LECTURE FINAL Flashcards
1
Q
What is congestive heart failure?
A
A multisystem derangement that occurs when the heart is no longer able to eject blood delivered to it by the venous system (Heart fails to pump blood adequately)
2
Q
Can heart tissue replicate?
A
No
3
Q
What happens if there is death of heart muscle?
A
It will not be regenerated - number of heart muscle cells was set as a fetus
4
Q
Any kind of loss of heart muscle cells =
A
Decreased ability of the heart to pump
5
Q
What happens after the heart has been diseased?
A
Compensatory mechanism
6
Q
What are the 3 compensations of congestive heart failure?
A
1) Activity of sympathetic NS
2) Hypertrophy
3) Dilation
7
Q
What are the 2 ways the Sympathetic NS is involved in CHF?
A
1) Positive Ionotropic effect
2) Positive Chronotropic effect
8
Q
What is the Positive Ionotropic effect?
A
Increase the ability of the heart to pump blood
9
Q
What is the positive Chronotropic effect?
A
Increased heart rate
10
Q
What does chronic compensation of the Symp. NS do to the heart during CHF?
A
Muscle can only be LOST, progressive loss of myofibrils and destruction
11
Q
What are the 2 types of Hypertrophy associated with CHF?
A
1) Concentric Hyp.
2) Eccentric Hyp.
12
Q
What is Concentric Hypertrophy?
A
Increased thickness without change of heart chamber size
13
Q
Concentric Hypertrophy happens due to?
A
PRESSURE overload
14
Q
What is an example of Concentric Hypertrophy?
A
LV:RV ratio can be increased from 2:1 > 8:1, and heart will deviate to the left
15
Q
What happens to the LV in concentric hypertrophy?
A
Systemic hypertension, aortic stenosis
16
Q
What happens to the RV during Concentric Hypertrophy?
A
Cor Pulmonale
17
Q
What is Eccentric Hypertrophy?
A
Increase of the heart muscle thickness with increased capacity (dilation) of the heart chamber
18
Q
Eccentric Hyp. Happens due to ?
A
VOLUME overload
- Only happens when there is overload of the heart chamber with extra volume of blood
19
Q
Eccentric hypertrophy can happen with ?
A
Aortic insufficiency OR mitral stenosis due to narrowing of the valve/lumen, leaving more and more blood in atrium of heart
20
Q
What is “Dilation” in regard to Compensatory mechanism of CHF?
A
Elongation of the heart myofibrils, increasing their contractility (Frank Starling law, like stretching a rubber band)
21
Q
If the dilated ventricle is about to maintain the cardiac output at a level that meets the needs of the body, the patient is in ?
A
Compensated HF
22
Q
If further dilation no longer results in increased contractility, but instead leads to a progressive decrease in myocardial contractility and a decline of cardiac output, the patient is in ?
A
Decompensated HF
23
Q
Mitral Insufficiency leads to ?
A
Enlargement of LA (dilation)
24
Q
What are the 2 types of HF?
A
Right and Left
25
What is Left Sided HF caused by?
Caused by anything that increases hydrostatic P (accumulation of fluid) in left side of heart (atrium or ventricle)
26
What are the most common causes of Left Sided HF?
- Systemic hypertension
- Mitral or Aortic valve disease
- Ischemic Heart disease
- Primary diseases of the myocardium (myocardiopathies are incurable)
27
Does left Sided HF have lung edema?
YES ALWAYS
28
What happens when there is an issue with the mitral valve in left Sided HF?
Blood accumulates in left atrium, more and more leads to the increase in hydrostatic pressure, increase pressure will eventually resist the flow of the blood from the pulmonary vein into the left atrium (accumulation of blood in pulmonary veins -> Equalization of hydrostatic pressure -> No movement of blood = stasis -> Stasis of blood in the alveoli - CONGESTION of PULMONARY CIRCULATION
29
What happens to the alveoli in left sided HF?
