Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neurology > Space Occupying Lesions > Flashcards

Space Occupying Lesions Flashcards

1
Q

what happens when the brain enlarges

A 
some blood +/‐
CSF must escape from cranial vault
to avoid rise in pressure.
• Once this process is exhausted,
venous sinuses are flattened and
there is little or no CSF.
• Any further increase in brain volume
results in rapid increase in ICP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what can cause raised ICP

A 
increased CSF (hydrocephalus)
focal lesion in brain (SOL)
diffuse lesion in brain (oedema)
increased venous volume 
physiological (hypoxia, hypercapnia, pain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is hydrocephalus

A

accumulation of excessive CSF within the ventricular system of the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the normal volume of CSF

A

120-150 mls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how much CSF is made per day

A

500ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

where is CSF produced

A

by the choroid plexus in the lateral and fourth ventricles of the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what absorbs CSF

A

arachnoid granulations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what does the CSF usually contain

A 
lymphocytes <4 cells 
neutrophils 0
protein < 0.4 g/l
glucose >2.2 mmol/l
no RBCs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what does increased lymphocytes in CSF mean

A

inflammation/ infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what does increased polymorphs in CSF mean

A

bacterial meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what can cause hydrocephalus

A

obstruction to CSF flow (inflammation, pus and tumours)
decreased resorption of CSF (post SAH, meningitis)
overproduction of CSF (v. rare: tumours of choroid plexus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is non communicating hydrocephalus

A

obstruction of flow of CSF occurs within ventricular system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is communicating hydrocephalus

A

obstruction to flow of CSF outside of the ventricular system (e.g. in subarachnoid space or at the arachnoid granulations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what happens if hydrocephalus occurs before/ after the closure of cranial sutures

A

before- cranial enlargement

after- expansion of ventricles and increased in ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is hydrocephalus ex vacuo

A

dilatation of the ventricular system and a compensatory increase in CSF volume secondaryto loss of brain parenchyma (e.g. in alzheimers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the physical effects of raised ICP

A 
• Intracranial shifts and
herniations – “Coning”
•Midline shift
•Distortion and pressure on cranial nerves and vital
neurological centres
• Impaired blood flow
• Cerebral Perfusion Pressure =
MAP – ICP
•Reduced level of consciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the causes of raised ICP

A 
infections
tumours
stroke
aneurysm
epilepsy
seizures
hydrocephalus
hypoxemia
meningitis
haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

describe a tentorial herniation

A

when medial aspect of temporal lobe herniates over the tentorial cerebellum

=compression of CN 3 (pupillary dilatation and impaired eye movements on side of lesion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

describe a subfalcine herniation

A

unilateral expansion of cerebral hemisphere which displaces the singular gyrus underneath the falx cerebri= weakness and sensory loss on opposite side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

describe a cerebellar herniation (uncal)

A

inferior descent of cerebellar tonsils below the foramen magnum (aka coning)
=puts pressure on brain stem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

describe a central herniation

A

the diencephalon and parts of the temporal lobes of both of the cerebral hemispheres are squeezed through a notch in the tentorium cerebelli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

describe a transcalvarial herniations

A

herniation through any defect in the skull (e.g. following fracture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the clinical signs of raised ICP

A

papilloedema
headache
neck stiffness
N&V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the most common space occupying lesions

A

tumours
abscess
haematomas
localised swelling (swelling and oedema around cerebral infarct)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are the most common clinical presentations of tumours

A 
focal symptoms 
headache (worse in morning) 
vomiting 
seizures 
visual disturbances 
papilloedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

where do most brain tumours in children occur

A

below the tentorium cerebelli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

where do most brain tumours in adults occur

A

above the tentorium cerebelli

28
Q

what are the commonest cancers to mets to brain

A

breast, bronchus, kidney, thyroid, colon, malignant

29
Q

how are brain tumours graded

A 
mitosis 
neovascularisation 
necrosis 
atypia 
cellularity
30
Q

what are the most common types of malignant primary brain tumour

A

astrocytomas

oligodendrogliomas
medulloblastoma (most common in children)

31
Q

what is the most common type of benign primary brain tumour

A

meningioma

schwannoma
craniopharyngioma
pituitary adenoma

32
Q

why are astrocytomas hard to resect

A

insidious brain infiltration

33
Q

what is a glioblastoma

A

grade 4 astrocytoma

34
Q

do grade 1 astrocytomas become malignant

A

no

35
Q

what are the features of a astrocytoma (grades 2+)

