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Med neuro > Cns Trauma/cns Infxn > Flashcards

Cns Trauma/cns Infxn Flashcards

0
Q

Epidural hematoma

A

Generally arterial

  • lucid interval
  • most commonly squamous temporal fracture
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1
Q

SCALP

A

Skin, connective tissue, aponeurosis, loose ct, pericranium

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2
Q

Subdural hematoma

A

Typically venous or parasagittal mass lesion

  • acute and chronic (osmotic/re-bleeding)
  • age, coagulopathy, generally traumatic
  • microscopic dating helpful for forensics
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3
Q

Subarachnoid

A

Bridging veins

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4
Q

Concussion

A
  • return to play controversy; second impact syndrome
  • 300x increase for repeat concussion
  • danger of acute brain injury are more acute between ages 10-18
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5
Q

Contusion hemorrhages: types and histology

A

Coup and contra-coup

  • primary and 180
  • illustrates deep vascular compromise
  • cerebral cortical contusion plaques
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6
Q

Parenchymal secondary to intercranial hemorrhage: cause

A

Related to amphetamine and cocaine use

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7
Q

Parenchymal hemorrhage with multiple petechial hemorrhages of white matter

A

Secondary to fractures of long bones containing marrow resulting in systemic that embolize

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8
Q

“Shaken baby”

A

Diffuse axonal injury

  • accumulation of beta-amyloid precursor protein
  • small hemorrhages of deep cortex and corpus callosum
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9
Q

Cervical injuries

A

Upper - often fatal
Lower - quadri/paraplegia
- corticosteroids = bad

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10
Q

Axial loading

A
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11
Q

Bacterial meningitis

A

Inflammation of arachnoid and pia (leptomeninges) and CSF

- most commonly staph and strep

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12
Q

CSF findings in bacterial meningitis

A

Cloudy appearance

Increased neutrophils, decreased glucose, increased protein

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13
Q

Mechanisms of infection in meningitis

A
  • direct implantation
  • spread from adjacent site (like mastoid air cells)
  • hematogenous
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14
Q

Brain abscess formation

A
  • 5-10% mortality

- includes vasogenic edema (increased ICP)

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15
Q

Tuberculous meningitis

A
  • commonly spread via hematogenous spread
  • basilar exudate
  • once common in children
  • sudden unexpected death
  • arachnoid fibrosis -> hydrocephalus
  • obliteritive endarteitis -> vascular occlusion and infarct
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16
Q

Potts disease

A
  • tuberculosis infxn in vertebrae

- can result in vertebral collapse, cord compression or humpback (gibbus)

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17
Q

CNS fungal infxns

A
  • candida
  • aspergillus
  • crypto neoform.
  • coccidioides imm.
18
Q

Candida

A
  • common saprophyte
  • may infect IV caths, prosthetic valves
  • granulomatous response
19
Q

Aspergillus infxn

A
  • Usually pulmonary origin
  • vasophillic
  • 45 branching hyphae
  • immunoenzymatic microplate assay
20
Q

Cryptococcus neoformans: epidemiology and testing

A
  • most common mycotic CNS infxn
  • immunocompromised: 50 % apparently immunocompetant
  • latex agglutination test
  • NOT usually mass lesion
21
Q

CNS enteroviruses

A 
- Echo and coxsackie A/B are most common 
     ~ fecal oral
     ~ crowding 
- polio
     ~ neurotrophic
22
Q

CNS arbo viruses

A
  • dengue: increasing in US
  • eastern equine (30% mortality)
  • western equine
  • St. Louis: high mortality in elderly
  • California: treehole mosquito
  • west Nile
23
Q

West Nile virus: contraction

A
  • contract able through Mosquitos, transfusion, organ transplantation and transplacental routes
24
Q

Herpes viruses

A

HSV-1: oral mucosal, encephalitis causing in adults
~ highly fatal, PCR diagnosis, cowdry type A inclusions
~ trt with acyclovir
HSV-2: spread to in birth canal infant -> meningitis
HHV-6: often fatal in infants, transplants
Varicella: ind DRG, can spread to brain

25
Q

CMV

A
  • typically subclinical
  • infection seen with giant cells and cowdry type A inclusions
  • typically immunocomp and infants
26
Q

Progressive multifocal leukoencephalopathy

A
  • immunocomp
  • acidophilic nuclear inclusions
  • astrocytes with bizarre nuclei
  • caused by papovirus
27
Q

Prions: diseases, histology

A
  • self replicating malignant proteins
  • CJD, vCJD, kuru (and animal variants)
  • spongiform encephalopathy
    ~ spongiosis
    ~ Astrocytosis
    ~ lack of inflammation
  • transmitted through transplants, transfusions, incited instruments
28
Q

Neurosyphillis

A
  • Manifestation of tertiary syphilis
  • rates lowering except in MSM
  • meningial syphillis, tabes dorsalis, parenchymal syphillis and congenital syphillis all part in parcel
29
Q

Neuroborreliosis

A
  • neuro Lyme disease
  • Ixodes transmission
  • cutaneous erythema migrans, serologic confirmation
  • potential neuro (confusion et al)
30
Q

Toxoplasmosis: acquired, congenital

A
  • congenital (transplacental) and acquired
    ~ congenital: mostly mild; can involve chorioretinitis, retardation
    ~ acquired: lymphadenitis, lymphadenopathy (may look like
    lymphoma) mostly in immunocomp (necrotizing encephalitis)
31
Q

Neuropathology of AIDS infxns

A
  • encephalopathy/encephalitis: sub cortical dementia
  • toxoplasmosis
  • CMV
  • cryptococcosis
  • lymphoma: mainly B cell, assoc. with EBV; high grade, aggressive
32
Q

Obliteritive endarteitis/ arachnoid fibrosis

A

Tuberculous meningitis

33
Q

Lucid interval

A
  • period of time of lucidity following onset of epidural bleed
34
Q

Loss of consciousness or duration of concussion symptoms greater than 15 minutes

A
  • return to play
35
Q

Uncal herniation

A

Generally associated with hemiparesis and CN III palsy

- progression produces kernohans notch phenomena

36
Q

kernohans notch phenomena

A

Uncus herniate to contralateral sup. cerebral peduncle

- this of course results in ipsilateral hemiparesis

37
Q

Normal ICP

A

~ 15 mmHg

38
Q

Treatment of ICP (per blueprints)

A
  • elevate the head
  • hyperventilation to PCO2 of 25 mmHg
  • barbiturates (phenolbarb)
  • drainage of CSF
  • hypertonic saline/mannitol
39
Q

Cytotoxic vs. vasogenic edema

A

Cytotoxic: minutes to hours, may be reversible
Vasogenic: hours - days, considered irreversible

40
Q

Cerebral amyloid angiography, HTN, berry aneurysm

A

Two primary causes of intraparenchymal hemorrhages in CVD

- hypertensive hemorrhage most often effects basal ganglia and thalamus

41
Q

Charcot-Bouchard aneurysm

A
  • non saccular, formed from multiple other smaller aneurysms
42
Q

Subarachnoid hemorrhage

A
  • sudden onset of severe headache without focal signs

- results in increased ICP -> reduces profusion -> brain death

43
Q

Fusiform aneurysm

A
  • Dilation due to atherosclerosis most commonly found in the basilar artery

Med neuro (17 decks)

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