Pushes transudate (not due to inflammation) into the alveoli
30
What happens to BOTH the capillaries and alveoli in left sided HF?
RUPTURE
31
Can blood cells be pushed into the alveoli with left sided HF?
YES
- Blood cells could be pushed into the alveoli (RBCs that are not in the blood cause them to lyse due to osmotic pressure > release hemoglobin into the surrounding tissue > heme + globin > heme contains iron which goes into the alveoli
32
What do alveoli macrophages do in left sided HF ?
Alveoli macrophages eliminate abnormal components in the alveoli > engulf iron - HEART FAILURE CELLS aka SIDEROPHAGES
33
What are Heart Failure Cells aka Siderophages?
Cells latent with iron from the destroyed RBCs as a result of pulmonary artery congestion
34
What will siderophages cause?
They will eventually have fibrosis within the alveolar walls due to healing
35
What is pulmonary edema associated with in left sided HF ?
Fibrosis within the alveolar walls due to healing, area where gas should be = DROWNING (drowning in their own blood)
36
What can pulmonary edema be caused by?
Anything that causes an accumulation of blood in left atrium (weakening of left atrium, stenosis, insufficiency, MI, etc)
37
Are there any breathing problems with left sided HF?
Yes, can see bubbling of the pink color from the mouth (transudate out of mouth)
38
What happens when left sided HF becomes “Chronic Congestive HF” ?
Changes the color of the lungs, brown induration of the lungs
(Pulmonary hemosiderosis) due to too much Hemosiderin
39
What are primary diseases of myocardium?
Myocardiopathies
40
Who does myocardiopathies affect?
Young people, no etiology, incurable
Around 50
** Patient dies within weeks
41
What are the different types of Cardiomyopathies?
- Dilated
- Hypertrophied
- Restrictive
42
What is the MC cardiomyopathy?
Dilated
43
What is Dilated Cardiomyopathy?
A condition in which the heart’s ability to pump blood is decreased because the LV is enlarged and weak
44
What happens during Dilated Cardiomyopathy?
Thinning of the wall
- Caused by: Myocarditis, perinatal statis (anything around the delivery of baby)
45
What are the causes of Dilated Cardiomyopathy ?
- Myocarditis
- Perinatal
- Idiopathic dilated cardiomyopathy (no known cause)
46
What is hypertrophied cardiomyopathy?
When the heart muscle cells enlarge and cause the walls of the ventricles, usually the LV, and especially the interventricular septum to thicken
47
What happens during hypertrophied cardiomyopathy ?
The ventricle size often remains normal, but the thickening may block blood flow out of the ventricles (obstructive hypertrophic cardiomyopathy) > can prevent flow into aorta
48
Is Hypertrophic Cardiomyopathy congenital ?
YES
49
What is restrictive cardiomyopathy?
A rare form of heart muscle disease that is characterized by restrictive filling of ventricles during diastole
50
What happens during restrictive cardiomyopathy?
The contractile function (squeeze) of the heart and wall thicknesses are usually normal, but the relaxation or filling phase of the heart is very abnormal (rigid, fibrous tissue within the heart wall)
51
What can the heart not do in Restrictive Cardiomyopathy?
Cannot distend easily
- Causes: Endomyocardial fibrosis, cardiac amyloidosis, hemochromatosis, and others
52
What are the causes of Restrictive Cardiomyopathy?
- Endomyocardial fibrosis
- cardiac amyloidosis
- hemochromatosis
53
What is always present in right sided HF?
There is always an increase in hydrostatic P in the pulmonary system = pulmonary artery hypertension
54
What is the flow fo pathology that happens after right sided HF?
Increased load of right ventricle > right ventricular hypertrophy > increased load to right atrium > systemic venous congestion and soft tissue edema
55
What is the first victim in right sided HF?
LIVER
56
What happens to the liver during right sided HF?
Hepatomegaly because the liver is overloaded by the venous blood due to not being able to flow to heart due to increased pressure from the right atrium, right ventricle, and pulmonary system
57
What happens if the liver is affected for an extended period of time due to right sided HF?
