Edema, Hydrocephalus, Intracranial Pressure

Question 1

What are the two types of cerebral edema?

Answer 1

Vasogenic
Cause: increased vascular permeability
Fluid shifts into intercellular spaces between cells in brain
Localized or generalized

Cytotoxic
Cause: cell membrane injury
Increased intracellular fluid within brain cells
Typically seen in hypoxia or with metabolic damage

Question 2

Treatment for vascular cerebral edema?

Answer 2

Steroids - reduce water permeability of tight junctions

Mannitol - A small sugar used to increased the amount of aprticles in the blood. That way it can suk the water out of the brain

Question 3

Treatment for cytotoxic cerebral edema?

Answer 3

There is none…

Question 4

What is it called when there is a black in the ventricular system in the brain causing hydrocephalus?

Answer 4

non-communicating hydrocephalus

Question 5

What is it called when there is a black in the subarachnoid space in the brain causing hydrocephalus?

Answer 5

communicating hydrocephalus

Question 6

What is it called when hydrocephalus occurs due to a dilated ventricular system and increased CSF volume because of brain atrophy in Alzheimer’s or Pick’s disease?

Answer 6

Hydrocephalus Ex Vacuo

Question 7

Apart from surgery to remove an obsutrction or add a shunt, what treatment can you use for hydrocephalus?

Answer 7

Decrease CSF production:

Acetazolamide:

• inhibits carbonic anhydrase inhibitor
• Arguably the most important body enzyme

Furosemide:
-Na, K, 2Cl Pump Inhibitor

Question 8

Cause and symptoms of increased intracranial pressure?

Answer 8

Most often caused by mass effect (edema, tumor, hemorrhage)
Symptoms: headache, papilledema
If severe, may lead to herniation

Question 9

What are the signs and symptoms of Herniation?

Answer 9

Symptoms/signs:
Headache
Papilledema
Focal signs
Vomiting
Decreased level of consciousness
Often fatal

Question 10

What is a subfalcine (cingulate) herniation?

Answer 10

Expansion of one hemisphere displaces cingulate gyrus under the falx.
Can cause compression of branches of anterior cerebral artery
…leading to weakness of limbs, aphasia, etc.

Question 11

What is it called when the temporal lobe is pressed against the tentorium?

Answer 11

Transtentorial (uncinate) herniation

Question 12

A transtentorial (uncinate) herniation can cause problems in what areas?

Answer 12

Third cranial nerve

• fixed, dilated pupil
• impaired ocular movements

Posterior cerebral artery
-ischemia in primary visual cortex

Brainstem

• Duret hemorrhages
• Impaired consciousness

Contralateral cerebral peduncle
-Hemiparesis

Question 13

Tonsillar Herniation is what exactly?

Answer 13

Displacement of the cerebellar tonsils through the foramen magnum
Compresses medulla, compromising vital respiratory and cardiac centers
Life-threatening!