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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
Q

what is astrocytoma

A

most common intraaxial

26
Q

Tx of astro

A

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

27
Q

what is meningioma

A
  • most common primary brain malig.

- middle aged with slight F>M

28
Q

Tx of meningioma

A
  1. watch if low grade

2. surgery for spreading

29
Q

what is pit. adenoma

A
  1. ant. pit

2. 3-4 decade

30
Q

3 main Sx of pit adeno

A
  1. mass effects
    - HA
    - bitemporal hemianopsia
  2. endocrine effects
  3. pit apopplexy
31
Q

order in which pit adeno will reduce hormones

A 
Go look for the adenoma please
GnRH
LH
FSH
TSH
ACTH
Prolactin
32
Q

4 sources of microbial access to brain

A
  1. Blood (most common)
  2. direct implantation (tumors)
  3. contiguous (sinus, ear)
  4. spread from PNS
33
Q

common infections

A
  1. meningitis
  2. epidural abscess
  3. subdural empyema
34
Q

what is cerebral abscess

A

pus in the brain substances

35
Q

common bact

A
  1. strep
  2. staph
  3. Gr-ve
36
Q

Tx of abscess

A
  1. aspiration
  2. ABX
  3. anticonvusants
37
Q

5 main bleeds into brain

A
  1. epidural
  2. acute SDH
  3. chonic SDH
  4. SAH
  5. ICH (hemmoragic stroke)
38
Q

features and TX of epidural

A
  • lucid period before

- craniotomy

39
Q

features and TX of acute SDH

A
  • no lucid interval, hemiparesis

- craniotimy

40
Q

features and TX chronic SDH

A
  • often asymotomatic, minor HA, confusion

- burr hole to drain

41
Q

features and TX of SAH

A
  • sudden worst HA of life

- can be conservative or surgery

42
Q

features and TX ICH

A
  • TIA-like or ICP

- lower BP, control ICP, craniotomy

43
Q

3 complications of SAH

A
  1. vasospasm
  2. hydroceph
  3. neurogenic pulm. edema
44
Q

3 therapies of vasospasm

A
  1. HTN
  2. Hypervolemia
  3. Hemodilution
45
Q

risk factors for ICH

A 
CALL HARM
CVA in past
Age over 55
Liver disease
Liquid blood (anticoag.)
HTN
Alc.
Race - black or asian
Male
46
Q

TX of ICH

A
  • decrease MAP
  • check PTT/INR
  • control raised ICP
  • follow lytes
  • surgery
47
Q

risk factors for aneurysms

A
  • polycystic kidney
  • AVMs
  • fibromuscular dysplasia
  • HHT
  • CT diseases
48
Q

Sx of aneuryms

A
  • rupture most commonly SAH

- sentinal bleed - thunderclap HA - requires coiling

49
Q

Tx of ruptured aneurysm

A

early surgery or coiling

-can clip

50
Q

6 types of vascular malformation

A
  1. AVMs
  2. cavernous malformations
  3. venous angioma
  4. cap. telangectasias
  5. AV fistulas
  6. occult
51
Q

def. AVM

A

tangle of abnormal vessels and shunts with no caps. between

52
Q

6 possible problems with AVMs

A
  1. hemmorage
  2. seizures
  3. mass effect
  4. focal neuro
  5. local HA
  6. bruit
53
Q

Tx of AVM

A

surgical excision is choice

54
Q

def. cavernous malformations

A

Neurosurgery clerkship (3 decks)

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