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SOLs Flashcards

1
Q

SIGNS of RAISED ICP? (4)

A

Papilloedema, Headache, N.V, Stiff Neck

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2
Q

Name the dif. forms of herniation? (4)

A

Subfalcine, Tentorial, Cerebellar, TransCalvarial

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3
Q

Where is Hydrocephalus Ex Vacuo seen?

A

Alzheimer’s Disease

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4
Q

Name 4 kinds of SOLs

A

Tumors/Abscess/Hematomas/Localized brain swelling (EDEMA around infarct)

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5
Q

70% of childhood brain tumors arise from ________

A

BELOW the tentorium cerebelli

—WHILST 70% OF ADULT CNS tumors= ABOVE

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6
Q

Where do brain tumors usually metastasize from?

A

breast, bronchus, kidney, thyroid, colon carcinomas and MALIGNANT melanoma

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7
Q

Most common malignant primary intracranial tumors in KIDS and ADULTS

A

ASTROCYTOMA (45-50%) and oligodendroglioma (1-6% incidence)

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8
Q

Why do high grade tumors cause edema?

A
  • they interfere with the integrity of the BBB, causing vasogenic edema
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9
Q

Name a grade 1 Astrocytoma. Can this become malignant?

A

Pilocytic Astrocytoma —no remains benign

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10
Q

Name a distinct histological ft of High grade tumors.

A

neo-angiogenesis- so very vascular tumors

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11
Q

Name 3 fts of a Medulloblastoma

A
  1. radiosensitive
  2. arises Midline of cerebellum
  3. poorly differentiated cells (EMBRYONAL cells)
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12
Q

Best management of Medulloblastoma

A

75%, 5 year survival with RESECTION and RADIOTHERAPY

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13
Q

Causes of Single Abscesses

A
  1. Local Extension (mastoiditis)

2. Direct Implantation (skull #)

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14
Q

Name 2 conditions which may cause Multiple Abscess formation

A

HEMATOGENOUS spread:

  1. Bronchopneumonia
  2. Bacterial Endocarditis
    - —also seen at the boundary of G-W matter
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15
Q

How to manage brain abscesses?

A
  • CT/ MRI to confirm
  • aspiration for CULTURE and rx
  • weeks of antibiotics
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16
Q

What organism usually causes ear abscesses?

A

B.Fragilis

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17
Q

What usually causes peripheral abscesses and deep abscesses?

A

peripheral- Bacterial

deep (basal ganglia)- Toxoplasma

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18
Q

How does meningitis cause raised ICP?

A

Becauses it causes edema and arachnoiditis–> lack of CSF absorption and therefore hydrocephalus

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19
Q

Gram +ve Cocci cause of bacterial meningitis in older adults/ children

A

Strep. Pneumoniae

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20
Q

Gram - rods cause of Meningitis

A

E.coli

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21
Q

Gram -ve cocco bacilli that causes bact. meningitis in KIDS

A

H.influenzae

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22
Q

What gram - diplococci commonly infects young children and aldolescents?

A

Neisseria Meningitidis

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23
Q

How does high vs low velocity missile injury differ?

A

High velocity penetrating wound, causes FAR MORE DAMAGE to the surrounding tissue than a low velocity wound; the SMALLER the contact time THE LARGER the force

