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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
Q

what is the morphology of syringomyelia?

A

DILATED CENTRAL CANALS, SPINDLES, HOLOCORD, TETHERED CONUS

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26
Q

what are syringomyelia type 1’s?

A

COMMUNICATING (WITH THE SUBARACHNOID SPACE, USUALLY AT THE LEVEL OF THE OBEX AT THE INFERIOR ASPECT OF THE FOURTH VENTRICLE)

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27
Q

what are syringomyelia type 2’s?

A

POSTTRAUMATIC

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28
Q

what are syringomyelia type 3’s?

A

TUMOR RELATED

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29
Q

what are syringomyelia type 4’s?

A

ARACHNOIDITIS RELATED – POSTOPERATIVELY, AFTER TRAUMA, FOLLOWING PYOGENIC, TUBERCULOUS OR LUETIC (SYPHILITIC) MENINGITIS, AFTER BLEEDING INTO THE SUBARACHNOID SPACE

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30
Q

what are syringomyelia type 5’s?

A

IDIOPATHIC

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31
Q

what are syringomyelia type 6’s?

A
  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
Q

what are the clinical features of syringomyelia?

A 
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
Q

what are the rarer symptoms of syringomyelia?

A

SEGMENTAL MYOCLONUS, PAROXYSMAL ARM POSTURING, ISOLATED HORNER’S, OROFACIAL PAIN (SYRINGOBULBIA), LIMB HYPERTROPHY, ORTHOSTATIC HYPOTENSION, REDUCED INTESTINAL MOTILITY
SLEEP APNOEA

34
Q

what are the symptoms of hindbrain hernias?

A

Headaches

Visual disturbance, dizziness, deafness/tinnutis, dysarthria/dysphagia, somatic sensory disturbance

35
Q

what is the management syringomyelia?

A
  • OPEN UP OBSTRUCTED CSF CHANNELS
  • DRAIN SYRINX CAVITY
  • LOWER OVERALL CSF PRESSURE
  • CONSERVATIVE MANAGEMENT
  • CSF SHUNTS
  • CSF CONDUITS
36
Q

what is a chiari malformation?

A

REDUCTION OR LACK OF DEVELOPMENT OF THE POSTERIOR FOSSA

37
Q

what is the pathophysiology of a chiari malformation?

A

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
Q

what are the congenital causes of chiari malformation?

A

HYDROCEPHALUS, CRANIOSYNOSTOSIS, HYPEROSTOSIS, X-LINKED VITAMIN D-RESISTANT RICKETS, AND NEUROFIBROMATOSIS TYPE I, CONNECTIVE TISSUE WEAKNESS (EHLERS-DANLOS, MARFAN)

39
Q

what are the acquired causes of chiari malformations?

A

SPACE OCCUPYING LESIONS (TUMOURS, HAEMATOMAS), HEAD TRAUMA

40
Q

how are chiari malformations diagnosed?

A

MRI SCAN
STRAIGHT X-RAYS
NEUROLOGICAL EXAMINATION
TYPE 2 - ULTRASOUND

41
Q

what is the management of chiari malformations?

A

based on clinical symptoms
raised ICP - ventriculoperitoneal or atrial shunt
Other signs - posterior fossa decompression

42
Q

what is the pathophysiology of Type 1 chiari malformations?

A

CEREBELLAR TONSILS LIE BELOW THE LEVEL OF THE FORAMEN MAGNUM

43
Q

what is the pathophysiology of Type 2 chiari malformations?

A

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
Q

what is the pathophysiology of Type 3 chiari malformations?

A
  • PART OF THE CEREBELLUM AND MEDULLA LIE WITHIN A CERVIO-OCCIPTAL MENINGOMYELOCELE
45
Q

what is the pathophysiology of Type 4 chiari malformations?

A

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
Q

what are the clinical features of type 2 chiari malformations?

A

PARALYSIS BELOW THE SPINAL DEFECT

47
Q

what are the clinical features of type 3 chiari malformations?

A

ABUNDANT NEUROLOGICAL DEFICITS

48
Q

what are the clinical features of type 4 chiari malformations?

A

NOT COMPATIBLE WITH LIFE

49
Q

what are the associated spinal conditions with type 1 chiari malformations?

A

SYRINGOMYELIA + HYDROMYELIA

50
Q

what are the associated spinal conditions with type 2 chiari malformations?

