Intracranial path

Question 1

4 general causes of ICP and their timeframes

Answer 1

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

Question 2

what is formula for cerbral blood flow

Answer 2

CPP/CVR

Question 3

what is formula for cerbrap perf. pressure

Answer 3

MAP-ICP

Question 4

how to monitor ICP acutely and chronically

Answer 4

1. acute - LP

2. Chronic - fiberoptic monitor

Question 5

6 general causes of increased ICP

Answer 5

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

Question 6

clin features of acute ICP

Answer 6

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

Question 7

*** cushings triad of high ICP

Answer 7

1. HTN
2. Brady
3. irreg resp

Question 8

3 chonic high ICP changes

Answer 8

1. HA
2. visual changes
3. decreased LOC

Question 9

7 treatment of ICP

Answer 9

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

Question 10

def. hydrocephalus

Answer 10

too much CSF in brain

- produced in choroid plexus and reabsorbed by arachnoid villae

Question 11

4 types of hydro

Answer 11

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

Question 12

signs of acute hydro

Answer 12

same as ICP with upward gaze

Question 13

signs of chronic (3)

Answer 13

AID
Ataxia
Incontinence
Dementia

Question 14

Tx of hydro

Answer 14

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

Question 15

def. idiopathic intracranial hypertension (IIH)

Answer 15

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

Question 16

Sx of IIH

Answer 16

same as ICP but no diplopia or LOC

Question 17

things to look for on MRI CT for ICP

Answer 17

1. lesions
2. midline shifts
3. loss of ventricles

Question 18

DDx for ring enhancing lesion on CT contrast

Answer 18

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

Question 19

4 main sources of brain mets

Answer 19

1. lung
2. breast
3. kidney
4. GI

Question 20

5 ways to classify tumors

Answer 20

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

Question 21

4 investigations for tumor

Answer 21

1. MRI
2. CT
3. sterotactic biopsy
4. mets workup

Question 22

tumors in

Answer 22

• infratentorial

- astrocytoma, medulloblastoma

Question 23

tumors in >15yo

Answer 23

• supratentorial

- mets, meningioma, high grade astrocytoma

Question 24

Tx of tumor mets

Answer 24

1. medical
   - phenytoin
   - dex
   - chemo
2. surgery
3. rads

Question 25

what is astrocytoma

Answer 25

most common intraaxial

Question 26

Tx of astro

Answer 26

low grade
- clsoe follow up, all option surg, rads, chemo
high grade
- surgery, prolong quality survivial

Question 27

what is meningioma

Answer 27

• most common primary brain malig.

- middle aged with slight F>M

Question 28

Tx of meningioma

Answer 28

1. watch if low grade

2. surgery for spreading

Question 29

what is pit. adenoma

Answer 29

1. ant. pit

2. 3-4 decade

Question 30

3 main Sx of pit adeno

Answer 30

1. mass effects
   - HA
   - bitemporal hemianopsia
2. endocrine effects
3. pit apopplexy

Question 31

order in which pit adeno will reduce hormones

Answer 31

Go look for the adenoma please
GnRH
LH
FSH
TSH
ACTH
Prolactin

Question 32

4 sources of microbial access to brain

Answer 32

1. Blood (most common)
2. direct implantation (tumors)
3. contiguous (sinus, ear)
4. spread from PNS

Question 33

common infections

Answer 33

1. meningitis
2. epidural abscess
3. subdural empyema

Question 34

what is cerebral abscess

Answer 34

pus in the brain substances

Question 35

common bact

Answer 35

1. strep
2. staph
3. Gr-ve

Question 36

Tx of abscess

Answer 36

1. aspiration
2. ABX
3. anticonvusants

Question 37

5 main bleeds into brain

Answer 37

1. epidural
2. acute SDH
3. chonic SDH
4. SAH
5. ICH (hemmoragic stroke)

Question 38

features and TX of epidural

Answer 38

• lucid period before

- craniotomy

Question 39

features and TX of acute SDH

Answer 39

• no lucid interval, hemiparesis

- craniotimy

Question 40

features and TX chronic SDH

Answer 40

• often asymotomatic, minor HA, confusion

- burr hole to drain

Question 41

features and TX of SAH

Answer 41

• sudden worst HA of life

- can be conservative or surgery

Question 42

features and TX ICH

Answer 42

• TIA-like or ICP

- lower BP, control ICP, craniotomy

Question 43

3 complications of SAH

Answer 43

1. vasospasm
2. hydroceph
3. neurogenic pulm. edema

Question 44

3 therapies of vasospasm

Answer 44

1. HTN
2. Hypervolemia
3. Hemodilution

Question 45

risk factors for ICH

Answer 45

CALL HARM
CVA in past
Age over 55
Liver disease
Liquid blood (anticoag.)
HTN
Alc.
Race - black or asian
Male

Question 46

TX of ICH

Answer 46

• decrease MAP
• check PTT/INR
• control raised ICP
• follow lytes
• surgery

Question 47

risk factors for aneurysms

Answer 47

• polycystic kidney
• AVMs
• fibromuscular dysplasia
• HHT
• CT diseases

Question 48

Sx of aneuryms

Answer 48

• rupture most commonly SAH

- sentinal bleed - thunderclap HA - requires coiling

Question 49

Tx of ruptured aneurysm

Answer 49

early surgery or coiling

-can clip

Question 50

6 types of vascular malformation

Answer 50

1. AVMs
2. cavernous malformations
3. venous angioma
4. cap. telangectasias
5. AV fistulas
6. occult

Question 51

def. AVM

Answer 51

tangle of abnormal vessels and shunts with no caps. between

Question 52

6 possible problems with AVMs

Answer 52

1. hemmorage
2. seizures
3. mass effect
4. focal neuro
5. local HA
6. bruit

Question 53

Tx of AVM

Answer 53

surgical excision is choice

Question 54

def. cavernous malformations