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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?

A

> 20mmHg

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
Q

How can raised ICP present?

A
  • Headache
  • Vomiting
  • Blurring of vision
  • Deterioration of consciousness
  • Bradycardia
  • HTN
  • Papilledema
26
Q

If there is a lesion in the frontal lobe, how would it present?

A
  • Weakness
  • Dysphagia
  • Personality changes
  • Dementia
27
Q

If there is a lesion in the parietal lobe, how would it present?

A
  • Sensory symptoms
  • Dressing apraxia
  • Visual field defects
28
Q

If there is a lesion in the temporal lobe, how would it present?

A
  • Dysphagia

- Visual field defects

29
Q

If there is a lesion in the occipital lobe, how would it present?

A
  • Visual field defects
30
Q

If there is a lesion in the posterior fossa, how would it present?

A
  • Dysmetria (in-coordination)
  • Gait ataxia
  • Cranial nerve palsies
  • Tremors
  • Nystagmus
31
Q

What is Cerebral Perfusion Pressure (CPP)?

A

The net pressure gradient that drives oxygen delivery to cerebral tissue
- CPP = Mean arterial pressure - ICP

32
Q

How would you initially manage raised ICP?

A
  • 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
Q

Why would you Head up tilt: 30-45 degrees for raised ICP?

A

Promotes venous outflow and CSF movement

34
Q

Why would you Keep neck straight and avoid tight ETT tapes for raised ICP?

A

Obstruction to jugular venous outflow increases ICP

35
Q

Why would you avoid hypotension for raised ICP?

A
  • To maintain cerebral blood flow

- Use vasopressors as required

36
Q

Why would you maintain adequate sedation for raised ICP?

A
  • Reduce metabolic demands
  • Ventilator asynchrony
  • Sympathetic responses
37
Q

Why would you Maintain euvolaemia and normo-hyper osmolar state sedation for raised ICP?

A

Reduced cerebral oedema

38
Q

Why would you maintain a normal PCO2 for raised ICP?

A
  • Raised PCO2 causes cerebral vasodilation and increases cerebral blood volume
39
Q

What general measures would manage raised ICP?

A
  • ABCDE
  • Patient position
  • Well sedated
  • ABG
  • Temperature
  • Scan
40
Q

What acute measures would manage raised ICP?

A
  • Heavy sedation +/- paralysis
  • CSF drainage
  • Osmotic therapy
  • Hyperventilation
  • Barbiturate therapy
41
Q

How would osmotic therapy be carried out for raised ICP?

A

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
Q

How would hyperventilation be carried out for raised ICP?

A
  • Reducing PaCO2 causes cerebral vasoconstriction and reduces intracranial blood volume
  • Results in rapid reduction in ICP
  • Effect only short-lived
43
Q

How would barbiturate therapy be carried out for raised ICP?

A
  • Phenobarbitone, thiopentone
  • Reduce brain metabolism and cerebral blood flow – lowering ICP
  • Usually used with continuous EEG monitoring
44
Q

What specialist measures could be done for raised ICP?

A
  • Removal of SOL

- Craniotomy

45
Q

What is a CT scan?

A
  • X-ray based imaging system

- Radiation hazard

46
Q

What is an MRI scan?

A
  • 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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