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Han's Neuro > Session 11 > Flashcards

Session 11 Flashcards

1
Q

What makes up the anterior circulation of the brain?

A

Internal carotid artery
Middle cerebral artery
Anterior cerebral artery
Posterior communicating artery

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2
Q

What makes up to posterior circulation of the brain?

A

Basilar artery
Vertebral artery
Posterior cerebral artery

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3
Q

Give two branches of the internal carotid artery.

A

Ophthalmic artery
Posterior communicating artery
Anterior choroidal artery.

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4
Q

Which structures do the posterior communicating arteries supply?

A

Midbrain, thalamus, temporal and occipital lobes.

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5
Q

What is a stroke?

A

Abrupt loss of focal brain function lasting more than 24 hours, that is either due to spontaneous haemorrhage into the brain or inadequate blood supply.

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6
Q

What is a TIA?

A

Sudden onset, with focal disturbance of brain function, which is presumed to be of vascular origin, and resolves within 24 hours.

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7
Q

Give three causes of cerebral infarcts.

A 
Large vessel atheroma
Cardiac embolism
Small vessel disease
Blood disorders
Cryptogenic
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8
Q

Give three causes of intracerebral haemorrhage.

A

Hypertensive/microaneurysms
Amyloid angiopathy
Haemostatic anticoagulant
Cocaine/ amphetamines/ tumour.

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9
Q

What is a TACS?

A

Total anterior circulation stroke. ICA or proximal MCA. Contralateral hemiparesis, hemianopia and higher cerebral dysfunction.

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10
Q

What is a PACS?

A

Partial anterior circulation stroke. Occlusion of MCA.

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11
Q

What is a LACS?

A

Lacunar stroke. Single perforating artery.

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12
Q

What is a POCS?

A

Posterior circulation stroke. Brainstem, cerebellar or occipital involvement.

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13
Q

Give three differentials of a stroke.

A 
Hypoglycaemia
Epilepsy
SOL
Demyelination
Retinal bleed
Migrainous Aura
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14
Q

Describe the treatment of a stoke.

A

IV thrombolytics within 3 hours of onset.
Endovascular intervention.
Early aspirin therapy.
Management in an acute stroke unit.

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15
Q

Give two ways to prevent a stroke.

A

Antithrombotic, treat risk factors such as hypertension, hypercholesterolaemia and diabetes, lifestyle changes.

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16
Q

What does FAST mean in terms of a stroke?

A

Facial weakness, arm weakness, speech porblems, time to call 999.

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17
Q

Describe the blood supply of the spinal cord.

A

Anterior spinal artery (anterior 2/3 of spinal cord)
Posterior spinal arteries (posterior columns)
21 pairs of segmental arteries
Artery of Adeamkiewicz.

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18
Q

Give three causes of anterior spinal artery occlusion.

A

Aortic disease, aortic surgery, vasculitis, sickle cell disease, hypotension, disc herniation.

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19
Q

Give two differentials of a spinal artery occlusion.

A

Mass lesion, acute inflammation, demyelination, sarcoid, TB, syphilis.

20
Q

What is the decorticate response?

A

Severe injury to hear or large infarct destroys connections between thalamus and cortex (above the red nucleus). Lower limbs become extended and the arms flexed. Hands clenched and the feed turned inwards.

21
Q

What is the decerebrate response?

A

Damage to lower brain or brainstem (below the red nucleus). Complete extension of lower and upper limbs, as well as the head.

22
Q

What is an extradural haemorrhage?

A

Arterial bleed between the skull and parietal layer of the dura. Typically regain consciousness, but deteriorate over the next few hours.

23
Q

What is a subdural haemorrhage?

A

Venous bleed between the dura and arachnoid mater. Tends to be crescent shape on CT and limited by dural reflections.

24
Q

What is a subarachnoid haemorrhage?

A

Arterial bleed between the pia and arachnoid mater. Presents with a thunderclap headache at the back of the head, neck stiffness and vomiting. Increased whiteness around the subarachnoid space. Blood within the CSF seen on lumbar puncture.

25
Q

What is an intracerebral haemorrhage?

A

Haemorrhagic stroke caused by bleeding within the brain tissue itself. Commonly caused by degeneration of small deep penetrating arteries, leading to a massive bleed.

26
Q

What is diffuse axonal injury?

A

Acceleration/decelleration causes shearing and injury to axons at the grey-white mater junction. Instantaneous loss of consciousness and most remain in a vegetative state.

27
Q

What is periorbital ecchymosis?

A

Racoon’s eye caused by basal skull fracture.

28
Q

What is mastoid ecchymosis?

A

Battle’s sign caused by basal skull fracture.

29
Q

What is the difference between coup and contrecoup injuries?

A 
Coup = contusion at the site of impact. 
Contrecoup = brain impacts on the opposite side of the skull.
30
Q

What is raised ICP?

A

When the pressure within the cranial cavity is more than 20mmHg, for more than 5 minutes.

31
Q

Describe the Monro-Keillie theory.

A

States that the skull is a closed fix box and it’s volume remains constant.
=volume of brain + volume of blood + volume of ECF.

32
Q

Describe the stages of raised ICP.

A

Stage 1= compensated state. E.g. due to a mass. CSF or venous blood volume must decrease.
Stage 2= decompensated state. If mass continues to grow and can no longer be compensated for. The brain has reached critical volume.
Stage 3= positive feedback. prevents cerebral perfusion and the brain becomes ischaemic.

33
Q

Why should you not do a lumbar puncture to reduce ICP?

A

Risk of coning = cerebellar tonsillar herniation through the foramen magnus.

34
Q

How can symptoms of raised ICP be exacerbated?

A

Lying down, with raised intrathoracic pressure, bending forward.

35
Q

Give three headache red flag signs.

A 
Associated with focal neurology/cognitive change. 
Visual disturbance. 
Neck stiffness/fever
Wakes the patient up
Head injury in last 90 days
Thunderclap
Change of headache with posture
36
Q

Give a sign of papilloedema.

A

Blurred optic disc margins on fundoscopy.

37
Q

Describe 3rd nerve palsy.

A

Ptosis, dilated pupil, down and out gaze.

38
Q

Describe 6th nerve palsy.

A

Inability to abduct affected eye.

39
Q

Describe loss of vestibulo/ocular reflex.

A

Eyes do not move when putting warm/cold water in the ears.

40
Q

What is cushing’s triad?

A

Irregular respirations, bradycardia and systolic hypertension.

41
Q

What is cushing’s reflex?

A

Raised ICP causes ischaemia. Want to increase BP, so increases sympathetic tone. Raises BP, detected by carotid baroreceptors, when then increase parasympathetic tone, causing bradycardia.

42
Q

Give three causes of raised ICP.

A 
Venous sinus thrombosis
Haemorrhage
Hydrocephalus
Brain tumour
Brain oedema
Meningioma
Abscess
43
Q

Give two causes of hydrocephalus.

A 
Choroid plexus papilloma
Spina bifida
Aqueduct stenosis
SOL
Obliterative arachnoiditis post brain bleed.
44
Q

What is idiopathic intracranial hypertension?

A

Raised ICP without an underlying cause and has no unknown pathophysiology. Common in overweight females, aged 20-40.

45
Q

What are Burr holes?

A

Drilling holes into the skull to drain sub-dural haematomas or to allow access to the brain for shunts or ICP monitoring catheters.

46
Q

What is a decompressive craniectomy?

A

Removal of a bone flap to relieve pressure.

47
Q

Which two shunts are used in hydrocephalus?

A

From the ventricles to either the peritoneum or to the right atrium.

Han's Neuro (11 decks)

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