C.N.S. Normal anatomy, congenital anomalies Flashcards by Iseoluwa Ojo

The brain Develops from the _______

neural tube

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Brain is Subdivided into:

○_____brain
○______brain
○____brain

Fore

Mid

Hind

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Primary brain vesicles

____encephalon (forebrain)
_____encephalon (midbrain)
_________encephalon (hindbrain)

Prosencephalon
Mesencephalon
Rhombencephalon

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Secondary brain vesicles
____encephalon
____encephalon
___encephalon
____encephalon
____encephalon

Telencephalon
Diencephalon
Mesencephalon
Metencephalon
Myelencephalon

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Prosencephalon gives you _________ secondary vesicle

Mesencephalon gives you _________ secondary vesicle

Rhombencephalon gives you _________ secondary vesicle

Telencephalon; Diencephalon

Mesencephalon

Metencephalon; Myelencephalon

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Prosencephalon gives you _________ Adult neural canal regions

Mesencephalon gives you _________ Adult neural canal regions

Rhombencephalon gives you _________ Adult neural canal regions

Lateral ventricles; Third ventricle

Cerebral aqueduct

Fourth ventricle; Central canal

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CNS congenital abnormalities

This refers to a morphological abnormality of the CNS that dates to the embryonic or fetal period, regardless of the mechanism of its origin.

_______ are most common

Accounts for between ____ to ——% of cases that occur in Nigeria (studies from Enugu, Jos, Kano, Lagos)

Neural tube defects (NTD)

60 to 90

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Neural tube defects
Anencephaly

○Total (____) or partial (____) _______ of the brain with absence of the _________ and _______

holo

mero

absence

cranial vault and covering skin.

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Neural tube defects: Anencephaly

○Results from failure of ________________________________

closure of the anterior portion of the embryonic neural tube.

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Anencephaly is compatible with life

T/F

Stillbirths or die immediately after birth

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Aetiology of anencephaly

○_____ and _____ deficiency

○Genetic defects: Inactivation of _____________

○Environmental: ______,________

Folate & Vit B12

NUAK2 kinase (anencephaly)

Maternal smoking, radiation,

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Craniorachischisis
○is basically ________ combined with a _________________________________

○Failure of ____________________

Anencephaly

contiguous bony defect of the spine and meninges.

closure of the anterior neuropore.

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Craniorachischisis is compatible with life

T/F

Stillborn foetus

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Neural tube defects: Iniencephaly
○Failure of ___________

○Characterised by ________ defect, _________ of the ______ vertebrae and _______________ on the cervical spine.

closure of neural tube

occipital bone

spinal bifida ; cervical

retroflexion of the head

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Neural tube defects: Iniencephaly

Associated with Trisomies ———— as well as lack of ____________, drugs e.g. _______, and ________.

18 & 13

folic acid supplementation

vinblastine; obesity

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Iniencephaly is compatible with life

T/F

Results in miscarriage or stillborn

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Neural tube defects: Encephalocele

○Characterised by a _______________ or _____________ skin covered lesion protruding through a __________________ as a result of the failure of the ___________________________________

pedunculated or sessile cystic,

defect in the cranium

surface ectoderm to separate from the neuroectoderm.

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Encephalocele

May be classified based on content/site

Content:

Meninges (________)

meninges and brain tissue (________)

brain (_________)

Meninges (meningocele)

meninges and brain tissue (meningoencephalocele)

brain (encephalocele)

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Encephalocele

May be classified based on content/site

Location: list 6

frontal, nasofrontal, occipital, parietal,orbital, nasal

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Encephalocele

Diagnosis:______ (pre- and post-natal)

Treatment:_______.

imaging

surgery

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Spina Bifida

Incomplete embryologic closure of the _____________

vertebral arches

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Most common NTD is ???

Spina bifida

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Spina bifida: Classification

○Anatomical: _______ ,______,_______

Cervical, Thoracic, Lumbosacral

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most common Anatomical location for Spina bifida is ??

