Clinical Correlates Flashcards
Plagiocephaly
Premature fusion of 1 side of either the coronal suture or lambdoidal sutures (sometimes both)
- stimulated by environmental/positioning remodeling
Craniosynostosis
Deformities that result from premature closure of a cranial sutures, usually genetic based but can be environmental
- asymptomatic but can be symptomatic if severe
- growth of brain occurs to the opposite side of the premature closure
Positional plagiocephaly (oblique head/ flat head syndrome)
Common condition of cranial malformation generally due to repetitive positioning during baby.
- usually results in a oblique slant to the sagittal axis with one side protruding or “bossing” and the other side flattening
(Contralateral and ipsilateral bossing and flattening) - treated via Dynamic Orthotic Cranioplasty (DOC) bands which force the skull back into normal shape
Scaphocephaly
Premature fusion of the sagittal suture (40-60%)
- causes compensated growth along the lambdoidal and coronal sutures
- most common type of craniosynostosis*
Brachycephaly
Premature fusion of the coronal suture (20-30%)
- causes compensated growth laterally along sagittal sutures
- second most common type of craniosynostosis*
Plagiocephaly
Premature fusion of 1 side of the crania, either the coronal or lambdoidal sutures (4%)
- causes compensational growth along the opposite side
- 2nd rarest craniosynostosis*
Trigonocephaly
Premature fusion of the metopic suture (10%)
- causes compensational growth laterally and posteriorly (flat head)
Type of craniosynostosis
Clover leaf craniosynostosis
premature fusion of the coronal, lambdoidal, sagittal sutures
- causes compensational growth in the shape of a clover leaf
- most rare form of craniosynostosis*
Microcephaly
Premature fusion of all sutures and fontanelles during early cranial development.
- causes decreased brain and cranium growth and severe mental/cognitive dysfunctions
Hydrocephaly
Congenital inability to absorb cerebral spinal fluid resulting in overproduction of it in the cranium
- usually caused by nonformation of a shunt from the CSF -> venous system
Increases intracranial pressure and causes hypertrophic growth of the calvaria (skull) bones along the sutures (Big head)
Le fort fractures
Fractures of the maxilla. Three types
1) horizontal fractures that pass superiorly to the maxillary alveolar process (roots of teeth)
- may or may not cross into the nasal septum and pterygoid plates
2) fractures that pass posterolateral from the maxillary sinuses through the infraorbital foramina and lacrimal foramina to the bridge of the nose
- this results in the entire central face to be separated from cranium
3) horizontal fracture that passes through superior orbital fosses and the ethmoid bone to the greater wings of the sphenoid and zygomatic sutures
- can result in maxilla and zygomatic bones along with the central face to separate from cranium
Cephalohematoma
Bleeding that occurs between a babies pericarnium layer of the scalp and calvaria bones and results from excessive trauma during birth.
- this blood becomes trapped and forms a hematoma that is usually benign
Bell palsy
Injury or inflammation via viral infections to the facial nerve (CN7) or its branches on one side causes a perminant passive or sad face appearance on that side/area.
- caused by loss of loss of Tone in the obicularis oculi
Symptoms:
- sad/ passive appearance
- very dry cornea (susceptible to ulceration/scaring if untreated)
- can prevent mastication and slurred speech
- cannot whistle and present with drainage from lacrimal and salary glands (drooling)
- can have skin irritations
Trigeminal Neuralgia (Tic douloureux)
Sensory dysfunction in CN 5 with idiopathic causes
- all 3 branches of CN5 are susceptible, however the following is the order of most common to least common
1) V2
2) V3
3) V1
Symptoms:
- most common in elderly patients
- paroxysm (sudden sharp pain) in the facial region can induce twitching
- depression
- difficulties eating, brushing teeth, shaving, etc.
