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Intracranial Hyper/Hypo Tension Flashcards

1
Q

what age group are most likely have IIH?

A
  • F>M

* CHILDBEARING YEARS

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2
Q

what is the pathophysiology of IIH?

A

increased intracranial pressure in the absence of lesions

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3
Q

what are the risk factors to IIH?

A 
Female sex
obesity
sleep apnoea
certain medications 
associated diseases: decreased flow due to scarring, obstruction to venous drainage, endocrine, nutritional disorders, others 
Familial
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4
Q

which medications are associated with IIH?

A

 NALIDIXIC ACID NITROFURANTOIN, KETOPROFEN, VITAMIN A INTOXICATION, ISOTRETINOIN, ALL-TRANS RETINOIC ACID, THYROID REPLACEMENT THERAPY, ANABOLIC STEROIDS

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5
Q

what are the disease causes of IHH due to decreased flow of scarring?

A

MENINGITIS, SUBARACHNOID HAEMORRHAG

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6
Q

what are the disease causes of IHH due to obstruction of venous drainage?

A

MIDDLE EAR OF MASTOID-OSTIC HYDROCEPHALUS, BILATERAL RADICAL NECK DISSECTIONS, SUPERIOR VENA CAVA SYNDROME, INCREASED RIGHT HEART PRESSURE

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7
Q

what are the disease causes of IHH due endocrine causes?

A

ADDISON’S, HYPOPARATHYROIDISM, OBESITY

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8
Q

what are the other disease causes of IIH?

A

SLE, URAEMIA, IRON DEFICIENCY ANAEMIA AND SARCOIDOSIS, HYPERVITAMINOSIS AND HYPERALIMENTATION

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9
Q

what is the triad of symptoms of IIH?

A

Headache, visual, tinnitus

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10
Q

what are the features of the headaches in IIH?

A

o DIURNAL VARIATION
o MORNING N & V
o PULSATILE
o THOUGHT TO BE DUE TO COMPRESSION AND DISTORTION OF THE DURA

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11
Q

what are the visual symptoms in IIH?

A 
o	VISUAL LOSS 
o	TRANSIENT VISUAL OBSCURATION’S
o	PHOTOPHOBIA
o	RETROBULBAR PAIN
o	OPTICAL DISC SWELLING
o	DECREASED VISUAL ACUITY
o	OCULAR MOTILITY DEFECTS
o	DIPLOPIA
o	RAPD
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12
Q

what are the diagnostic investigations for IIH?

A

MRI brain with MRV - normal
CSF - raised pressure, normal constituents
Visual loss

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13
Q

what is the management of IIH?

A 
weight reduction
Pharmacotherapy
Analgesia
Ventricular atrial/lumbar peritoneal shunt
monitor visual fields & CSF
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14
Q

What is the pharmacotherapy of IIH?

A

Primary - acetazolamide

Secondary - furosemide or Topiramate or Acetazolamide + furosemide

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15
Q

what are the causes of Spontaneous Intracranial hypotension?

A
  • IDIOPATHIC
  • COLLAGEN DISORDERS
  • DURAL DIVERTICULA
  • TRAUMA
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16
Q

what are the clinical features of SIH?

A 
orthostatic headaches
neck/interscapular/arm pain
diplopia/visual field defects
dizziness
muffled hearing
galactorrhoea
impaired sphincter control
symptomatic subdural haematoma
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17
Q

what is the pathophysiology of SIH?

A

CSF leaks out of dural sac

SIH leaks out of holes in dura an is absorbed into spinal epidural venous plexus

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18
Q

how is SIH diagnosed?

A 
MRI 
Lumbar Puncture 
CT myelography
Spinal MRI
isotope myelography
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19
Q

what are the features of LP?

A

o LOW PRESSURE

o PLEOCYTOSIS, RAISED PROTEIN, XANTHOCHROMIA

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20
Q

what is the management of SIH?

A

Conservative - bed rest, fluids, analgesia
Epidural blood patches
Surgical repair

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21
Q

what are the causes of syringomyelia?

A

Congenital - chiari malformation

Acquired - trauma

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22
Q

what is a syrinx?

A

CYST (OR CAVITY) FORMS WITHIN THE SPINAL CORD

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23
Q

what is hydromyelia?

