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Neurosurgery clerkship > Intracranial path > Flashcards

Intracranial path Flashcards

1
Q

4 general causes of ICP and their timeframes

A
  1. vascular - sudden
  2. metabolic- hours to days
  3. infectious - days to weeks
  4. tumor - months
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2
Q

what is formula for cerbral blood flow

A

CPP/CVR

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3
Q

what is formula for cerbrap perf. pressure

A

MAP-ICP

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4
Q

how to monitor ICP acutely and chronically

A
  1. acute - LP

2. Chronic - fiberoptic monitor

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5
Q

6 general causes of increased ICP

A
  1. occupying lesion
    - tuor, pus, blood
  2. increase blood flow
    - vasolidation, outflow obst.
  3. cerebral edema
    - vasogenic, osmotic, cytotoxic
  4. hydrodephalus
  5. pseudo tumor
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6
Q

clin features of acute ICP

A
  • HA
  • NV
  • LOC down
  • drop in GCS
  • papilledema
  • abnormal EOM
  • herniation symptoms
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7
Q

*** cushings triad of high ICP

A
  1. HTN
  2. Brady
  3. irreg resp
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8
Q

3 chonic high ICP changes

A
  1. HA
  2. visual changes
  3. decreased LOC
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9
Q

7 treatment of ICP

A 
ICPHEAD
Intubate
Calm (sedate)
Place drain
Hyperventilate
Elevate
Adequate BP
Diuretic
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10
Q

def. hydrocephalus

A

too much CSF in brain

- produced in choroid plexus and reabsorbed by arachnoid villae

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11
Q

4 types of hydro

A
  1. obstructive
    - circulation blocked
  2. non-obstructive
    - absorption blocked
  3. normal pressure
    - persistent ventricle dilation
  4. ex vacuo
    - due to atrophy of surrounding tissue
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12
Q

signs of acute hydro

A

same as ICP with upward gaze

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13
Q

signs of chronic (3)

A

AID
Ataxia
Incontinence
Dementia

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14
Q

Tx of hydro

A
  • vent drainage
  • shunts
  • remove obst. if there
  • LP for transient
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15
Q

def. idiopathic intracranial hypertension (IIH)

A

raised ICP or hydro with no sign of any lesion or cause

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16
Q

Sx of IIH

A

same as ICP but no diplopia or LOC

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17
Q

things to look for on MRI CT for ICP

A
  1. lesions
  2. midline shifts
  3. loss of ventricles
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18
Q

DDx for ring enhancing lesion on CT contrast

A 
MAGICAL DR
Mets
Abscess
Glioblastoma
Infarct
Contusion
AIDS (toxo)
Lymphoma
Demylenation
Resoving hematoma
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19
Q

4 main sources of brain mets

A
  1. lung
  2. breast
  3. kidney
  4. GI
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20
Q

5 ways to classify tumors

A
  1. primary vs. mets
  2. intra vs. extracranial
  3. supra vs. infratentorial
  4. adult vs. peds
  5. benign vs. malig
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21
Q

4 investigations for tumor

A
  1. MRI
  2. CT
  3. sterotactic biopsy
  4. mets workup
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22
Q

tumors in

A
  • infratentorial

- astrocytoma, medulloblastoma

23
Q

tumors in >15yo

A
  • supratentorial

- mets, meningioma, high grade astrocytoma

24
Q

Tx of tumor mets

A
  1. medical
    - phenytoin
    - dex
    - chemo
  2. surgery
  3. rads
25
what is astrocytoma
most common intraaxial
26
Tx of astro
low grade - clsoe follow up, all option surg, rads, chemo high grade - surgery, prolong quality survivial
27
what is meningioma
- most common primary brain malig. | - middle aged with slight F>M
28
Tx of meningioma
1. watch if low grade | 2. surgery for spreading
29
what is pit. adenoma
1. ant. pit | 2. 3-4 decade
30
3 main Sx of pit adeno
1. mass effects - HA - bitemporal hemianopsia 2. endocrine effects 3. pit apopplexy
31
order in which pit adeno will reduce hormones
``` Go look for the adenoma please GnRH LH FSH TSH ACTH Prolactin ```
32
4 sources of microbial access to brain
1. Blood (most common) 2. direct implantation (tumors) 3. contiguous (sinus, ear) 4. spread from PNS
33
common infections
1. meningitis 2. epidural abscess 3. subdural empyema
34
what is cerebral abscess
pus in the brain substances
35
common bact
1. strep 2. staph 3. Gr-ve
36
Tx of abscess
1. aspiration 2. ABX 3. anticonvusants
37
5 main bleeds into brain
1. epidural 2. acute SDH 3. chonic SDH 4. SAH 5. ICH (hemmoragic stroke)
38
features and TX of epidural
- lucid period before | - craniotomy
39
features and TX of acute SDH
- no lucid interval, hemiparesis | - craniotimy
40
features and TX chronic SDH
- often asymotomatic, minor HA, confusion | - burr hole to drain
41
features and TX of SAH
- sudden worst HA of life | - can be conservative or surgery
42
features and TX ICH
- TIA-like or ICP | - lower BP, control ICP, craniotomy
43
3 complications of SAH
1. vasospasm 2. hydroceph 3. neurogenic pulm. edema
44
3 therapies of vasospasm
1. HTN 2. Hypervolemia 3. Hemodilution
45
risk factors for ICH
``` CALL HARM CVA in past Age over 55 Liver disease Liquid blood (anticoag.) HTN Alc. Race - black or asian Male ```
46
TX of ICH
- decrease MAP - check PTT/INR - control raised ICP - follow lytes - surgery
47
risk factors for aneurysms
- polycystic kidney - AVMs - fibromuscular dysplasia - HHT - CT diseases
48
Sx of aneuryms
- rupture most commonly SAH | - sentinal bleed - thunderclap HA - requires coiling
49
Tx of ruptured aneurysm
early surgery or coiling | -can clip
50
6 types of vascular malformation
1. AVMs 2. cavernous malformations 3. venous angioma 4. cap. telangectasias 5. AV fistulas 6. occult
51
def. AVM
tangle of abnormal vessels and shunts with no caps. between
52
6 possible problems with AVMs
1. hemmorage 2. seizures 3. mass effect 4. focal neuro 5. local HA 6. bruit
53
Tx of AVM
surgical excision is choice
54
def. cavernous malformations
benign vascular hamartomas causing irregular sinusoidal vascular channels with no interveneing neural tissues -

Neurosurgery clerkship (3 decks)

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