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24
Q

Name the 3 types of skull fracture

A
  1. Linear - straight sharp #; but NO movement of bone
  2. Compound- full thickness scalp lacerations
  3. Depressed
25
What risk does a Linear Fracture hold?
Risk of potentially RUPTURING the Middle Meningeal Artery
26
Where does DIFFUSE AXONAL INJURY usually occur?
in central areas of the brain, at moment of injury
27
Main difference between Epidural and Subdural Hematoma?
Epidural - accumulation of ARTERIAL blood | Subdural is accumulation of venous blood
28
Common Extradural hematoma
fracture of the pterion bone on the tempero-parietal region causing the rupture of the Middle Meningeal Artery
29
What occurs if you leave an extradural hematoma untreated?
- compression, midline shift and herniation | - mortality of 10-20%
30
Subdural hemorrhage involves what blood vessels?
It involves the disruption of the BRIDGING veins which extend from the brain surface into the subdural space...between dura mater and arachnoid mater
31
What is different about an Acute Subdural hematoma and a Chronic one?
Chronic subdural hematoma results in prodn of a yellow fluid called Neomembrane
32
What occurs in Cerebellar Tonsil Herniation?
Caused by increased pressure in the POSTERIOR fossa forcing cerebellar tonsils out through the foramen magnum.
33
What is the presentation of a Cerebellar Tonsil Herniation?
Ataxia/ VI CN palsy/ +Babinski's>loss of consciousness -apneoa/ irregular breathing
34
Subfalcian herniation is caused by a _______
Frontal Mass---the cingulate gyrus is forced under the rigid falx cerebri.....SILENT until anterior cerebral artery is compressed and causes STROKE (==> c/l LEG weakness and abulia)
35
Why does hydrocephalus develop secondary to Alzheimer's disease?
- d.t LOSS of brain parenchyma in AD | - --> dilatation of the VS and compensatory INCR. in CSF volume
36
What are the effects of RAISED ICP?
- intracranial SHIFTS and HERNIATIONS- CONING - midline SHIFT - PRESSURE on CRANIAL nerves and vital neurological centres - impaired blood flow (CPP= MAP- ICP) - Reduced level of consciousness
37
What are the common fts of brain tumors?
1. focal symptoms (70%) 2. HEADACHE (50%) 3. seizures (30%) 4. vomiting 5. visual disturbances ----PAPILLOEDEMA and focal deficit
38
Name 2 fts of metastatic brain tumors.
1. multiple | 2. often seen in the BOUNDARIES between grey and white matter
39
What is the grading of prmary brain tumors based on?
1. Mitoses 2. Neovascularisation 3. Necrosis 4. Atypia
40
Name the most common benign adult brain tumor?
- Meningioma and Pituitary adenoma
41
Most common benign children tumor?
craniopharyngioma
42
List the 4 genetic mutations that predispose a person to v. agressive brain tumors?
- IDH1 - P53 - PDGFRA - PI3KCA
43
Histologically, palisading of the cells is commonly seen in which brain tumor?
- Glioblastoma
44
2nd most common tumor in children AFTER pilocytic astrocytomas.
- medulloblastoma | 20% of pediatric CNS neoplasms
45
What is seen morphologically in brain abscesses?
- central necrosis - edema - fibrous capsule
46
What are the symptoms of abscesses?
- fever | - raised ICP
47
What is seen in the CSF in bact. meningitis?
- abundant polymorphs | - decr. glucose
48
Causal organism for bacterial meningitis in NEONATES?
- E-COLI
49
Possible, gram +ve rod, causal pathogen for bacterial meningitis in an older person?
Listeria Monocytogenes
50
What is the relation between time of force of contact in blunt injuries of the brain?
- the SMALLER the contact time; the LARGER the force - ----so the brain moves within the cranial cavity and makes contact with the inner table of the cranium and BONY protrusions
51
What is primary injury?
- the direct impact that has occurred TO the NEURONES | - ---irreversible
52
Examples of primary injuries to the brain>
- diffuse axonal injury - diffuse VASCULAR injury - surface contusions/ lacerations - petechial hemorrhage
53
How is a linear # managed?
- no interventions needed - pts pbserved for a while - back to normal activities
54
What is diastatic #?
- when the # occurs ALONG the suture lines of the skull | -
55
Name the most SERIOUS skull #?
- basillar skull #
56
What is coup and contracoup?
- coup : occurs to the brain on the SIDE of the IMPACT | - contracoup: diamtrically OPP. point of impact
57
Why are contracoup injuries worse?
1. theory: denser CSF moves to coup side 1st --FORCING brain to contra-coup side 2. Cavitation theory---- low pressure at side of contr-coup creates CAVITATION bubbles ==> damaged parenchyma
58
What may occur post DAI?
-as many as 50% develop COMA after trauma - to be d.t white matter damage and DAI - reduced consciousness > vegetative state

NEUROLOGY (36 decks)

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