It becomes chronic passive congestion
- Diffuse liver necrosis (MC cause)
58
What happens if there is congestion in the venous system due to right sided HF?
Increased pressure in central vein due to inability to expel blood to the right heart - increased pressure to hepatocytes
59
What happens when there is no pressure to the hepatocytes?
Increased pressure continues to increase due to increased load to right ventricle and right atrium > compression of hepatocytes leads to pressure atrophy/necrosis
60
What is it called when there is pressure atrophy to the hepatocytes?
Nutmeg liver
61
What does progression of right sided HF later begin to involve?
There is an escape of fluid into tissue, peripheral edema
(discrepancy of hydrostatic P inside and outside blood vessels, increased pressure inside pushes fluid out of the vessel into the tissue)
62
What is it called when there is swelling in the peripheral limbs due to right sided HF?
Pedal (pitting) edema
- Anterior medial portion of the leg over the tibia
63
What results will happen with right sided HF?
- Hepatomegaly
- pedal edema
- Accumulation of transudate in tissues
- Anascara
- cyanosis
64
What is the “accumulation of transudate” in right sided HF?
Pericardial effusion, pleural effusion, and Ascites
65
What is Anascara ?
Total swelling of the body
66
Where would you see Cyanosis in right sided HF?
Where there is mucous, lips, and nail beds
67
What are the most common causes of right sided HF?
- left sided HF
| - cor pulmonale
68
What are clinical features of right sided HF?
- enlarged heart (dilation and hypertrophy)
- distended neck veins
- enlarged liver
- cyanosis
- Muscle fatigue
- edema (peripheral)
- accumulation of transudate (in cavities discussed)
69
What is cor pulmonale?
Aka pulmonary heart disease
| Disease of right sided cardiac chambers
70
What is cor pulmonale caused by?
Pulmonary hypertension resulting from pulmonary parenchyma or pulmonary vascular disease
71
Describe the long definition of cor pulmonale aka pulmonary heart disease
term used to describe disease to the right-sided cardiac
chambers caused by pulmonary hypertension resulting from pulmonary parenchymal or pulmonary
vascular disease -- pathology of the heart caused by lung pathology -- left heart could be completely
normal, but the right heart affected by lung pathology :: lung emphysema (rupture of the alveolar walls &
capillaries → pressure increased as discussed earlier)
72
What are the causes of cor pulmonale ?
- Chronic obstructive pulmonary disease (COPD)
| - Diffuse Interstitial (restrictive) diseases
73
What is COPD?
Lung emphysema and bronchiectasis
74
What is diffuse interstitial (restrictive) diseases?
Pneumoconioses and idiopathic pulmonary fibrosis
75
What pneumoconiosis?
Silicosis and asbestosis
76
How do you develop pneumoconiosis?
Inhale substances and the body treats the particles as intruders -> attracts phag. Cells -> engulfs particles (inorganic) -> Unable to digest the inorganic material (intruders) -> kills the phag cell and then the cells lyse and the enzymes (active) start to DIGEST THE LUNGS -> process happens over again -> healing of lung tissue by useless CT -> Respiratory insufficiency and dies
77
What are the symptoms and clinical features of right sided heart failure?
- Dyspnea
- muscle fatigue
- heart (enlarged, tachycardia)
- fine rales in the lung bases
- Hepatomegaly; sometimes tender liver
- edema, accumulation of fluid in the body cavities
- cyanosis
78
What are the different types of dyspnea associated with HF (mostly left)?
- exertion dyspnea
- orthopnea
- paroxysmal nocturnal dyspnea
79
What is exertional dyspnea?
Normal breathing until exertion, heart can cope during resting but not activity
80
What is orthopnea?
Dyspnea due to a change in position from standing to lying down, because the lack of gravity when lying down brings blood flooding back to overworked heart
81
What is paroxysmal nocturnal dyspnea?
