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NEURO CLERKSHIP > Lecture slide decks Trauma, Tumors, Pages 10-22 > Flashcards

Lecture slide decks Trauma, Tumors, Pages 10-22 Flashcards

1
Q

what is second impact syndrome?

A

dangerous, rapid swelling of cerebral tissue on repeated trauma, thout to result from a failure of cerebral autoregulation

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2
Q

What is a common traumatic vascular problem following mild trauma?

A

traction to arteries–> dissection of occlusion of vertebral or carotid arteries.

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3
Q

What are some of the particular dissection syndromes?

A

hemispheric ( ICA) or Wallenberg (vertebral)

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4
Q

what should you always exam after an accident to visualize vascular injury?

A

pupils reaction- retina

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5
Q

Is vertigo a chronic or acute symptom of TBI?

A

chronic along with epilepsy, post-traumatic headaches, cranial nerve abnormalities

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6
Q

What are the 4 categories of GCS?

A

eyes open, best verbal response, best motor response, flexion to pain

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7
Q

what is our key imaging to TBIs?

A

non-contrast CT
no-role for hyperacute MRI. If suspect dissection/occlusion get CT angiogram

CSPINE plain film and skull

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8
Q

when should we admit TBI patients?

A

acute blood
subdural hematoma
GCS

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9
Q

when do we have ICU admission and intubation of TBI?

A

GCS

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10
Q

If patient is in coma should we EEG monitor brain?

A

yes

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11
Q

what is management of increased intracranial pressure?

A

hyperventilation
osmotic agents (mannitol)
sedation
surgery

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12
Q

What are the most common brain tumors found in children?adults?

A

astrocytoma and medulloblastoma

malignant astrocytoma (GBM, glioma) and meningiomas

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13
Q

brain tumors more common in male or femal?

A

male except meningiomas which are most common in female

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14
Q

What are the known risk factors for brain tumor?

A

brain irradiation and acquired immunosupression

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15
Q

HIV increases risk of what brain tumors?

A

primary CNS lymphoma, intracranial leiomyosarcomas and GBM

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16
Q

chronic immunosuppressive therapy increases what type of brain tumor?

A

primary CNs lymphoma

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17
Q

neurofibromatosis 2 has increased risk of schwannomas and meningiomas, what about NF type 1?

A

gliomas

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18
Q

Li-fraumini has a higher risk for what tumors?

A

glioma and medulloblastoma

choroid plexus carcinomas

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19
Q

tuberous sclerosis has an increased risk of what brain tumor?

A

subependymal giant cell astrocytoma and cortical hamartomas

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20
Q

VHL syndrome increases what tumor?

A

hemangioblastomas

RCC too

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21
Q

burkitt syndrome and hereditary nonpolposis colorectal cancer have a higher risk of what tumors?

A

GBM and medulloblastoma

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22
Q

GBM brain tumors more common in white or black?

A

white

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23
Q

what is the only environmental risk factor for GBM?

A

ionizing radiation

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24
Q

grade 1 gliomas are what type and often in what population?

A

pilocytic astrocytoma and in young adults

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25
Q

meningiomas are uncommon in children, but what are they associated with in children?

A

NF type 2

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26
Q

what are the two classic presentations for pituitary tumors besides secretion of hormones?

A

bitemporal hemianopia

pituitary apoplexy

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27
Q

what is the most common metastatic tumor to the brain

A

nonsmall cell lung cancer

melanoma, small cell lung, breast renal and GI

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28
Q

what are the 3 most common metastatic tumors to the spinal cord?

A

lung breast prostate

29
Q

how does location of tumors vary in children?

A

majority of cerebellar tumors in young children and cerebral tumors in older children or infants.

30
Q

in children, the peak age for malignancy tumors is what?

A

3-4 years

31
Q

when can a corpus callosum be associated with dementia? with behavioral changes and severe memory loss?

A

anterior

splenium

32
Q

Ipsilarteral deafness and facial numbness with weakness and ataxia indicate a tumor where?

A

cerebelloponine angle

33
Q

what is impaired upgaze and pupillary abnormalities? where is the lesion

A

parinaud syndrome

lesion in the pineal region

34
Q

when do false localizing signs occur with tumor?

A

increased intracranial pressure

35
Q

what nerve is often squished with ICP on the petrous ridge?

