Cerebrovascular disease and trauma Flashcards
1
Q
What is cerebral oedema?
A
Excess accumulation of fluid in the brain parenchyma
Result is raised intracranial pressure
2
Q
What are the types of cerebral oedema?
A
Vasogenic – disruption of the blood brain barrier
Cytotoxic – secondary to cellular injury e.g. hypoxia/ischaemia
3
Q
How does oedema form?
A
4
Q
What is this?
A
Oedema
Lack of sulci on imaging
5
Q
Draw out the ventricular system
A
6
Q
What are the types of hydrocephalus?
A
- Non-communicating involves obstruction of flow of CSF
- Communicating involves no obstruction but problems with reabsorption of CSF into venous sinuses
7
Q
What are the consequences of raised ICP?
A
- ICP is measured in mmHg and, at rest, is normally 7–15mmHg for a supine adult
- Enclosed bony box- pressure can increase because of localised (space occupying) lesions, oedema or both
- Increased pressure forces brain against unyielding bony wall of skull
- This results in herniation of brain structures where space is available
8
Q
A
Hernia
9
Q
Why is stroke bad?
A
- Stroke is the third biggest cause of death in the UK and the largest single cause of severe disability
- Each year more than 110,000 people in England will suffer from a stroke
- This costs the NHS over £2.8 billion
10
Q
What is a stroke WHO?
A
- A stroke is a clinical syndrome characterised by rapidly developing clinical symptoms and/or signs of focal, and at times global loss of cerebral function, with symptoms lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin (Hatano, 1976)
- This definition includes stroke due to cerebral infarction, primary intracerebral haemorrhage, intraventricular haemorrhage and most cases of subarachnoid haemorrhage
- It excludes subdural haemorrhage, epidural haemorrhage, intracerebral haemorrhage (ICH) or infarction caused by infection or tumour
11
Q
What is a TIA?
A
- TIA is a warning stroke that should be taken very seriously
- TIA is caused by a clot; the blockage is temporary
- Most TIAs last less than five minutes; the average is about a minute. Unlike a stroke, when a TIA is over, there is usually no permanent injury to the brain
- 1/3 of those with TIA get significant infarct within 5 years
- REMEMBER: TIA important predictor of future infarct
12
Q
What is Non-traumatic intra-parenchymal haemorrhage?
A
- Haemorrhage into the substance of the brain - rupture of a small intraparenchymal vessel
- Most common in basal ganglia
- Hypertension > 50% of bleeds
- Presentation with severe headache, vomiting, rapid loss of consciousness, focal neurological signs
13
Q
What is a AV malformation?
A
- Occur anywhere in the CNS
- Become symptomatic between 2nd and 5th decade (mean age 31.2 years)
- Present with haemorrhage, seizures, headache, focal neurological deficits
- High pressure – MASSIVE BLEEDING!!!
- Seen on angiography
- Morbidity after rupture 53-81% - high in eloquent areas
- Mortality 10-17.6%
- Treatment: surgery, embolization, radiosurgery
14
Q
What does this show?
A
Stroke
15
Q
What is cavernous angioma?
A
- “Well-defined malformative lesion composed of closely packed vessels with no parenchyma interposed between vascular spaces”
- Can be found anywhere in the CNS, usually symptomatic after age 50
- Pathogenesis unknown
- Present with headache, seizures, focal deficits, haemorrhage
- Low pressure – recurrent bleeds
- Treatment: surgery
20
Q
Where are the vascular territories?
A