Patient must sleep in upright position
82
NERVOUS SYSTEM DISEASES
NEW TOPIC
83
What is Hydrocephalus ?
Refers to the accumulation of excessive CSF in the ventricular system of the brain > increases hydrostatic P
84
What is contained in the ventricles of the brain?
Spaces in the brain filled with CSF
- capacity is 150mL
85
What produces CSF?
Choroid Plexus, 500mL each day (movement of fluid within the brain)
86
What is the long process by which CSF flows (long def.) ?
Fluid made in the lateral ventricles → flows through interventricular
foramen of Monroe → along with fluid produced in 3rd ventricle, flow through the
aqueduct of Sylvius into the 4th → flows out of the ventricles of the brain thru 3 openings: foramen of
Magendie AKA median aperature & 2 foramen of von Luscka AKA lateral apertures → goes to the the space
surrounding the cerebellum called the cisterna magna → flows into subarachnoid space → absorption of CSF
into the arachnoid granulations (designed for absorption of CSF) → flows into superior sagittal sinus (runs along
superior fissure) [main collector of venous blood in the brain] → goes into the transverse sinus → sigmoid →
jugular vein into the blood → superior vena cava (away from the brain)
87
What is the major symptom of hydrocephalus?
Increased intracranial pressure (caused by both communicating and non communicating hydrocephalus, but NOT ex vacuo)
88
What are the signs and symptoms of Hydrocephalus?
- headache
- nausea and/or vomiting
- papilledema
(Swelling of optic disc)
89
What are the 2 types of hydrocephalus?
Communicating and non communicating
90
What is communicating hydrocephalus?
Caused by an impairment of CSF flow OUTSIDE the ventricular system
91
What are the 2 pathogenic mechanisms of communicating hydrocephalus ?
1) Overproduction of CSF (reabsorption is normal)
2) Abnormal reabsorption of CSF (production is normal) can be due to swelling of the arachnoid granulation due to swelling of the dura (meningitis)
92
What are the 2 common things with communicating hydrocephalus ?
Both have normal communication with outside of brain with no obstruction
93
What is non communicating hydrocephalus caused by?
Impairments of CSF flow (buildup of fluid) WITHIN the ventricular system
94
What can cause Noncommunicating hydrocephalus ?
An obstructive tumor
Ex: Ependymoma, cranopharyngioma (non removable tumor)
95
What is the most common tumor that can block CSF flow?
Most common in cerebral aqueduct/aqueduct of Silvius = APEDIOMA **
Hemorrhagic stroke, etc
96
When something blocks the CSF movement within ventricular system (any tumor) non-communicating, what can this lead to?
Lack of communication between the ventricles and outside
97
What does granular (cranio)pharyngioma create? And what is it?
Creates Non-communicating hydrocephalus
- Walls made from tissue of the pituitary - CANNOT be removed > prevents normal flow of CSF
98
What does accumulation of CSF in the brain cause (or brain tumor)?
Increased hydrostatic pressure
99
What are the 3 major signs and symptoms due to increased intracranial pressure?
1. Headache
2. Nausea vomiting
3. Papilledema
100
Why would you have nausea during increased ICP?
Body is trying to get rid of fluid
101
What is Papilledema?
Swelling of the optic disc (do not see boundaries of the disc)
102
What is the 3rd type of Hydrocephalus?
Hydrocephalus ex vacuo
103
What happens during Hydrocephalus ex vacuo?
Brain atrophy occurs accompanied by CSF filling spaces making up for lost tissue
104
How is hydrocephalus ex vacuo different compared to communicated and non-communicated hydrocephalus?
There is NORMAL ICP
105
What clinical sign is apparent with hydrocephalus ex vacuo ?
Loss of memory
106
What are examples of hydrocephalus ex vacuo?
Alzheimer’s disease and Huntington’s
107
Alzheimer’s aka
Pick’s disease
108
What happens during Alzheimer’s disease?
- Decreases mass inside and outside brain
- Diminish gray matter
- Parts of brain that create memories are replaced by CSF accumulation
109
What happens during Huntington’s Disease?