A

EXCESS CSF CONTAINED WITHIN THE EPENDYMA OF THE CENTRAL CANAL

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24
Q

what is syringomyelia?

A

WHEN FLUID DISSECTS INTO THE SURROUNDING WHITE MATTER FORMING A CYST CAVITY OR SYRINX

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25
what is the morphology of syringomyelia?
DILATED CENTRAL CANALS, SPINDLES, HOLOCORD, TETHERED CONUS
26
what are syringomyelia type 1's?
COMMUNICATING (WITH THE SUBARACHNOID SPACE, USUALLY AT THE LEVEL OF THE OBEX AT THE INFERIOR ASPECT OF THE FOURTH VENTRICLE)
27
what are syringomyelia type 2's?
POSTTRAUMATIC
28
what are syringomyelia type 3's?
TUMOR RELATED
29
what are syringomyelia type 4's?
ARACHNOIDITIS RELATED – POSTOPERATIVELY, AFTER TRAUMA, FOLLOWING PYOGENIC, TUBERCULOUS OR LUETIC (SYPHILITIC) MENINGITIS, AFTER BLEEDING INTO THE SUBARACHNOID SPACE
30
what are syringomyelia type 5's?
IDIOPATHIC
31
what are syringomyelia type 6's?
1. CHIARI II MALFORMATION WITH HYDROCEPHALUS 2. CHIARI I MALFORMATION WITHOUT HYDROCEPHALUS 3. EXTRAMEDULLARY COMPRESSIVE LESIONS AT THE CRANIOCERVICAL JUNCTION OR ALONG THE LENGTH OF THE SPINAL CANAL 4. SPINAL CORD TRAUMA 5. INTRAMEDULLARY TUMORS AND INTRA- PERIMEDULLARY INFECTIONS 6. MULTIPLE SCLEROSIS
32
what are the clinical features of syringomyelia?
``` Dissociated sensory loss Cuts & burns on hands Small muscle wasting Clawed hands Loss of upper limb reflexes Increased lower limb reflexes Hyperhidrosis Involuntary movements ```
33
what are the rarer symptoms of syringomyelia?
SEGMENTAL MYOCLONUS, PAROXYSMAL ARM POSTURING, ISOLATED HORNER’S, OROFACIAL PAIN (SYRINGOBULBIA), LIMB HYPERTROPHY, ORTHOSTATIC HYPOTENSION, REDUCED INTESTINAL MOTILITY SLEEP APNOEA
34
what are the symptoms of hindbrain hernias?
Headaches | Visual disturbance, dizziness, deafness/tinnutis, dysarthria/dysphagia, somatic sensory disturbance
35
what is the management syringomyelia?
* OPEN UP OBSTRUCTED CSF CHANNELS * DRAIN SYRINX CAVITY * LOWER OVERALL CSF PRESSURE * CONSERVATIVE MANAGEMENT * CSF SHUNTS * CSF CONDUITS
36
what is a chiari malformation?
REDUCTION OR LACK OF DEVELOPMENT OF THE POSTERIOR FOSSA
37
what is the pathophysiology of a chiari malformation?
DOWNWARD PRESSURE OF HYDROCEPHALUS causes TRACTION FROM TETHERED SPINAL CORD OR CSF LEAK THROUGH A MYELOCELE INTO AMNIOTIC SAC IN FOETAL LIFE RESULTED IN CAUDAL DISPLACEMENT OF THE POSTERIOR FOSSA STRUCTURES
38
what are the congenital causes of chiari malformation?
HYDROCEPHALUS, CRANIOSYNOSTOSIS, HYPEROSTOSIS, X-LINKED VITAMIN D-RESISTANT RICKETS, AND NEUROFIBROMATOSIS TYPE I, CONNECTIVE TISSUE WEAKNESS (EHLERS-DANLOS, MARFAN)
39
what are the acquired causes of chiari malformations?
SPACE OCCUPYING LESIONS (TUMOURS, HAEMATOMAS), HEAD TRAUMA
40
how are chiari malformations diagnosed?
MRI SCAN STRAIGHT X-RAYS NEUROLOGICAL EXAMINATION TYPE 2 - ULTRASOUND
41
what is the management of chiari malformations?
based on clinical symptoms raised ICP - ventriculoperitoneal or atrial shunt Other signs - posterior fossa decompression
42
what is the pathophysiology of Type 1 chiari malformations?
