CNS Trauma Flashcards
Excess fluid in brain parenchyma
Cerebral oedema
Enlarged cerebral ventricles
Elderly
Triad of: Dementia, apraxic gait, urinary incontinence
Normal pressure hydrocephalus
Obstructed CSF flow
Physical blockage
Non-communicating hydrocephalus
No obstruction to CSF flow
Lack of CSF absorption - meningitis, SAH
Communicating hydrocephalus
Raised ICP can result in…
Herniation
Normal ICP
7-15mmHg
3 main types of herniation
Subfalcine (under falx cerebri - most common)
Transtentorial (inner part of temporal lobe (uncus) compresses brainstem)
Tonsilar (coning - cerebellum through foramen magnum)
Cerebellum through foramen magnum (coning)
Tonsilar herniation
Uncus (inner temporal lobe) pushes into brainstem
Transtentorial herniation
Brain pushes under falx cerebri
Most common type of herniation
Subfalcine herniation
Stroke symptoms <24h
Resolves without permanent brain damage
Amaurosis fugax (blurred vision)
TIA
Headache, seizure, focal neurology (if severe - vomiting, LOC)
Haemorrhage
Rupture of small parenchymal vessel
Basal ganglia
Hypertension
Non-traumatic intra-parenchymal haemorrhage
High pressure system between artery and vein prone to rupture
Massive bleeding
Arteriovenous malformation
Lesion of closely packed vessels with no parenchyma in between
Low pressure recurrent bleeds
Cavernous angioma
Rupture of Berry aneurysm (80% internal carotid bifurcation)
THUNDERCLAP headache
Xanthochromia on LP
SAH
Most common site of Berry aneurysm formation
Internal carotid artery bifurcation
Tissue necrosis
Permanent damage in affected area
No recovery
Cerebral infarct
Fewer macrophages
Limited tissue damage
Partial recovery
Cerebral haemorrhage
Direct collision of brain with skull vs. rebound collision of brain with skull
Coup vs. countecoup
Panda eyes
Otorrhoea, rhinorrhoea (straw coloured CSF leaking)
BBB broken - infection risk
Basal skull fracture
Injury to axons from shear force
Commonest cause of coma
Diffuse axonal injury
Repetitive traumatic brain injury (boxers, American football) Tauopathy Neurodegenerative disease Suicide risk Autopsy diagnosis
Chronic traumatic encephalopathy
Lucid interval then loss of consciousness
Middle meningeal artery
Biconvex lens on CT
Extradural haemorrhage
Associated with polycystic kidney disease
SAH (Berry aneurysms)
Lucid interval then increasing headache + confusion
Between dura mater + arachnoid mater
Bridging veins
Crescent-shaped on CT
Subdural haemorrhage
Weakness, nystagmus, blurred vision, intention tremor
MS
Contralateral LEG paralysis
Cognitive deficits
ACA stroke
Contralateral FACE + ARM paralysis
Dominant side affected - aphasia
Non-dominant side affected - neglect
Eye deviates towards side of lesion
MCA stroke
Occipital - Contralateral hemianopia
Midbrain - CNIII and IV palsy incl. pupil changes
Thalamic - amnesia, decreased LOC
PCA stroke
Sensory deficits - pain + temperature
Cross body - ipsilateral face, contralateral trunk + limbs
Ataxia + nystagmus
PICA stroke (Wallenberg syndrome or lateral medullary syndrome)
Small infarcts in deep penetrating arteries of deep brain structures (basal ganglia, pons, internal capsule, thalamus)
Different syndromes
1. Pure motor (contralateral arm, leg, face) - most common, posterior limb of internal capsule
2. Pure sensory (hemisensory loss) - ventral thalamic
3. Ataxic hemiparesis (ipsilateral ataxia + leg paresis) - ventral pons or internal capsule
4. Dysarthria-clumsy hand syndrome (hand weakness, clumsiness, dysarthria, facial weakness, clumsiness) - ventral pons or genu of internal capsule
Lacunar stroke
Anterior spinal artery
Hypoglossal nerve
Tongue deviation (ipsilateral tongue weakness)
Medial medullary syndrome stroke
Locked in syndrome
Proximal basilar artery stroke
Unconscious
Collapsed at home
Pin-point pupils
Brain stem infarction
History of strokes + TIAs
Now aggressive + forgetful
Vascular dementia
Blurred vision + vomiting
Diabetic
Localised to upper anterior head
Glaucoma
Obese
Worsening headaches worse in morning
Benign intracranial HTN
