CVD & trauma

Question 1

what are the main types of cerebral oedema?

Answer 1

Vasogenic – disruption of the blood brain barrier

Cytotoxic – secondary to cellular injury e.g. hypoxia/ischaemia

Question 2

what are 3 ways that cerebral oedema can form?

Answer 2

Cytotoxic;
fluid leaves vasculature, though aquaporin 4 - AQP4, into astrocyte foot process.

Hydrocephalic;
Fluid leaves ventricle, past epdenyma cells, through aqp4 then past astrocytes.

Vasogenic;
when the integrity of the BBB is disturbed this is the oedema that results. out of vasculature

Question 3

what are 3 ways that cerebral oedema can be removed?

Answer 3

From cells / astrocytes Into bloodstream

Into subarachnoid space

Into cerebral ventricles

all mediated via AQP4

Question 4

what is the biggest venus sinus in brain and what is its course?

Answer 4

Sagittal sinus

Runs along the midline

Question 5

describe the function of the ventricular system in the brain?

Answer 5

the choroid plexus is located in the lateral ventricle and makes CSF

CSF makes its way down to the 4th ventricle, where it can go down the spine OR

passes through a foramen to go into the subarachnoid space

once it flows to top of head, csf is resorbed into venus sinuses/ system through arachnoid granulations

csf is then recycled

Question 6

what are the forms of hydrocephalus?

Answer 6

Non-communicating -
involves obstruction of flow of CSF

Communicating -
involves no obstruction but problems with reabsorption of CSF into venous sinuses

Question 7

what is the Consequence of raised ICP?

Answer 7

herniation of brain structures where space is available

Question 8

what are the forms of herniation in the brain?

Answer 8

Subfalcine herniatiion – supra tentorial herniation

Transtentorial herniation -
aka uncal herniation - medial temporal lobe

Tonsillar herniation - doesn’t involve cortex – this is cerebellum herniating through - CONING

Question 9

what is the timing in the definition of stroke?

Answer 9

with symptoms lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin

Question 10

difference between TIA and stroke?

Answer 10

Most TIAs last less than five minutes; the average is about a minute. Unlike a stroke, when a TIA is over, there is usually no permanent injury to the brain

Question 11

aetiology of TIA?

Answer 11

TIA is caused by a clot; the blockage is temporary

Question 12

PROGNOSIS of a TIA?

Answer 12

1/3 of those with TIA get significant infarct within 5 years

Question 13

a 55 y/o man with a hx of essential hypertension but is known to be non-compliant with medication is brought into AnE by family with severe headache, vomiting.

You suspect CNS pathology and perform some neurological exams and discover focal neurological signs.

During the test he rapidly losses of consciousness.

You are the F1 on duty. what is going on with him?

Answer 13

Likely a Non-traumatic intra-parenchymal haemorrhage

rupture of a small intraparenchymal vessel

Hypertension > 50% of bleeds

Most common in basal ganglia

Question 14

how would an Arteriovenous malformation present?

prognosis? Rx? aetiology?

Answer 14

haemorrhage, seizures, headache, focal neurological deficits

Treatment: surgery, embolization, radiosurgery
Prognosis; rupture -> poor prognosis

Aetiology - congenital !

Question 15

which cns tumour presents as:

Present with headache, seizures, focal deficits, haemorrhage Low pressure – recurrent bleeds

Answer 15

Cavernous angioma

Question 16

which cns tumour is described as;

composed of closely packed vessels with no parenchyma interposed between vascular spaces”

Answer 16

Cavernous angioma

Question 17

what causes Sub-arachnoid haemorrhage?

Answer 17

Rupture of a berry aneurysm

Question 18

where does Rupture of a berry aneurysm occur most?

Answer 18

80 % - internal carotid artery bifurcation,

20% occur within the vertebro-basilar circulation

Question 19

how does Sub-arachnoid haemorrhage present?

Answer 19

Present with sudden onset of severe headache, vomiting, loss of consciousness

Question 20

how might a berry aneurysm be treated?

Answer 20

endovascular treatment - coils

reduces blood flow hence risk of bursting

Question 21

70-80% of strokes are caused by ___?

Answer 21

Infarcts -

and cerebral atherosclerosis most common cause of infarcts

Question 22

what is the prognosis of haemorrhagic vs ischaemic strokes?

Answer 22

Infarct:
Tissue necrosis (stains)
Rarely haemorrhagic
Permanent damage in the affected area
No recovery

Haemorrhage:
Bleeding
Dissection of parenchyma
Fewer macrophages
Limited tissue damage (periphery)
Partial recovery

Question 23

what is the particular risk with head fractures?

Answer 23

Infection risk – associated with fractures

Question 24

what is a Contusion?

Answer 24

Brain in collision with skull
Surface “bruising”
If pia mater torn then becomes laceration

Question 25

in traumatic brain injuries, what is the commonest cause of coma in the absence of bleeding?

Answer 25

Diffuse axonal injury

Question 26

axonal injury mainly affects which structures?

Answer 26

Midline structures particularly affected e.g. corpus callosum, rostral brainstem and septum pellucidum

Question 27

what is otorrhea / rhinorrhea

Answer 27

csf leaking out of ear / nose

straw coloured fluid. following fissure fractures

Question 28

acceleration / deceleration injury can lead to what?

Answer 28

contusion

due to rebound. sometimes called coup/contrecoup

Question 29

what protein is implicated in CTE - chronic traumatic encephalopathy?

Answer 29

Tau protein