CEREBELLAR TONSILS LIE BELOW THE LEVEL OF THE FORAMEN MAGNUM
43
what is the pathophysiology of Type 2 chiari malformations?
PART OF THE CEREBELLAR VERMIS, MEDULLA AND 4TH VENTRICLE EXTEND OF THE FORAMEN MAGNUM, OFTEN TO THE MIDCERVICAL REGION. THE LOWER CRANIAL NERVES ARE STRETCHED AND THE CERVICAL NERVE ROOTS RUN HORIZONTALLY OR IN AN UPWARD DIRECTION
44
what is the pathophysiology of Type 3 chiari malformations?
- PART OF THE CEREBELLUM AND MEDULLA LIE WITHIN A CERVIO-OCCIPTAL MENINGOMYELOCELE
45
what is the pathophysiology of Type 4 chiari malformations?
CONSIDERED SEPARATE ENTITY, CHARACTERIZED BY A LACK OF CEREBELLAR DEVELOPMENT IN WHICH THE CEREBELLUM AND BRAIN STEM LIE WITHIN THE POSTERIOR FOSSA WITH NO RELATION TO THE FORAMEN MAGNUM.
46
what are the clinical features of type 2 chiari malformations?
PARALYSIS BELOW THE SPINAL DEFECT
47
what are the clinical features of type 3 chiari malformations?
ABUNDANT NEUROLOGICAL DEFICITS
48
what are the clinical features of type 4 chiari malformations?
NOT COMPATIBLE WITH LIFE
49
what are the associated spinal conditions with type 1 chiari malformations?
SYRINGOMYELIA + HYDROMYELIA
50
what are the associated spinal conditions with type 2 chiari malformations?
SYRINGOMYELIA, HYDROMYELIA, SPINA BIFIDA
51
what are the associated cranial conditions with type 1 chiari malformations?
HYDROCEPHALUS
52
what are the associated cranial conditions with type 2 chiari malformations?
HYDROCEPHALUS (85%), AQUEDUCT STENOSIS AND FORKING, SMALL POSTERIOR FOSSA, BASILAR IMPRESSION Z SHAPED MEDULLA, ENLARGED MASSA INTERMEDIA, FUSION OF THE SUPERIOR AND INFERIOR COLLICULU WITH TECTAL BREAKIG, MICROGYRIA, HYPOPLASTIC TENTORIUM CEREBLLI AND FALX, SKULL LACUNAE
53
what are the general clinical features of chiari malformations?
Headache - worsened on valsalva tinnitus, lhermittes sign, vertigo, nausea, nystagmus, facial pain, muscle weakness, dysphagia, restless leg syndrome, sleep apnoea, sleep disorders, ataxia, paralysis (clockwise fashion), papilloedema, pupil dilation, dysautonomia, central cord symptoms
54
what is the normal mean CSF pressure?
10mmHg
55
what is hydrocephalus?
EXCESSIVE ACCUMULATION OF CSF LEADING TO THE ENLARGEMENT OF THE BRAIN VENTRICLES. o EITHER DUE TO OBSTRUCTION OR OVER PRODUCTION
56
what are the different classifications of hydrocephalus?
``` Infantile Childhood/Adult - acute and chronic Obstructive Communicating Normal Pressure Hydrocephaus ex Vacuo ```
57
what is the pathophysiology of obstructive hydrocephalus?
o OCCURS DUE TO AN OBSTRUCTION IN THE FLOW OF THE CSF IN THE VENTRICULAR SYSTEM o FOURTH VENTRICLE IS SMALL IN COMPARISON TO THE THIRD AND LATERAL VENTRICLES. o OBSTRUCTION CAN BE DUE TO TUMOURS COMPRESSING THE VENTRICLES, A COLLOID CYST OBSTRUCTING THE THIRD VENTRICLE CAN BE SEEN OR STENOSIS OF THE AQUEDUCT.
58
what is the pathophysiology of communicating hydrocephalus?
o ENLARGEMENT OF THE VENTRICULAR SYSTEM BUT WITH NO OBSTRUCTION OF FLOW BETWEEN VENTRICLES AND THE SUBARACHNOID SPACE. o THE PROBLEM IS WITH CSF ABSORPTION DUE TO IMPAIRMENT OF THE ARACHNOID GRANULATIONS.
