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TCA 4 - Headache > Intracranial SOL > Flashcards

Intracranial SOL Flashcards

1
Q

What are primary brain tumours?

A

Arise from intracranial structures

e. g:
- Meninges = meningioma
- Glial cells = gliomas or astrocytomas

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2
Q

What are secondary brain tumours?

A

Arise from primary tumours that come from the lung (most common), breast, bowel, skin or kidneys

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3
Q

What are the presentations of space occupying lesions?

A

o Symptoms of neurological deficits due to compression/damage of adjacent structures
o Symptoms of cortical/meningeal irritation
o Hormonal effects
o Systemic effects/generally unwell

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4
Q

How is pronator drift caused?

A

UMN damage along the descending motor pathways (corticospinal tract or corticobulbar tract)

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5
Q

What happens in pronator drift?

A
  • Raise both arms horizontally up to shoulder level, palms facing upwards, with eyes closed
  • Lowering or pronation of one arm is indicative of paresis
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6
Q

What is the most common malignant brain tumour?

A

Glioblastoma

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7
Q

What is the most common benign brain tumour?

A

Meningioma

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8
Q

How would you diagnose a brain tumour?

A
  • Neurological examination
  • CT or MRI
  • CSF studies
  • Bloods
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9
Q

How can high grade glioma tumours arise?

A
  • De novo
    OR
  • Malignant transformation of low-grade tumours
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10
Q

Is surgery a good treatment for gliomas?

A

No, could cause a loss of function

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11
Q

What would you give for gliomas?

A

Dexamethasone

  • Reduces oedema by decreasing vasodilation and permeability of capillaries
  • Decreases leukocyte migration to sites of inflammation

Radiotherapy

Chemotherapy

Treatment of associated problems

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12
Q

What do meningiomas arise from?

A

Arachnoid cap cells

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13
Q

How do meningiomas cause symptoms?

A

Compression

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14
Q

Are meningiomas benign or malingant?

A

Benign

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15
Q

How do you treat meningiomas?

A

Surgical excision

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16
Q

What can cause meningiomas?

A
  • Trauma
  • Radiation
  • Oncogenic virus
  • Hormones
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17
Q

What is a vestibular schwannoma?

A

Benign tumour arising from the nerve sheath of vestibular nerves (8th CN)

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18
Q

How does a vestibular schwannoma usually present?

A

Ipsilateral hearing problem and tinnitus

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19
Q

What other nerves can vestibular schwannoma effect?

A

5th, 7th and lower CNs

20
Q

How would you treat a vestibular schwannoma?

A
  • Surgical excision if possible

- Radiosurgery

21
Q

What is normal ICP?

A

<15mmHg in adults

22
Q

What is a pathological ICP?

23
Q

What is the stages of pathological ICP?

A

Stage 1: Structures compensate for change in another structure

Stage 2: No more structures to replace

Stage 3: Critical, pressure starts to rise steeply

24
Q

What causes raised ICP?

A
  • Increase in brain/tissue/mass volume
  • Increase in CSF volume
  • Increase in blood volume
  • Infection
  • Vascular
  • Hydrocephalus
25
How can raised ICP present?
- Headache - Vomiting - Blurring of vision - Deterioration of consciousness - Bradycardia - HTN - Papilledema
26
If there is a lesion in the frontal lobe, how would it present?
- Weakness - Dysphagia - Personality changes - Dementia
27
If there is a lesion in the parietal lobe, how would it present?
- Sensory symptoms - Dressing apraxia - Visual field defects
28
If there is a lesion in the temporal lobe, how would it present?
- Dysphagia | - Visual field defects
29
If there is a lesion in the occipital lobe, how would it present?
- Visual field defects
30
If there is a lesion in the posterior fossa, how would it present?
- Dysmetria (in-coordination) - Gait ataxia - Cranial nerve palsies - Tremors - Nystagmus
31
What is Cerebral Perfusion Pressure (CPP)?
The net pressure gradient that drives oxygen delivery to cerebral tissue - CPP = Mean arterial pressure - ICP
32
How would you initially manage raised ICP?
- Head up tilt: 30-45 degrees - Keep neck straight and avoid tight ETT tapes - Avoid hypotension - Maintain adequate sedation - Maintain euvolaemia and normo-hyper osmolar state - Maintain normal PCO2
33
Why would you Head up tilt: 30-45 degrees for raised ICP?
Promotes venous outflow and CSF movement
34
Why would you Keep neck straight and avoid tight ETT tapes for raised ICP?
Obstruction to jugular venous outflow increases ICP
35
Why would you avoid hypotension for raised ICP?
- To maintain cerebral blood flow | - Use vasopressors as required
36
Why would you maintain adequate sedation for raised ICP?
- Reduce metabolic demands - Ventilator asynchrony - Sympathetic responses
37
Why would you Maintain euvolaemia and normo-hyper osmolar state sedation for raised ICP?
Reduced cerebral oedema
38
Why would you maintain a normal PCO2 for raised ICP?
- Raised PCO2 causes cerebral vasodilation and increases cerebral blood volume
39
What general measures would manage raised ICP?
- ABCDE - Patient position - Well sedated - ABG - Temperature - Scan
40
What acute measures would manage raised ICP?
- Heavy sedation +/- paralysis - CSF drainage - Osmotic therapy - Hyperventilation - Barbiturate therapy
41
How would osmotic therapy be carried out for raised ICP?
Mannitol - Osmotic diuretic - Reduces brain volume by drawing free water out of tissue into circulation (dehydrates brain parenchyma) - Only use for short period to buy some time
42
How would hyperventilation be carried out for raised ICP?
- Reducing PaCO2 causes cerebral vasoconstriction and reduces intracranial blood volume - Results in rapid reduction in ICP - Effect only short-lived
43
How would barbiturate therapy be carried out for raised ICP?
- Phenobarbitone, thiopentone - Reduce brain metabolism and cerebral blood flow – lowering ICP - Usually used with continuous EEG monitoring
44
What specialist measures could be done for raised ICP?
- Removal of SOL | - Craniotomy
45
What is a CT scan?
- X-ray based imaging system | - Radiation hazard
46
What is an MRI scan?
- Magnetic wave based imaging system - Provides a better spatial resolution of soft tissue lesions - More expensive

TCA 4 - Headache (4 decks)

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