A

SYRINGOMYELIA, HYDROMYELIA, SPINA BIFIDA

51
Q

what are the associated cranial conditions with type 1 chiari malformations?

A

HYDROCEPHALUS

52
Q

what are the associated cranial conditions with type 2 chiari malformations?

A

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
Q

what are the general clinical features of chiari malformations?

A

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
Q

what is the normal mean CSF pressure?

55
Q

what is hydrocephalus?

A

EXCESSIVE ACCUMULATION OF CSF LEADING TO THE ENLARGEMENT OF THE BRAIN VENTRICLES.
o EITHER DUE TO OBSTRUCTION OR OVER PRODUCTION

56
Q

what are the different classifications of hydrocephalus?

A 
Infantile
Childhood/Adult - acute and chronic
Obstructive
Communicating
Normal Pressure
Hydrocephaus ex Vacuo
57
Q

what is the pathophysiology of obstructive hydrocephalus?

A

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
Q

what is the pathophysiology of communicating hydrocephalus?

A

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
Q

what is the pathophysiology of normal pressure hydrocephalus?

A

o IS A PARTICULAR FORM OF CHRONIC COMMUNICATING HYDROCEPHALUS, CHARACTERIZED BY ENLARGED CEREBRAL VENTRICLES, WITH ONLY INTERMITTENTLY ELEVATED CEREBROSPINAL FLUID PRESSURE

60
Q

what is the pathophysiology of hydrocephalus ex vacuo?

A

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
Q

what are the causes of congenital hydrocephalus?

A
  • CHIARI MALFORMATION OR SPINA BIFIDA
  • AQUEDUCTAL STENOSIS
  • DANDY-WALKER COMPLEX
  • CONGENITAL ARACHNOID CYSTS
  • ATRESIA OF FORAMEN OF MUNRO
62
Q

What are clinical features congenital hydrocephulus?

A

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
Q

what are the MRI features of congenital hydrocephalus?

A

EXPANSION OF VENTRICLES, FLATTENING OF THE GYRAE, FULLNESS OF THE SULCI, RAISED ICP

64
Q

what are the causes of acquired hydrocephalus?

A
  • TUMOURS
  • HAEMORRHAGE
  • INFECTIONS
  • TRAUMA
65
Q

what are the clinical features of acquired hydrocephalus?

A
  • HEADACHES
  • VOMITING.
  • DIPLOPIA.
  • IMPAIRED UPGAZE
  • RAISED ICP.
  • PAPILLODEMA
  • DROWSINESS.
  • INCONTINENCE.
  • GAIT ABNORMALITIES
66
Q

how is hydrocephalus diagnosed?

A

detailed antenatal history
measurement of head
MRI
CT

67
Q

how is hydrocephalus management?

A

Valves/shunts

Endoscopic 3rd Ventriculostomy

68
Q

what are the complications valve/shunts?

A

Overdrainage - acute SDH, slit ventricles
Under drainage - blcokage, displaced/disconnected catheter
Infection

69
Q

what is the the pathophysiology of NPH?

A

enlarged ventricles

70
Q

what are the causes of NPH?

A

Idiopathic

Post Inflam - SAH, meningitis, trauma, craniotomy

71
Q

what is the mechanism of idiopathic NPH?

A

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
Q

what are the risk factors to NPH?

A

AGE > 65 YEARS, VASCULAR DISEASE, DIABETES

73
Q

what is the clinical triad of NPH symptoms?

A

ATAXIA, MEMORY DECLINE AND URINARY INCONTINENCE

74
Q

how is NPH diagnosed?

A
  • CLINICAL + CT
  • MRI
  • TRACER DIFFUSION STUDIES
  • ICP MEASUREMENT
  • LP “TAP-TEST”
  • LUMBAR DRAINAGE TESTS
  • INFUSION STUDIES
75
Q

what are the features looked at CSF infusion studies?

A 
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
Q

what is the management of NPH?

A

• ‘TAP TEST’ LP OR LUMBAR DRAIN AND MEASURE NPH TRIAD PRE AND POST CSF DRAINAGE
• IF IMPROVE - SHUNT
VALVEs

77
Q

what types of shunts are used NPH management?

A

o LUMBO-PERITONEAL SHUNTS
o VENTRICULOPERITONEAL SHUNTS
o ENDOSCOPIC VENTRICULOSTOMY

Neurology (18 decks)

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