GENETIC
- Atrophy of midbrain striatum nuclei > causes increase in the size of the ventricular system, leads to compensatory accumulation of CSF
110
What does Huntington’s Disease cause?
CHOREA
111
What does diagnosis of hydrocephalus depend on?
AGE
112
Less than 18 month (in regard to hydrocephalus) =
OPEN fontanelles
113
More than 18 months (in regard to Hydrocephalus) =
CLOSED fontanelles
114
When you are born, what is the appearance of your cranial vault ?
6 fontanelles at birth - movable cranial vault bones and unclosed growth plates
115
5 of the fontanelles are closed at 2 months, but ______ may be open until 18 months ?
FRONTAL fontanelle
116
What would non-closure of the fontanelles cause?
Increased space in the ventricular system =
Increased hydrocephalus
117
What happens if the parietal bones overlap during birth?
It can add pressure on the superior sagittal sinus, causing hydrocephalus
118
What is the treatment of hydrocephalus?
Tube/shunt between the brain into the stomach or jugular brain
119
CEREBROVASCULAR DISEASE
NEW TOPIC
120
Under normal circumstances, the brain receives _____
15% of the cardiac output and utilized fought 20% of the oxygen consumed by the body
121
What is the most sensitive hypoxic organ?
The brain
122
What are the 3 major categories of cerebrovascular disease?
1. Parenchymal injuries
2. Infarcts (ischemic stroke)
3. Hemorrhage’s (hemorrhagic stroke)
123
What are “Parenchymal injuries” associated with cerebrovascular disease?
Parenchymal injuries associated with a generalized with a generalized reduction in blood flow, including global hypoxia - ischemic encephalopathy
- LEAST COMMON
124
What are “Infarcts” associated with cerebrovascular disease?
Infarcts (ischemic stroke) caused by local vascular obstruction
- zone of NECROSIS due to oxygen deficiency
125
How common is “Infarcts (ischemic stroke)” in cerebrovascular disease?
Makes up 80% of all CVD (MC)
126
What are hemorrhages (hemorrhagic stroke) associated with cerebrovascular disease?
Within the brain parenchyme or subarachnoid space
- Makes up 15% of all CVD
127
What is a hemorrhage?
An escape of blood from a ruptured vessel
128
What is ischemia?
A restriction of blood supply to tissue causing a shortage of oxygen and glucose
129
What is an infarct?
Tissue death (necrosis) due to lack of oxygen
130
When does Ischemic stroke occur?
When an artery to the brain is blocked
131
What are the 2 types of ischemic stroke?
Lacunar infarction and thrombosis of cerebral arteries
132
Lacunar infarction makes up ____
8-9% of all ischemic infarction
133
Lacunar infarction is associated with ?
Hyaline arteriosclerosis ****
134
What happens during Lacunar infarction?
Dramatic narrowing of the lumen of arterioles = reduced blood flow to the brain
135
What does Lacunar infarction affect?
MIDBRAIN
136
What type of infarction do people have subtle manifestations and don’t realize they have it?
Lacunar infarction
137
Thrombosis of cerebral arteries is due to ______
Atherosclerosis
138
What is thrombosis of cerebral arteries associated with?
Atheroma accumulate in the walls - activation of the platelet plug, thrombus formation, necrosis of tissue
139
In thrombosis of cerebral arteries, what happens if the thrombus breaks off?
If thrombus tears and becomes an embolism, it goes with blood flow to vessels who have small lumen - leads to development of thromboembolism
140
What are the most common areas of atheroma ?
1. Bifurcation of the CC artery
2. Bifurcation of the internal carotid artery
3. Middle cerebral artery
141
Where is the bifurcation of the common carotid artery?
Divided into int/ext at the level of C5
142
Where is the bifurcation of the internal carotid artery?
Divided into ant/middle cerebral artery
143
What is the most vulnerable area for ischemic stroke (atheroma)?