A

6th

36
Q

ipsilateral hemiparesis from tumor occurs because?

A

uncal herniation causing contralateral compression of cerebral peduncle on the tentorium

37
Q

what vessel is squished with ICP herniation?

A

PCA through tentorial notch—> personality,gait, urinary, tinnitus, cortical blindnes

38
Q

what is the most common symptom of tumors? what will EEG show?

A

seizures 1/3 of patients

epileptogenic focus
may appear generalized, but have a focus

39
Q

what are the signs of cord compression from a tumor?

A

progressive weakness below level of tumor and sensory changes, brisk reflexes, upgoing toes, urinary retention

40
Q

sexual dysfunction, amenorrhea, infertility, fatigue, malaise, weight gain, weight loss, hypercholesterol should key us into a tumor where?

A

pituitary

41
Q

bony artifact may create a missed tumor situation in what area?

A

posteror fossa

42
Q

do we do contrast for tumors?

A

contrast and non contrast

43
Q

why is chemo of limited use in brain tumor?

A

BBB

44
Q

what is used for more malignant tumors? slower growing?

A

radiation

gamma knife

45
Q

what is treatment for ICP with tumors?

A

corticosteroids to reduce edema- dexamethasone, prednisone (remember prophylactic abx if needed and PPI for stomach)

46
Q

are prophylactic seizure meds used with tumors/

A

no- but once they have one then they need one

47
Q

what anti-convulsant increases risk of steven’s johnson when using beam radiation?

A

phenytoin

48
Q

what is the pupil abnormaility in a comatose patient in metabolic issue? tectal area? pons? midbrain?uncal herniation?

A 
small reactive
large fixed hippus
pinpoint
midposition, fixed
single dilated, fixed
49
Q

decorticate positioning is due to what?

A

bilateral hemisphere damage of the corticospinal tracts

flexion of arms

50
Q

decerebrate positioning is due to what?

A

bilateral damage to the upper brainstem with th arms adducted and extended

51
Q

what is a tentorial herniation? and what does in compress?

A

uncus temporal lobe through tentorium cerebelli

compress midbrain- CN 3 palsy

52
Q

what is a central herniation?

A

herniation of the diencephalon downwards onto brainstem

53
Q

coma results from either what two things?

A
  1. bilateral cerebral hemispheres

2. bilateral damage to midbrain, upper pons

54
Q

bilateral lesions need to be above what in order to cause coma in ARAS?

A

rostral pons, midbrain

55
Q

ascending paralysis happens why?

A

lateral corticospinal tract is leg, trunk, arm outside in

56
Q

crossed defects of paralysis like ipsilateral opthalmoplegia and contralateral body paralysis happen where?

A

In the brainstem- face is spared if lesion is below the pons

57
Q

UMN vs. LMN atrophy?

A

no atrophy UMN, yes atrophy LMN

58
Q

Fasciculations UMN lesion or LMN?

A

LMN

59
Q

is upper limb extensor weakness

A

no other way, flexes

60
Q

is upper limb extensor weakness

A

yes- extended position

61
Q

where does decussation of the spinothalamic tract take place?

A

anterior white commissure

at the level or a couple levels above

62
Q

what is sensory loss distribution of brainstem lesions?

A 
contralateral sensory loss to the
upper limb, trunk and lower limb
but because such a lesion involves
nearby structures such as the
trigeminal system, ipsilateral facial
numbness is also present
63
Q

what is the sensory loss distribution of VPL nucleus or above

A

contralateral sensory loss to the face, upper limb, trunk or lower limb

64
Q

is fasciculus gracilis or cuneatus more lateral?

A

fasiculus cuneatus

65
Q

what nucleus sends parsympathetics to the oculomotor nerve?

A

edinger-westphal nucleus- comes from the pretectal and LGN

66
Q

where does the pathway for pupillary dilation begin?

A

hypothalamus

67
Q

fibers that eventually terminate at the facial sweat glands travel along which part of the carotid?

A

the external

the ones that go to the pupil travel on the internal carotid

68
Q

when does ptosis and miosis occur without anhidrosis?

A

lesion on the internal carotid

69
Q

a lesion involving the optic pathway posterior to the optic chiasm will affect vision how?

A

both eyes, nasal field ipsi side and temporal field contralateral side

NEURO CLERKSHIP (7 decks)

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