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neuro > PATHOLOGY- raised ICP > Flashcards

PATHOLOGY- raised ICP Flashcards

1
Q

does the brain behave like a fluid or solid?

A

both

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2
Q

what is the brain suspended in?

A

the CSF in the skull

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3
Q

what supports the brain?

A

the dura

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4
Q

What is hydrocephalus?

A

accumulation of excessive CSF in the brain

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5
Q

what types of hydrocephalus are there and describe them

A

NON COMMUNICATING:
-obstruction to flow of CSF occurs within ventricular system

COMMUNICATING:
-Obstruction of flow of CSF outside of ventricular system e.g. in subarach space or in the arachnoid granulations

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6
Q

whatwhat are the causes of hydrocephalus?

A

Obstruction to flow of CSF:
-inflammation
-pus
-tumours

Decrease resorption of CSF:
-post SAH
-meningitis

Overproduction of CSF:
-tumours of choroid plexus
-very rare!

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7
Q

how may hydrocephalus present differently before cranial sutures close?

A

Before cranial suture closer= cranial enlargement

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8
Q

how may hydrocephalus present differently after cranial sutures close?

A

After cranial sutures closed= expansion of ventricles and increase in ICP

presentation of increased ICP:
-N+V
-headache (worse in morning and straining)
-pupillary dysfunction +/- papilloedema
-changes in vision
-decrease level of consciousness

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9
Q

what is hydrocephalus ex vacuo

A

When the brain tissue around the ventricles shrinks due to Alzheimers, fronto temporal dementia or stroke

Not a real hydrocephalus

  • the dilatation of ventricular system and compensatory increase in CSF volume secondary to loss of brain parenchyma
    -ICP is normal
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10
Q

what conditions cause hydrocephalus ex vacuo

A

conditions that cause loss of brain parenchyma e.g. Alzheimers, fronto temporal dementia, infarct on one side

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11
Q

-Brain enlarges, some blood +/- CSF must escape to avoid rise in pressure

-a further increase in brain volume occurs and there is a rapid increase in ICP

why?

A

-if brain enlarges, some blood +/- CSF must escape to avoid rise in pressure

-once this process is exhausted, venous sinuses are flattened and there is little remaining CSF

-any further increase in brain volume results in rapid increase in ICP

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12
Q

examples of causes of raised ICP

A

-increase CSF (hydrocephalus)
-focal lesion in the brain (space occupying lesion)
-diffuse lesion in the brain (e.g. oedema)
-increased venous volume
-physiological (hypoxia, hypercapnia, pain)

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13
Q

what effects does raised ICP have on the brain?

A

-Intracranial shifts and herniations e.g. ‘coning’
-Midline shift
-Distortion and pressure on cranial nerves and vital neurological centres
-impaired blood flow
Cerebral perfusion pressure= MAP- ICP

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14
Q

give examples of brain herniations

A

-Subfalcine herniation
-Tentorial (and central) herniation
-Cerebellar
-Transcalvarial

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15
Q

Describe a Subfalcine herniation

A

Subfalcine herniation - unilateral/ asymmetric expansion of the cerebral hemisphere displaces the gyrus under the false cerebri

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16
Q

presentation of Subfalcine herniation

A

-can cause compression of anterior cerebral artery causing weakness in the contralateral leg

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17
Q

describe a Tentorial (and central) herniation

A

when the medial innermost aspect of the temporal lobe herniates over the tentorium cerebelli

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18
Q

presentation of Tentorial (and central) herniation

A

compression of ipsilateral CN III and can cause pupillary dilatation, impairment of ocular movements on the same side as the herniation

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19
Q

describe a cerebellar herniation

A

displacement of the cerebellar tonsils through the foramen magnum

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20
Q

why is a cerebella herniation life threatening?

A

-it compresses the brain stem and so the respiratory centres in the medulla oblangata

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21
Q

describe a transcalvarial herniation

A

-swollen brain herniates through any defect in the dura and skull

22
Q

what are clinical signs of raised ICP?

A

-reduced level of consciousness
-papilloedema
-headache
-N+V
-neck stiffness

23
Q

examples of space occupying lesions?

A

-Tumours
-Abscess
-Haematomas
-Localised brain swelling (e.g. swelling and oedema around cerebral infarct)

24
Q

where do most brain tumours in children occur in relation to the tentorium cerebello?

A

70% occur below the tentorium cerebelli

25
Q

where do most brain tumours in adults occur in relation to the tentorium cerebello?

A

70% occur above the tentorium cerebelli

26
Q

where are brain tumour metastases most commonly found ?

A

in between grey and white matter

Most common:
-breast
-bronchus
-kidney
-thyroid
-colon

27
Q

what is the most common type of primary brain tumour

A

astrocytoma

28
Q

who does Grade I astrocytoma typically affect

A

children

29
Q

does a Grade I astrocytoma tend to progress

A

no

30
Q

what is the most common primary brain tumours in children?

A
  1. Medullablastoma
  2. Pilocytic astrocytoma
31
Q

examples of malignant primary intracranial tumours?

A

-astrocyotoma
-oligodendroglioma
-medullablastoma

32
Q

exmaples of benign primary intracranial tumours?

A

-meningioma

33
Q

medullablastoma histologically?

A

-poorly differentiated/ embryonal

34
Q

complications of medullablastoma?

A

hydrocephalus

-occurs in the midline of the cerebellum and so can readily disrupt the flow of CSF leading to hydrocephalus

35
Q

What causes a single abscess?

A

Either local extension or direct implantation

Local extension
→ E.g. mastoiditis, chronic otitis, paranasal sinusitis, facial and dental infections

Direct implantation
E.g. skull fracture

36
Q

what causes multiple abscesses?

A

Occur from haematogenous spread

→ In lung E.g. bronchopneumonia, bacterial endocarditis, bronchiectasis, lung abscess

→ Congenital heart disease (left to right shunt and loss of pulmonary filtration of organism)

→IV drug abuse

37
Q

where do single abscesses tend to occur?

A

they tend to occur adjacent to the source

38
Q

where do multiple abscesses tend to occur?

A

they tend to occur at grey and white matter boundary

39
Q

how do abscesses present?

A

-fever
-raised ICP
-symptoms of underlying cause

40
Q

how do abscesses affect the brains structure?

A

-oedema and midline shift

41
Q

investigations for abscess?

A

-CT or MRI (shows ring enhancing lesion)
-Aspiration for culture and treatment

42
Q

treatment for abscess

A

antibiotics + drainage

43
Q

bacterial meningitis- what?

A

-inflammation of the leptomeninges and CSF within the subarachnoid space

44
Q

cause of bacterial meningitis summary table

A
45
Q

how does CSF of someone with bacterial meningitis differ than someone without

A

with bacterial meningitis:
-abundant polymorphs and decreased glucose in CSF

46
Q

what can arachnoiditis later cause

A

Arachnoiditis can later cause lack of CSF absorption, hydrocephalus and raised ICP

47
Q

what two classes can trauma be split into

A

-missile (penetrating)
-non missile (blunt)

48
Q

difference between primary and secondary traumatic head injury?

A

PRIMARY HEAD INJURY (impact)
-injury to neurones
-irreversible
-preventative measures

SECONDARY INJURY
-haemorrhage
-oedema
-potentially treatable

49
Q

what is a contra coup injury?

A

-injury to brain at opposite of site of impact

50
Q

coup injury?

A

-injury to the brain at the site of impact

neuro (44 decks)

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