Middle cerebral artery ***
144
Liquefaction necrosis results from?
Cerebrovascular disease
145
What is liquefactive necrosis?
Replacement of damaged brain by neuralgia = GLIOSIS
146
What are the sources of thromboemboli in the brain?
Left sided heart failure
- mitral stenosis
- subacute bacterial endocarditis
- MI
147
What is Transient Ischemic Attack (TIA)?
Sequelae of thrombosis - resolution
148
What happens in Transient Ischemic Attack (TIA)?
Development of temporary ischemic stroke - patient develops manifestations of stroke and loss of motor function/speech/eyesight
(UNILATERAL)**
149
What is the duration of Transient Ischemic Attack (TIA)?
Lasts several minutes and the symptoms go away
150
What is a major symptom of TIA?
Loss of vision explained by Involvment of opthalmic artery
151
What is important diagnosis in TIA associated with the opthalmic artery thrombosis?
Aka AMAUROSIS FUGAX
- Temporary unilateral loss of vision
- Similar symptoms
152
What is the treatment of opthalmic artery thrombosis (aka AMAUROSIS FUGAX) associated with TIA?
Anticoagulant
153
Hemorrhagic stroke subcategory:
Intracerebral aka parenchymal aka hypertensive (long term)
154
What is intracerebral/parenchymal/hypertensive Hemorrhagic Stroke associated with?
Hyaline arteriosclerosis
155
What is the mechanism of injury with intracerebral/parenchymal/hypertensive - Hemorrhagic stroke?
In the case of long term hypertension, development of hyaline arteriosclerosis, replacement of normal vascular wall with hyaline tissue weakening of the vascular wall
156
What does intracerebral aka parenchymal aka hypertensive - Hemorrhagic Stroke lead to?
Death of parenchyme
157
What is the most dangerous part of high BP?
Hemorrhagic stroke
- Intracerebral aka parenchymal aka hypertensive
- Sudden increase or decrease of BP
158
What is the development sequence of hemorrhagic stroke?
1. Dramatic pressure into adjacent tissue which results in
compression of walls in ventricle and formations of
non-communicating hydrocephalus
2. Development of poisoning of brain tissue by blood
▪ Because blood gets outside of the vessels- poisonous for the
nervous tissue
3. Pressure atrophy of brain tissue
▪ Usually results in death
▪ If survival, there is scar tissue formation
159
What happens from subarachnoid hemorrhagic stroke?
Rupture of multiple aneurysms that develop within several cerebral arteries (circle of Willis)
160
What is an aneurysm?
Pouching of vascular wall
161
Where does subarachnoid hemorrhagic stroke go?
Goes into subarachnoid space (not cerebral tissue)
- Does not result in death of neural tissue, just blood in the subarachnoid space
162
What is the etiology of subarachnoid hemorrhagic stroke?
Hypertension may be involved, but it is genetic
163
What is the way in which subarachnoid hemorrhagic strokes occur?
The middle layer of arteries are weakened and eventually leads to destruction of the elastic fibers and slow formation of pouching
- usually occurs in bifurcations
164
When does a subarachnoid hemorrhage occur
Usually before 50 y.o.
165
What are the 2 examples of subarachnoid hemorrhage?
1. Berry aneurysm
| 2. Congenital giant aneurysm
166
Aka of Berry Aneurysm :
Saccular Aneurysm
167
What does Berry Aneurysm cause?
Papilledema
- Berry A. Is most vulnerable to rupture (> 1cm)
168
Congenital Giant Aneurysm aka
Giant Aneurysm
| Diameter = > 1cm, up to 5 cm
169
What are the symptoms of congenital Giant aneurysm ?
Similar to space occupying lesions (headache, papilledema, nausea, vomiting )
- MUST BE REMOVED
170
Aneurysms are most vulnerable to rupture between _____
4-7 mm
171
CNS TRAUMA
NEW TOPIC
172
What is the major factor of CNS trauma ?
Car accidents
173
What is a hematoma?