Lumbosacral

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Spina bifida : Severity of defect Spina bifida ______ Spina bifida _________ ___________/_____________

occulta cystica Myelocele/syringomyelocele

Spina bifida : Severity of defect Spina bifida occulta: just a ——————-, ____________________ Spina bifida cystica: ______ of the _____________ and or __________________. Myelocele/syringomyelocele: defective _____________ leading to ________

vertebral defect; does not affect spinal cord and meninges herniation; meninges (dura & arachnoid); spinal cord (meningo-/myelomeningocele) closure of the spinal canal; CSF leakage

Myelomeningocele and myelocele are associated with neurologic deficits including _______,________, and ______

bladder and bowel dysfunction, paraplegia.

__________ and _______ are associated with neurologic deficits including bladder and bowel dysfunction, paraplegia.

Myelomeningocele and myelocele

Spina bifida Diagnosis is by imaging (may be confused with _________________). Increased levels of _____ in maternal blood in certain cases Amenable to _________

sacrococcygeal teratomas AFP surgery

Hydrocephalus The __________ of ________________ in the ventricular system.

accumulation excessive cerebrospinal fluid

Hydrocephalus This usually results in the _______ of the ________ and increased ——————

dilatation ventricles intracranial pressure.

The incidence of congenital hydrocephalus in the U.S. is ___/1000 live births. Globally, the incidence is higher in ______ and _______ (145 and 316/100,000 live births). It is lowest in _______ (68/100000 live births)

3 Africa and Latin America North America

Hydrocephalus (Classification) ________ hydrocephalus ________ hydrocephalus

Primary Secondary

Hydrocephalus (Classification) Primary hydrocephalus: characterised by _______________ alongside ___________

increased volume of CSF increased intracranial pressure.

Hydrocephalus (Classification) Primary hydrocephalus: It can be divided into: ○_____________ ○________________

Communicating Non-communicating

Secondary hydrocephalus: caused by _____________ with resultant compensatory ___________. In this case, there is ______________________________

reduction in neural tissue increase in CSF volume no increase in intracranial pressure.

CSF production Produced by the _________ in the ________________ _____ -_______ mls in volume

choroid plexus lateral, 3rd, 4th ventricles 120 - 150

Primary Hydrocephalus Aetiology ○________ to CSF flow ○_____________ of CSF ○__________________ of CSF

Obstruction Increased production Reduced absorption

Non-communicating Hydrocephalus Characterised by ———- to CSF flow at the level of the _____________,____________,_____________ or __________________

obstructions intraventricular foramen, 3rd ventricle, aqueduct of sylvius or the foramen of Lushcka and Magendie.

Non-communicating Hydrocephalus Aetiology ○ Congenital : ______ of the aqueduct ___________ malformation Intra-uterine _______ Progressive _______ of the aqueduct and ____________ ____________ syndrome

Stenosis Arnold-Chiari meningitis gliosis; arachnoid cysts Dandy-Walker

Non-communicating Hydrocephalus Aetiology ○ Acquired: ________ __________ ___________________

Tumours Haemorrhage Inflammatory lesions

Non-communicating Hydrocephalus Aetiology ○ Acquired: Tumours e.g. ____________,_________ Haemorrhage: ————,———-,————- Inflammatory lesions: _________,_________

choroid plexus papillomas, ependymoma Epidural, subdural, intraventricular Meningitis, cerebral abscess

Communicating Hydrocephalus CSF _________ within the _________ and the ___________.

freely flows dilated ventricles spinal canal

Communicating Hydrocephalus Aetiology: ○Overproduction of CSF e.g. _________ ○Impaired reabsorption e.g. following ______,___________ etc ○Congenital absence of _________

choroid plexus papilloma meningitis, subdural haemorrhage arachnoid villi

Secondary hydrocephalus •__________ hydrocephalus •Hydrocephalus ______

Normal pressure ex-vacuo

Secondary hydrocephalus •Normal pressure hydrocephalus: ○(Slow or Rapid?) but persistent increase in CSF. ○The ______ around the ventricles compensate and the fluid pressure in the head _________

Slow tissues; does not increase.