Herpes zoster infection of the trigeminal (CN5) ganglion
Eruption of herpes vesicles along the sensory path way of the affect branch(s)
- most common branch affect is V1 (ophthalmic)
- can produce coronal ulceration and scarring of the cornea
Buccal nerve block
When preforming any cheek surgeries/operations, the buccal nerve must be blocked
- site of anesthesia is into the retromolar fossa which is a triangular depression posterior to the 3rd molar tooth and between the anterior border of the ramus and temporal crest
- open mouth wide and place your tongue behind your last molar, this is the area*
Infraorbital nerve block
When treating wounds of the teeth, upper lip or cheek, anesthesia into the infra orbital nerve must be obtained
- site of anesthesia is in the superior aspect of the oral vestibule, to determine where specifically on this aspect, pressure is applied around it and where ever pain occurs is the site
- inside the mouth, most superior part to the 1st molar (usually but can vary) and on the anterior gum line*
Scalp infections
The loose connective tissue layer of the scalp, “often referred to as the danger zone of the scalp”, is very susceptible to infection since pus and blood spread easily to this site.
- infections here can also pass into emissary veins which take the infection into the cranium
- ecchymoses in the eyelids with no reported trauma is a cardinal sing of a scalp infection that has spread*
- a scalp infection cannot pass into the neck due to occipital bellies and also beyond the zygomatic bones due to the epic racial aponeruosis
Difference between superficial and deep scalp lacerations
Superficial: has not penetrated the cranial aponeurosis
- do not gape and do not require sutures
Deep: has penetrated the cranial aponeurosis
- do gape (very wide in the coronal region if the laceration is here) and require sutures to heal
Malar flush
Rash that breaks out along the zygomatic bone outline
- indicative of certain diseases, must commonly associated with lupus and TB infections
Fractures of mandible
Usually results in two fractures, not just one.
- only exception is a fracture of the coronoid process of the mandible, however this is extremely rare
Resorption of alveolar bone
Extraction of teeth causes alveolar bone to resort in the regions
- causes bone loss in the alveolar bone, but filling of the tooth cavity with bone
can result in exposure of the mental foramina which can result in mental nerve impingement
Fractures of the calvaria
Usually result in comminuted depressed fractures
Most common type is a linear fracture which occurs at the site of impact and spreads out ward
- rare type is contrecoup (counterblow) fractures where a depressed fracture occurs directly opposite of the site of force*
Meningitis
Infections of the leptomeninges usually caused by bacteria, virus or fungal infections
- bacterial is the most serious
Symptoms:
- headache
- fever and chills
- stiff neck
- vomiting
- cardinal sign of meningitis is cloudy CSF with increased number of proteins*
Viral meningitis = normal glucose w/ lymphocytes in CSF
TB meningitis = decreased glucose w/ lymphocytes in CSF
Bacterial meningitis = decreased glucose w/ polymorphonuclear leukocytes in CSF
Meningiomas
Tumors that arise from meninges
- idiopathic causes but seem to be relegated to chromosome 22
Surgical removal or radiation kills the tumors
Vertebral-basilar circulation
Includes the vertebral arteries, the basilar artery, and the basilar artery branches
This circulation supplies medulla, pons, mesencephalon and cerebellum
Vertigo/ Meniere disease
Bursting of the membranous labyrinth caused by excess endolymph production or blockage of the endolymphatic duct
Marked by tinnitus, hearing loss and vertigo
- ballooning of the cochlear duct, saccule and utricle*
Tinnitus
Ringing of the ear via prolonged exposure to Loud noises
Ottis media
Infection of the middle ear usually secondary to upper respiratory infections
Earache and a bulging red tympanic membrane indicates this
Can produce impaired hearing via scarring if left untreated
Ottis externa
Infection/inflammation of the external acoustic meatus
-usually develops from water in the ear or bacterial infections
Marked by redness of the outer ear and pulling on the auricle/Tragus causes pain
Mastoidits
Infections of the mastoid air cells that results in a middle ear infection and inflammation of the mastoid process
Infection can spread into middle cranial fossa and cause Osteomyelitis if untreated
Motion sickness
Discordance between the vestibular and visual stimuli
Caused by otoliths not functioning properly for linear/ angular acceleration
Subarachnoid hemorrhage
Usually caused by rupture of one or more of saccular aneurysms
Mixes with CSF as well and is caused primarily by head trauma
- presents with yellow CSF = indicative of RBCs
Septic thrombosis of cavernous sinus
Infections from orbit, paranasal sinuses or face cause thrombi into the cavernous sinus
Can affect abducens, oculomotor, trochlear, ophthalmic and maxillary nerves
Strokes (cerebrovascular accidents)
Disruption of normal blood flow of brain resulting in death of brain cells.