Collection of blood outside of the vessels
174
What are the 3 major categories of CNS trauma?
1. Epidural hematoma
2. Subdural Hematoma
3. Brain Traumatic Injury (parenchyme)
175
Know your layers ->
(Superficial to deep)
- Dura mater
- Arachnoid mater
- Pia mater
176
What is an epidural hematoma?
Normally no space between the skull and dura > in this case, arterial hemorrhage pushes against the dura and creates space at the expense of the cranial fossa
177
What artery does blood leak from in an epidural hematoma?
Meninges arteries - middle meningeal artery
178
Will you have increased hydrostatic P in epidural hematoma?
YES
- Along with compression of brain tissue
179
What swells during epidural hematoma?
Swelling of white matter - accumulation of fluid around axons
- loss of brain function
- prevents/diminishes neural activity
180
What happens to the brain during Epidural Hematoma?
Shift of brain to the other side fo skull
- Noncommunicating hydrocephalus is possible
181
What are the types of Herniations that can occur during Epidural hematoma ? **
1. Subfalcine Herniation
2. Transtentorial (Uncal, uncinate) herniation
3. Cerebellar Tonsilar Herniation
182
What happens during Subfalcine herniation?
- Compression of the anterior cerebral artery
| - Compression of the cingulate gyrus against the fall Cerebri
183
What results from a Transtentorial (Uncal, uncinate) herniation?
Compression of free margin of temporal lobe against tentorium cerebelli
184
What gets compressed during Transtentorial (Uncal, uncinate) herniation ?
Compression of CN III =
Palsy of CN III **
185
What are the results of Transtentorial (Uncal/uncinate) herniation?
- Paralysis of sphincter papilla muscle responsible for narrowing pupil
- Ipsilateral pupil dilation
- Results in permanent dilation of pupil on the same side of herniation
186
What is ipsilateral pupil dilation?
Mydriasis aka Blown Pupil
187
What herniation is more serious, Subfalcine or Transtentorial?
Transtentorial
188
What is the most serious herniation associated with Epidural hematoma?
Cerebellar Tonsilar Herniation
189
What happens during Cerebellar Tonsilar Herniation ?
Herniations of cerebellar tonsils and brainstem into foramen magnum (can result in death)
190
What gets compressed during Cerebellar Tonsilar herniation
- Midbrain
| - Cardiovascular and respiratory centers compressed = can lead to parathesis/ cardiopulmonary arrest
191
What can cerebellar Tonsilar herniation lead to?
Secondary brainstem hemorrhage
- aka duret hemorrhage
- develops in pons
- arterial hematoma
192
What is a severe consequence of cerebellar Tonsilar herniation ?
Lost consciousness in 15-25 min and die within 45 min
193
Where is the most dangerous place for an epidural hematoma?
Temporal bone
194
Why is the temporal bone the most dangerous place for an epidural hematoma?
Middle meningeal artery (largest of meningeal arteries)
195
What is the sequence of Epidural Hematoma?
1. Trauma
2. Break of skull
3. Cuts meningeal A.
4. Increases hydrostatic P.
5. Convexity
6. Swelling
7. Death (highly likely)
196
What is affected in Subdural hematoma?
Superior cerebral veins
197
Aka of superior cerebral veins =
Bridging veins
- carries blood from the brain to superior sagittal sinus to be drained: major blood collector of brain
198
What does Subdural hematoma result from?
Results from rupture of bridging veins due to sudden change of head velocity
199
What is the MOI in Subdural hematoma?
Trauma to head, law of inertia, the brain still has room to move when skull is impacted, creates tearing/shearing force
200
What happens during a Subdural hematoma?
Leakage fo blood in Subdural space
- venous hematoma
201
What exactly happens with a Subdural hematoma, what causes damage?
Direct contact of blood with the brain - leads to dysfunction and atrophy of the brain tissue
202
When will you see signs and symptoms for Subdural hematoma?
