Define stroke
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
TIA
1/3 of those with a TIA get significant infarction within 5 years
Haemorrhage main cause and where it’s most common
50 percent of bleeds
most common in basal ganglia
AVM malformation
high pressure big bleeds
seizures
headaches
symtomatic between 20s and 50s
treatment - surgery, embolisation, radiosurgery
AVM malformation
high pressure big bleeds caused by a malformation of the arteriovenous vessels
seizures
headaches
symptomatic between 20s and 50s
treatment - surgery, embolisation, radiosurgery
congential
Cavernous angioma
congenital lesion / cavity
less bleeding
Sub arachnoid
rupture of berry aneurysm
ppl are born with it
risk of rupture if it’s above a certain size
cthunder club headache
Sub arachnoid haemorrhage - when is it found? w
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
Infarction
how much
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
Where do you get infarctions most commonly? What else can cause
Often near carotid bifurcation
Air emboli
Middle cerebral artery branches
Differential diagnosis for infarction vs haemorrhage
Haemorrahge - you can get some recovery
Infarction - you do not recover
What is the most common cause of non-traumatic intraparenchymal haemorrhage?
Hypertension
Head trauma classification
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
Fractures of the skull - presentation
CSF through ear or nose (otorrhoea or rhinorrea)
there is an infection risk
Battle sign - skull fracture classic sign
Panda eyes - periorbital haemorrhage
What is cerebral contusion?
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
Which cells are affected after d
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
