Neurology #4 Precision and Pearls Flashcards
An epidural hematoma is bleeding between _______ and the ______. This is MC due to ….
The skull and dura
MC due to rupture of middle meningeal artery and associated with temporal bone fracture
What are the symptoms of an epidural hematoma (there are three phases)
-Brief LOC
-Lucid Interval
-Neuro deterioration
What are other symptoms of an epidural hematoma-
-CNIII palsy: fixed, dilated, blown pupil
-Cushing Reflex: hypertension + bradycardia + respirations irregular
What is the diagnostic of choice for an epidural hematoma and what is seen (this is unique)
-CT head without contrast: biconvex (lens shaped) and doesn’t cross suture lines
Treatment for an epidural hematoma
-Hematoma evacuation or craniotomy
On the other hand, a subdural hematoma is bleeding between the _____ and the ________.
This is MC due to
Dura and arachnoid membranes
MC due to rupture of cortical bridging veins
What are some risk factors for a subdural hematoma?
Elderly, alcoholics
Shaken baby syndrome
Symptoms of a subdural hematoma
-Develop over a longer period of time
-Gradual increase in neuro symptoms
What is the diagnostic of choice for a subdural hematoma and what is seen?
Ct head without contrast
-Concave (crescent shaped) density that can cross suture lines
Management of a subdural hematoma
-Surgery if > 5 mm or greater midline shift (craniotomy, etc.)
An astrocytoma, the MC brain tumor in adults, has a few different types.
-Pilocytic Astrocytoma (Grade I) is MC in ______
-Glioblastoma Multiforme (Grade II) is MC in _____
Kids
Adults. MC primary CNS tumor in adults
Symptoms of an astrocytoma
-Focal deficits (frontal and temporal MC)
-Headache
-May wake patient up at night due to headache
-Increased ICP, AMS, neuro deficits
Even though a CT or MRI with contrast is the best diagnostic for an astrocytoma, what is seen on a brain biopsy if the patient has a pilocytic astrocytoma?
Rosenthal fibers (Corkscrew)
Management for an astrocytoma
-Surgical excision
-If Grade IV = surgery + radiation + chemo
Glioblastoma Multiforme is the MC and most aggressive CNS tumor in adults. What are some risk factors?
What is seen on brain MRI with contrast?
-Males, Age > 50, HHV-6, CMV infections
-Lesion with variable ring of enhancement
On the other hand, a meningioma is a benign, slow growing tumor MC in the _________
Although often asymptomatic, what is seen on MRI with contrast
-MC in the dura
-Intensely enhancing, well-defined lesion attached to the dura
An oligodendroglioma, a tumor of the oligodendrocytes, which are cells that make up the glial tissue of the brain, appears how on a histologic study?
-Soft, gray-pink calcified tumors (fried egg shape)
Ependymal cells line the ventricles and the spinal cord. An ependymoma is MC in kids and is MC where?
4th ventricle, spinal cord, medulla
What is seen on brain biopsy for an ependymoma?
-Perivascular pseudo rosettes (tumor cells surrounding a blood vessel)
Subcalvian Steal Syndrome is due to reversed (retrograde) blood flow from vertebral artery to ipsilateral arm due to decreased blood flow in the subclavian artery. What is the MCC?
What are some symptoms?
Subclavian artery stenosis or occlusion
-Most asymptomatic
-Arm claudication with exercise, paresthesias
-Syncope, dizziness, nystagmus, vertigo, gait problems
-BP difference between arms (>15 mmHg in affected arm)
Treatment for subclavian steal syndrome
-Revascularization or percutaneous transluminal angioplasty
Regarding Spinal Cord Syndrome, Anterior Cord problems occur MC after a blowout vertebral fracture. Other etiologies are…
Aortic Dissection, SLE, AIDS
Symptoms of Anterior Cord Syndrome
-Motor Deficits: Lower Extremity > Upper
-Sensory Deficit: Pain, temperature, bladder dysfunction
-Preserved: Vibration, Proprioception
Central Cord Syndrome occurs after
Hyperextension injuries, falls, gun-shot wounds
Symptoms of Central Cord Syndrome
-Motor Deficits: Upper extremity > LE (hands MC)
-Sensory Deficits: Pain, Temperature in UE (shawl distribution)
-Preserved: Vibration, Pressure, Proprioception
Posterior Cord Syndrome is rare, but what are the symptoms?
-Loss of proprioception and vibration ONLY
-Preserved: Pain, Touch, NO MOTOR DEFICITS
What is Brown-Sequard Syndrome?
What is it MC after?
MC after a penetrating trauma
Deficits:
-Ipsilateral: Motor, Vibration, Proprioception
-Contralateral: Pain & Temperature 2 levels below injury