24-48 hours and a 2nd trauma could be fatal (why athletes who experience this trauma should continue playing)
203
What are the 2 types of Subdural hematoma?
1. Acute
| 2. Chronic
204
What happens with acute Subdural hematoma?
Sudden change of head velocity that develops in the normal brain (normal people falling)
205
What happens with Chronic Subdural hematoma?
Usually develops in elderly people with brain atrophy
- typical with Alzheimer’s , Parkinson’s, and Huntington’s
206
What are the things associated with brain traumatic parenchymal injury?
- concussion
- Diffuse Axonal injury
- contusion
- laceration (aka traumatic brain hemorrhage)
- Basilar skull fracture
207
What happens during a brain traumatic parenchymal injury?
Damage of brain in different degree and severity
- MC cause of post traumatic dementia
208
What is brain traumatic parenchymal injury associated with?
Concussion
209
What is concussion clinical syndrome?
Characterized by immediate and transient loss of neurological function secondary to mechanical forces
210
What is concussion characterized by?
2 factors: loss of consciousness and amnesia
211
What is amnesia?
Temporary loss of memory of events prior to, during, and after they occur
212
What system is affected with concussion associated with brain traumatic parenchymal injury ?
Reticular Activating System (temporary function loss of RAS with concussion)
- Set of neurons which connect various parts of the brain with one another and negatively effected by trauma
213
What is the most common cause of post traumatic dementia?
Diffuse Axonal injury
214
What happens during diffuse Axonal injury ?
Elongation of white matter - stretching
- may result in tear of white matter structures
215
Where does diffuse Axonal injury normally occur?
In posterior portions of brainstem and cervical spine
216
What is the MOI with diffuse Axonal injury?
Acceleration-deceleration trauma
(Car accident whiplash*)
- Shaken baby syndrome
217
What do you see within Diffuse Axonal injury?
Subinclusions found in area of axon tear, due to accumulation of proteins (micro tears in white matter), amyloid protein precursor-Axonal spheroids
- aka AXONAL SWELLING
218
What disease would you see with Diffuse Axonal injury ?
Alzheimer’s disease
219
What happens with contusion?
Hemorrhage’s in the Superficial brain parenchyma caused by blunt trauma - anatomical damage to brain tissue
(More serious than concussion )
220
What are the 2 types of contusions?
Coup and contra coup
221
What is coup contusion characterized by?
Damage of brain underneath area of impact
- mobile impact force on immobile head
222
What is contra coup contusion characterized by?
Damage of brain on opposite side of impact
- Mobile head runs into immobile object (person runs into wall)
223
What is laceration aka
Traumatic brain hemorrhage
224
What happens during laceration?
Tear of brain tissue (and therefore blood vessels)
** DONT CONFUSE WITH STROKE
225
What are the 2 types of hemorrhage associate with laceration?
1. Traumatic Subarachnoid hemorrhage
| 2. Intracerebral/parenchymal hemorrhage
226
What happens during traumatic subarachnoid hemorrhage?
Leakage of blood in subarachnoid space as a result of trauma - develops in superficial areas
227
What happens during intracerebral/parenchymal hemorrhage?
Leakage of blood in brain tissue as a result of trauma
228
What happens with a basilar skull fracture?
Fracture of orbital plates of frontal bone or greater wing of sphenoid development of bilateral periorbital hemorrhage (bruising of both eyes) and rhinorrhea (runny nose for no reason)
- Raccoon sign
229
What are the 2 types of fracture associated with Basilar skull fracture?
Fracture of orbital plates of frontal bone or greater wing of sphenoid
Fracture of pyramid of temporal bone or anterior aspect of the occipital bone
230
What happens during the 2nd type of fracture during basilar skull fracture?
Fracture of pyramid of temporal bone or anterior aspect of the occipital bone - development of battle sign (bruising behind ear)
- leakage of CSF from ear > otorrhea
231
What can happen as a result of basilar skull fracture?
Development of an infection of the CNS - antibiotics would be prescribed
