NEURO 2: CEREBROVASCULAR DISEASE, CNS INFECTION, ICP, HYDROCEPHALUS Flashcards
What causes cerebral aneurysm?
Congenital lesion in the medial layer of a cerebral blood vessel causes weakness and ballooning of the vessel
What is the term for the feeling of stiff neck before rupture of a cerebral aneurysm, and what causes it?
Menigismus: irritation of the meninges due to blood leaking into the CSF
What are 3 consequences of rupture of cerebral aneurysm?
- Increased intracranial pressure
- Vasospasm
- Hydrocephalus
What is the term for a procedure to treat cerebral aneurysm by threading a wire into the area of outpouching, which acts as a thrombogenic?
Endovascular coiling
What is the term for a procedure where a clip is placed to cut off the cerebral aneurysm from blood supply?
Aneurysm clipping
What are 2 ways to manage vasospasm after cerebral aneurysm rupture?
- IV fluids to maintain blood volume
- Calcium channel blockers
Why are analgesics, laxatives, antitussives, and antiemetics used in management of patients with cerebral aneurysm?
Important to prevent straining or coughing to avoid rupture
Why does aryteriovenous malformation cause enlargement of veins?
Lack of capillary bed, so blood flows directly from arteries (high pressure) to veins (weaker vessels)
What are 3 consequences of AVM?
- Rupture
- Compression to surrounding tissue
- Vascular steal
What is the term for an audible whooshing noise heard with stethoscope placed against the head in some cases of AVM?
Bruit
What is the term for a procedure where a catheter is threaded into the AVM so a substance can be injected to seal it off from blood supply?
Endovascular embolization
What are 2 other ways AVM can be treated?
Surgical excision and irradiation
Which pathogen is the most common cause of meningitis, and where does is usually reside in humans?
Streptococcus pneumoniae
Normal inhabitant of nasopharynx
What are 3 potential causes for bacterial meningitis?
- Blood infection
- Neurosurgery
- Head trauma
What are 2 areas of the blood brain barrier that are considered “weak?”
Choroid plexus
Circumventricular organs
In infants with bacterial meningitis, what is the term for reflex flexion of the hips when the neck is forcibly flexed?
Brudzinski neck sign
In infants with bacterial meningitis, what is the term for the inability to straighten the leg when the hip is flexed 90 degrees?
Kernig sign
What characteristics of CSF taken by a lumbar puncture would indicate bacterial meningitis?
- Increased protein and WBCs
- Decreased glucose
- Culture & sensitivity grows pathogen
What 3 characteristics of CSF taken by a lumbar puncture would indicate bacterial meningitis?
- Increased protein and WBCs
- Decreased glucose
- Presence of pathogen on culture & sensitivity
Which viruses most commonly cause encephalitis?
Herpes simplex virus, West Nile virus
Where does herpes simplex virus normally lay dormant in people who had previous infection?
Trigeminal ganglion
What ocular change is associated with increased intracranial pressure, and why?
Blurred vision, caused by edema of the optic disc (papilledema)
How is ICP monitored in hospital?
Intraventricular catheter
What are 3 surgical procedures used to treat increased intracranial pressure depending on the cause?
- Lesion removal
- Shunt insertion
- Decompressive craniectomy
What are 4 medical treatments used to treat intracranial pressure depending on the cause?
- Hyperventilation to induce vasoconstriction
- Hypertonic fluid infusion
- Barbiturate-induced coma
- Head-up and neutral body positions
What are 3 kinds of hydrocephalus, and how do they differ?
- Obstructive (non-communicating): block of CSF flow between ventricles
- Non-obstructive (communicating): impaired CSF flow outside ventricles, but flow between ventricles remains open
- Normal pressure: increased CSF volume causes loss of brain tissue
Which type of hydrocephalus is most common in children?
Obstructive (non-communicating) hydrocephalus
Which type of hydrocephalus is most common in older adults?
Normal pressure hydrocephalus
What is the triad of early symptoms that could indicate normal pressure hydrocephalus?
- Gait instability
- Urinary incontinence
- Cognitive impairment
What is the term for a procedure where CSF is drained into the peritoneal cavity?
Ventriculoperitoneal shunt
What is the term for a procedure where CSF is drained from the third ventricle into the basal cisterns?
Endoscopic third ventriculostomy