59
what is the pathophysiology of normal pressure hydrocephalus?
o IS A PARTICULAR FORM OF CHRONIC COMMUNICATING HYDROCEPHALUS, CHARACTERIZED BY ENLARGED CEREBRAL VENTRICLES, WITH ONLY INTERMITTENTLY ELEVATED CEREBROSPINAL FLUID PRESSURE
60
what is the pathophysiology of hydrocephalus ex vacuo?
o ENLARGEMENT OF CEREBRAL VENTRICLES AND SUBARACHNOID SPACES, AND IS USUALLY DUE TO BRAIN ATROPHY (AS IT OCCURS IN DEMENTIAS), POST-TRAUMATIC BRAIN INJURIES AND EVEN IN SOME PSYCHIATRIC DISORDERS, SUCH AS SCHIZOPHRENIA – OCCURS DUE TO LOSS IN BRAIN PARENCHYMA
61
what are the causes of congenital hydrocephalus?
* CHIARI MALFORMATION OR SPINA BIFIDA * AQUEDUCTAL STENOSIS * DANDY-WALKER COMPLEX * CONGENITAL ARACHNOID CYSTS * ATRESIA OF FORAMEN OF MUNRO
62
What are clinical features congenital hydrocephulus?
o LARGE HEAD o THIN AND SHINY SCALP WITH VISIBLE DILATED VEINS o BULGING OR TENSE FONTANELLE o DOWNWARD LOOKING EYES o RAISED ICP AND DIPLOPIA o MACEWEN SIGN: CRACKED POT SOUND ON HEAD PERCUSSION
63
what are the MRI features of congenital hydrocephalus?
EXPANSION OF VENTRICLES, FLATTENING OF THE GYRAE, FULLNESS OF THE SULCI, RAISED ICP
64
what are the causes of acquired hydrocephalus?
* TUMOURS * HAEMORRHAGE * INFECTIONS * TRAUMA
65
what are the clinical features of acquired hydrocephalus?
* HEADACHES * VOMITING. * DIPLOPIA. * IMPAIRED UPGAZE * RAISED ICP. * PAPILLODEMA * DROWSINESS. * INCONTINENCE. * GAIT ABNORMALITIES
66
how is hydrocephalus diagnosed?
detailed antenatal history measurement of head MRI CT
67
how is hydrocephalus management?
Valves/shunts | Endoscopic 3rd Ventriculostomy
68
what are the complications valve/shunts?
Overdrainage - acute SDH, slit ventricles Under drainage - blcokage, displaced/disconnected catheter Infection
69
what is the the pathophysiology of NPH?
enlarged ventricles
70
what are the causes of NPH?
Idiopathic | Post Inflam - SAH, meningitis, trauma, craniotomy
71
what is the mechanism of idiopathic NPH?
o ABNORMAL ABSORPTION OF CEREBROSPINAL FLUID (CSF) o BUILD-UP OF TOXIC METABOLITES IN THE CSF o ABNORMAL ARTERIAL PULSATILITY COMPRESSING THE VENOUS VASCULATURE
72
what are the risk factors to NPH?
AGE > 65 YEARS, VASCULAR DISEASE, DIABETES
73
what is the clinical triad of NPH symptoms?
ATAXIA, MEMORY DECLINE AND URINARY INCONTINENCE
74
how is NPH diagnosed?
* CLINICAL + CT * MRI * TRACER DIFFUSION STUDIES * ICP MEASUREMENT * LP “TAP-TEST” * LUMBAR DRAINAGE TESTS * INFUSION STUDIES
75
what are the features looked at CSF infusion studies?
``` o V = IR (OHM’S LAW); R = V/I o Rout = Po – Pe / RATE OF INFUSION  Rout = RESISTANCE TO OUTFLOW  Po = MEAN OPENING PRESSURE  Pe = MEAN PRESSURE AT EQUILIBRIUM ```
76
what is the management of NPH?
• 'TAP TEST' LP OR LUMBAR DRAIN AND MEASURE NPH TRIAD PRE AND POST CSF DRAINAGE • IF IMPROVE - SHUNT VALVEs
77
what types of shunts are used NPH management?
o LUMBO-PERITONEAL SHUNTS o VENTRICULOPERITONEAL SHUNTS o ENDOSCOPIC VENTRICULOSTOMY

Neurology (18 decks)

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