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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
meningiomas are uncommon in children, but what are they associated with in children?
NF type 2
26
what are the two classic presentations for pituitary tumors besides secretion of hormones?
bitemporal hemianopia pituitary apoplexy
27
what is the most common metastatic tumor to the brain
nonsmall cell lung cancer melanoma, small cell lung, breast renal and GI
28
what are the 3 most common metastatic tumors to the spinal cord?
lung breast prostate
29
how does location of tumors vary in children?
majority of cerebellar tumors in young children and cerebral tumors in older children or infants.
30
in children, the peak age for malignancy tumors is what?
3-4 years
31
when can a corpus callosum be associated with dementia? with behavioral changes and severe memory loss?
anterior splenium
32
Ipsilarteral deafness and facial numbness with weakness and ataxia indicate a tumor where?
cerebelloponine angle
33
what is impaired upgaze and pupillary abnormalities? where is the lesion
parinaud syndrome lesion in the pineal region
34
when do false localizing signs occur with tumor?
increased intracranial pressure
35
what nerve is often squished with ICP on the petrous ridge?
6th
36
ipsilateral hemiparesis from tumor occurs because?
uncal herniation causing contralateral compression of cerebral peduncle on the tentorium
37
what vessel is squished with ICP herniation?
PCA through tentorial notch---> personality,gait, urinary, tinnitus, cortical blindnes
38
what is the most common symptom of tumors? what will EEG show?
seizures 1/3 of patients epileptogenic focus may appear generalized, but have a focus
39
what are the signs of cord compression from a tumor?
progressive weakness below level of tumor and sensory changes, brisk reflexes, upgoing toes, urinary retention
40
sexual dysfunction, amenorrhea, infertility, fatigue, malaise, weight gain, weight loss, hypercholesterol should key us into a tumor where?
pituitary
41
bony artifact may create a missed tumor situation in what area?
posteror fossa
42
do we do contrast for tumors?
contrast and non contrast
43
why is chemo of limited use in brain tumor?
BBB
44
what is used for more malignant tumors? slower growing?
radiation | gamma knife
45
what is treatment for ICP with tumors?
corticosteroids to reduce edema- dexamethasone, prednisone (remember prophylactic abx if needed and PPI for stomach)
46
are prophylactic seizure meds used with tumors/
no- but once they have one then they need one
47
what anti-convulsant increases risk of steven's johnson when using beam radiation?
phenytoin
48
what is the pupil abnormaility in a comatose patient in metabolic issue? tectal area? pons? midbrain?uncal herniation?
``` small reactive large fixed hippus pinpoint midposition, fixed single dilated, fixed ```
49
decorticate positioning is due to what?
bilateral hemisphere damage of the corticospinal tracts flexion of arms
50
decerebrate positioning is due to what?
bilateral damage to the upper brainstem with th arms adducted and extended
51
what is a tentorial herniation? and what does in compress?
uncus temporal lobe through tentorium cerebelli compress midbrain- CN 3 palsy
52
what is a central herniation?
herniation of the diencephalon downwards onto brainstem
53
coma results from either what two things?
1. bilateral cerebral hemispheres | 2. bilateral damage to midbrain, upper pons
54
bilateral lesions need to be above what in order to cause coma in ARAS?
rostral pons, midbrain
55
ascending paralysis happens why?
lateral corticospinal tract is leg, trunk, arm outside in
56
crossed defects of paralysis like ipsilateral opthalmoplegia and contralateral body paralysis happen where?
In the brainstem- face is spared if lesion is below the pons
57
UMN vs. LMN atrophy?
no atrophy UMN, yes atrophy LMN
58
Fasciculations UMN lesion or LMN?
LMN
59
is upper limb extensor weakness
no other way, flexes
60
is upper limb extensor weakness
yes- extended position
61
where does decussation of the spinothalamic tract take place?
anterior white commissure | at the level or a couple levels above
62
what is sensory loss distribution of brainstem lesions?
``` 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
what is the sensory loss distribution of VPL nucleus or above
contralateral sensory loss to the face, upper limb, trunk or lower limb
64
is fasciculus gracilis or cuneatus more lateral?
fasiculus cuneatus
65
what nucleus sends parsympathetics to the oculomotor nerve?
edinger-westphal nucleus- comes from the pretectal and LGN
66
where does the pathway for pupillary dilation begin?
hypothalamus
67
fibers that eventually terminate at the facial sweat glands travel along which part of the carotid?
the external | the ones that go to the pupil travel on the internal carotid
68
when does ptosis and miosis occur without anhidrosis?
lesion on the internal carotid
69
a lesion involving the optic pathway posterior to the optic chiasm will affect vision how?
both eyes, nasal field ipsi side and temporal field contralateral side

NEURO CLERKSHIP (7 decks)

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