CNS malformations- Parks Flashcards
What are the 6 types of nervous system pathology?
- contusion, necrosis (traumatic closed head injury)
- cerebral edema
- herniation
- malformations (NTDs and spina bifida)
- Hydrocephalus
- Developmental Problems (Arnold-Chiari malformation)
When the brain moves around, within the skull, it is called a (blank). It can lead to a contusion which can also lead to a (blank) clinically.
closed head injury
concussion
Whats the difference between a cotusion and concussion?
contusion-> is the lesion in the brain
Concussion->temporary unconsciousness caused by a blow to the head
When the brain hits the front of the skull it is called (blank). When the brain hits the back of the skull it is called (blank)
coup
contrecoup
When cells die in closed head injury you will get (blank) .
edema
Following trauma you will get (Blank) edema from a damaged BBB
vasogenic edema
What other kinds of edema is present in trauma but just to a lesser extend than vasogenic edema?
cytotoxic edema
cerebral edema
What besides trauma shows cerebral edema?
tumors, inflammation (encephalitis)
In vasogenic edema, fluid shifts from (Blank) into extracellular space.
vascular
Following stroke and hypoxic-ischemia insult (cardiac arrest) you will get (Blank) edema
cytotoxic edema
Cytoxic edema results because of (blank) and (Blank) being injured
neurons and glial cells
When you damage the BBB (Blank) will leak out between cells
fluid
How does injury lead to swelling?
injury-> hypoxia-> sodium moves into cell and potassium out-> water moves into cell-> extensive vaculation and swelling-> Hydropic degeneration
Whn you have cerebral edema what does the brain look like?
flattened gyri and shallow sulci
How do you get herniation?
when you have swelling in your brain and the brain has no place to escape so herniates
What are the three kinds of herniation?
falx herniation
uncal herniation
cerebellar herniation
What is the worst hernation? Why?
uncal herniation
cuz it will affect your brain stem and cause nerve impingement and artery occlusion
An uncal herniation will impinge what cranial nerve and what will this present as?
CN 3 and present as ipsilateral dilation of pupil
Why will you get vision problems with uncal herniation?
the uncus will impinge on the posterior cereral artery which supplies the visual cortex which will cause ischemia there and therefore vision problems
Uncal transtentorial herniation refers to impaction of the (blank) gyrus into the (blank) opening just anterior to and adjacent to the midbrain
anterior medial
tentorial opening
How do you get a coma when you have an uncal herniation?
due to compression of the midbrain against the OPPOSITE tentorial edge
Why can you sometimes get a babinskis sign and hemiparesis contralaterla to the original hemiparesis?
due to compression of the opposite cerebral peduncle
Uncal herniation may aso compress the anterior and posterior (blank) causing (Blank)
cerebral arteries
hydrocephalus
What is the Kernohan-Woltman sign?
when you get a babinskis sign and hemiparesis from compression of cerebral peduncle by an uncle herniation
(blank) are small areas of bleeding in the ventral and paramedian parts of the upper brainstem, (midbrain and pons).
Duret hemorrhages
What will extreme displacement of the brainstem result in? Is it fatal?
duret hemorrhage
usually fatal
Why does durets hemmorhage cause death?
because it will create a mass affect and apply too much pressure to the brain stem respiratory center and induce ischemia resulting in inability to breath and respiratory failure
What are the brain stem respiratory center components?
- pneumotaxic center
- caudal pons
- retrotrpezoid nucleus
If you have impingement, compression or a messed up posterior cerebral artery what will result?
vision problems
If you see a brown spot in the brain what is it?
ischemic necrosis-infarct
A subdural hematoma can result in a (blank)
uncal herniation
The neural tube closes around day (Blank)
28-30
WHen are fetuses most susceptible to teratogens?
3-9 weeks
What are the three neural tube defects that people can possibly live with?
- spina bifida occulta
- meningocele
- myelomeningocele
In a meningocele, what does the spinal cord look like?
it is intact, you just have a weird bubble protruding out your back
IN myelomeningocele, what does the spinal cord look like?
the spinal cord and nerves go out into the sac protruding in your back
Which is more sever, meningocele or myelomeningocele?
myelomeningocele
What result if you have a myelomeningocele?
you get bladder and walking problems, nerve and artery impingments
Is spina bifida occulta pretty bad?
No not at all, you just dont have completey formed vertebrae and but you dont get spinal or nerve protrusion through the gap.
How can you tell if a women is pregnant with a fetus that has a neural tube defect?
LOok for elevatd AFP levels in her blood.
if you have open neural tube, a ton of AFP will leak out into the amniotic fuid which leak into the maternal blood
What do moms need to eat when pregnant?
folate and iron
How do babies get congenital hydrocephalus?
they get edema before suture fusion
How do you treat congenital hydrocephalus?
you use a ventricuar catheter to drain the fluid
T or F congenital hydrocephalus (CHC) is one of the most frequent congenital malformation of CNS
T
What are the risk factors for CHC?
- -Lack of prenatal care
- maternal diabetes
- maternal HTN
- -maternal consumption of alcohol
- certain infections (parvovirus B19)
- maternal antidepressants (SSRIs)
How does CSF start and end?
gets produced by the choroid plexus and goes through the ventricles into the subarachnoid space where it is reabsorbed by the arachnoid villi
What happen if you get inflammation in the arachnoid villi?
you get scarring which will cause them to be unable to reabsorb CSF and thus results in hydrocephaly
WHat are the 2 types of hydrocephalus?
- noncommunicating
- communicating
What is a noncommunicating hydrocephalus?
localized obstruction within the ventricular system. (only that ocal ventricle enlarges while the other ventricles do NOT enlarge)
What is a communicating hydrocephalus? WHen does this typically occur?
entire ventricular system enlarges.
-from reduced CSF reabsorption
What do adult patients with hydrocephalus complain of?
urinary incontinence, headache, apraxia (cant move the way you want to), dementia
What do dialated ventricles indicate?
hydrocephalus
What is hydrocephalus caused by?
- impaired reabsorption
- obstruction
- overproduction is rare
What are all the place you can get hydrocephalus?
-Problems at the foramen of monroe, third ventricle, fourth ventricle, pineal regions, cerebral aqueduct
What kinds of obstructions can cause hydrocephalus?
- absorptive obstruction
- basilar obstruction
What are the ways you can get absorptive obstruction?
- arachnoditis (posthemorrhagic)
- postmenigitic
- venous thrombosis
What can happen in the pineal region of the brain that can induce hydrocephaly?
tumor
What can happen in the cerebral aqueduct that can induce hydrocephaly?
- aqueductal stenosis
- aqueductal forking
- subependymal gliosis
- periaqueductal gliomas
What can happen in the foramen of monro that can cause hydrocephaly?
- gliosis
- colloid cysts
What can happen in the third ventricle that can cause hydrocephaly?
- chiasmal gliomas
- craniopharyngiomas
- arachnoid cysts
What can happen in the fourth ventricle that can cause hydrocephaly?
- medulloblastomas
- ependymomas
- astrocytomas
- Dandy-Walker cysts