- most common neurological disorders in US adults*
Cardinal symptom is sudden neurological symptoms out of nowhere
Two types ischemic (blockage) or hemorrhagic (bleeding)
Cerebral herniations
Herniations of brain into one of three compartments
- infratentorial
- right and left supratentorial
Caused by lesions/tumors
Most common types are the following
- subfalcine = inferior, free border of falx cerebri
- tentorial = around border of tentorial notch
- tonsillar = cerebellar tonsils through foramen magnum
Epidural hemorrhage
Caused by lesion or vessel burst with blood pooling between the caval bones and the periosteal layer of the dura mater.
Subdural hemorrhage
Blood pooling between the meningeal dura layer and the arachnoid layer
Usually a result from dural venous lesions/bursts
Saccular/berry aneurysms
Most common form of cerebral aneurysms
- most commonly occurs when circle of Willis needs to anastomosis
- this causes a subarachnoid hemorrhage if it ruptures*
Concussion
Head injury with temporary loss of brain function
- can cause loss of consciousness but not always
Symptoms tend to resolve after one or two days but can persist for months as post-concussion syndrome
- only roughly 15% of cases escalade to this
Cerebral contusion
Brushing of the brain by forceful contact between inner surface of skull and polar regions of cerebral hemispheres via head trauma
Edema levels often decide degree of symptoms
Develops scars after macrophages engulf and destroyed bruised brain tissue
- usually doesn’t require surgery though
Non-communicating vs communicating hydrocephalus
Non-communicating = obstruction of CSF within ventricular system and leads to dilation of ventricles
- usually cerebral aqueduct or intraventricular foramen
Communicating = obstruction of CSF outside ventricular system
- usually by impaired reabsorption from the arachnoid granulations, or overproduction of CSF
Leakage of CSF
Fractures of floor of the middle cranial fossa as well as tympanic membrane rupture can lead to CSF leakage from external acoustic meatus (CSF otorrhea)
Fractures of the anterior cranial fossa and cribiform plate May result in CSF leakage through nose (CSF rhinorrhea)
- both causes major increase in meningitis chances*
Guillian-Barre syndrome
Inflammation disease in CSF and CNS that causes demyelination of axons in peripheral nerves
CSF notes massive increase in proteins with normal glucose and some WBC
Hyperthyroidism
Overactive thyroid that results in multiple symptoms surrounding increased metabolism
Almost never caused by too much TSH being released
is almost always found in Graves’ disease where you get enlarged bulging eyes
Hypothyroidism
Underactive thyroid
Symptoms surround slow metabolism specifically weight gain and exhaustion
Goiter
Massively enlarged thyroid caused by a lack of iodine in the diet
Lingual/ectopic thyroid
Thyroid fails to descend during development and stays behind the tongue
Branchial cysts
Embryological Grooves do not obliterate and remain, filling with fluid or draining fluid to external surface (leaking)
Pharyngeal arch syndrome
Insufficient migration of neural crest cells into the arches during week 4 can cause cartilages to not degrade normally
Causes variety of congenital defects in the eyes, ears, mandible and palate
Treacher-Collins syndrome
Underdevelopment of the zygomatic bones via 1st arch defects
Symptoms are
- under developed jaw
- underdevelopment of zygomatic bones
- retracted tongue
- poor teeth
- external ear defects
Causes abnormalities to the external, Middle and inner ear
Hearing, seeing and breathing can all be affected
Pierre robin sequence
Underdeveloped mandible, cleft palate and defects of the eye and ear via 1st arch defects
Symptoms
- hypoplastic mandible
- bilateral cleft palate
- defects of the eyes and eats
Cervical (branchial) cysts
Cervical sinus/2nd groove remnants remain and form cysts that grow overtime
Usually found in the neck inferior to the ankle of the mandible (gonion)
Not usually apparent under early adulthood
Cervical (branchial) fistula
Abnormal canal that opens into the tonsillar sinus, through the neck and then ultimately into the carotid stealth
Caused by persistence of both the 2nd groove and 2nd pouch