Secondary hydrocephalus •Normal pressure hydrocephalus: ○May result from head trauma, infections, post-surgery or be insidious ○Characterised by problems with ________,_________, and —————

walking, bladder control and difficulty with reasoning

Clinical features of hydrocephalus Infants: (Small or Large?) head (slow or rapid?) increase in head size bulging ________ _________ vomiting problems with ______ eyes fixed _________ (“________”) seizures.

Large ; rapid anterior fontanelle projectile; feeding downwards; sun setting

Clinical features of hydrocephalus Older children/young to middle aged adults: headache, _________ nausea and vomiting difficulty in __________ poor ————— loss of ______ control _______ loss

blurred vision maintaining balance coordination bladder memory

Clinical features of hydrocephalus Older adults: ________ problems (____ feeling ____), ——— impairment and _________ loss of _________ poor __________________

Walking; feet; stuck mental ; dementia bladder control coordination and balance

Investigations of hydrocephalus Imaging: Ultrasound, MRI, CT Scan ○ ______ ventricles, loss of ____________ and sites of obstruction Neurological examination

Enlarged sulcal gyral pattern

Treatment of hydrocephalus Surgery: ○______ ○________ ———- _______ ○Choroid villi ________ ○__________ / removal of tumour

○Shunts ○Endoscopic third ventriculostomy ○Choroid villi cauterisation ○Debulking / removal of tumour

Treatment of hydrocephalus Drugs: ______ and _______ are useful in reducing CSF production Physiotherapists, speech therapists etc

furosemide and acetazolamide

____________ is world spina bifida and hydrocephalus day

October 25th

Neural Tube Begins as neural _____ to neural _____ which “closes” to form neural ____ Process complete by ________ gestation

plate fold Tube 28 weeks

Neural Tube ___________ = cranial and caudal open ends of tube (First or Last?) structures to close

Neuropores Last

Neural Tube Defects: Risk Factors Low ———- intake during pregnancy _________ drugs, Especially _______ and ________

folic acid Antiepileptic valproic acid ; carbamazepine

Neural Tube Defects Risk Factors Folate in pregnancy Normal-risk mothers: _____ mcg/day High-risk mothers: ___mg/day

400 4

ANENCEPHALY Ultrasound: ____ calvaria _____-like appearance of fetus

Open Frog

ANENCEPHALY Mother will have ______hydramnios Why?

poly Baby can’t swallow amniotic fluid normally

Least common neural tube defect is ????

ENCEPHALOCOELE

ENCEPHALOCOELE Most common site:________ bone

occipital

SPINA BIFIDA: Clinical Features May damage ____________ nerves _____/______ dysfunction _______ symptoms Treatment: surgery

spinal cord Motor / sensory Urologic

Spina Bifida Occulta Often has skin abnormalities: ____,______ Usually (asymptomatic or symptomatic?)

dimple, tuft of hair asymptomatic

Least common type of spina bifida is ?????

Meningocele

Meningocele Usually ( asymptomatic or symptomatic?) (Good or Bad?) prognosis

asymptomatic Good

Dandy-Walker Malformation ______ or ———— of the _____________ (Enlarged or Shrunken?) _______ ventricle

Hypoplasia or agenesis; cerebellar vermis Enlarged; 4th

Dandy-Walker Malformation ______ of ——- ventricle  hydrocephalus Imaging findings: Small ________ Dilated ________

Cysts; 4th cerebellum 4th ventricle

Dandy-Walker Malformation Often detected by _______ in utero

ultrasound

Dandy-Walker Malformation Many, many associated symptoms/conditions: ____,______, or ______defects ____________________

Heart, facial or limb Spinal bifida

Dandy-Walker Malformation Affected children _________ Delayed ________ ________ dysfunction (crawling, walking) Ataxia

Hydrocephalus development Motor

NPH(normal pressure hydrocephalus) PATIENTS ARE _______,________, and ————

WET, WOBBLY & WACKY