A 
nuclear atypia 
mitosis
necrosis (4)
neovascularisation (4)
proliferation 
anaplasia
palisading
36
Q

what is the most common tumour in children

A

medulloblastoma

37
Q

what are the features of a medulloblastoma

A

poorly differentiated
embryonal
occurs in midline of cerebellum
very radiosensitive- good prognosis

38
Q

what are the causes of single brain abscesses

A 
local extension (e.g. mastoditis)
direct implantation (e.g. skull fracture)

(tend to occur adjacent to the source)

39
Q

what are the causes of multiple abscesses

A

haemotogenous spread (bronchopneumonia, bacterial endocarditis, congenital heart disease, IV drug use)

(tend to occur at grey and white matter boundary)

40
Q

what are the symptoms of an abscess

A

fever
raised ICP
+ symptoms of underlying cause

41
Q

what investigations and Tx for brain abscess

A

CT/ MRI to diagnose
apsirate for culture and Tx
weeks of antibiotics (hard to get into CNS)

42
Q

what is bacterial meningitis

A

inflammation of the leptomeninges

and CSF within the subarachnoid space

43
Q

how does bacterial meningitis cause raised ICP

A

severe oedema

44
Q

what is seen in CSF in bacterial meningitis

A

polymorphs

low glucose

45
Q

what can arachnoiditis cause

A

lack of CSF absorption = hydrocephalus = raised ICP

46
Q

e coli:

what type of bacterial is it and who does it cause bacterial meningitis

A

gram -ve rod

neonates

47
Q

H influenza:

what type of bacterial is it and who does it cause bacterial meningitis

A

gram -ve cocco-bacilli

infants and children

48
Q

n meningitidis:

what type of bacterial is it and who does it cause bacterial meningitis

A

gram -ve diplococci

adolescents and young adults

49
Q

s pneumoniae:

what type of bacterial is it and who does it cause bacterial meningitis

A

gram +ve cocci in chains

older adults or children

50
Q

L monocytogenes:

what type of bacterial is it and who does it cause bacterial meningitis

A

gram +ve rods

older adults

51
Q

what are missile and non missile injuries

A

missile= penetrating

non missile- blunt

52
Q

what can penetrating brain injuries cause

A

focal damage
lacerations in region of brain damage
haemorrhage

53
Q

does a high or low velocity penetrating brain injury cause more damage

A

high

54
Q

what is a non missile injury and what determines the extend of its damage

A

sudden acceleration/ deceleration of head

smaller the contact time the larger the force

55
Q

what is a primary brain injury

A
  • Injury to neurones
  • Irreversible
  • Preventative measures

(hallmark is change in consciousness immediately)

56
Q

what is a secondary brain injury

A
  • Haemorrhage
  • Oedema etc
  • Potentially treatable
57
Q

what are the types of scalp lesions

A

bruising (contusions)
lacerations
bleeding
(route for infection)

58
Q

what are the types of skull fracture

A

• Linear ‐ straight sharp fracture line, that may cross
sutures (diastatic fracture)
•Compound ‐ associated with full thickness scalp lacerations
•Depressed

if base of skull fracture then compound or open as damage to paranasal sinus

59
Q

what is coup and contra coup

A

in the context of brain surface contusions and lacerations:

  • Coup- brain hits side of injury
  • Contra coup- hits opposite side, tend to be worse than coup
60
Q

what is a diffuse axonal injury

A

Occurs at moment of injury
a blunt trauma puts a shearing strain on axons which tear

affects central areas
causes reduced consciousness and coma
can lead to vegetative state

61
Q

what can cause secondary injury to the brain

A 
-Intracranial haematoma
• Reduced cerebral blood flow
• Hypoxic brain damage
• Excitotoxicity
• Oedema
• Raised ICP
• Infection
62
Q

what does Ca2+ influc do to protease and phospholipase

A

activates them- causing lipid membrane disruption

63
Q

where are most traumatic intracranial haematomas

A

intradural (sub dural, intracerebral, subarachnoid)

64
Q

what are traumatic extradural haematomas like

A 
•Usually a complication of
fracture in tempero‐parietal
region that involves middle
meningeal artery
• Immediate brain damage
often minimal
•But untreated, midline shift –
compression and herniation
65
Q

what is a subdural haemorrhage and what causes it

A

• Collections of blood between the internal surface of dura mater
and arachnoid mater
• Caused by disruption of bridging veins that extend from the
surface of the brain into subdural space

66
Q

what is the pressure put on the brain by a subdural haemorrhage like

A

Gyral contours preserved –

pressure evenly distributed

67
Q

what are chronic subdural haemorrhages associated with

A

brain atrophy
less associated with trauma
will present subtly

Neurology (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions