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Neurology > Space Occupying Lesions & Raised ICP > Flashcards

Space Occupying Lesions & Raised ICP Flashcards

1
Q

Define hydrocephalus

A

Accumulation of excessive CSF within the ventricular system of the brain

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2
Q

State three mechanisms of hydrocephalus

A
  • overproduction of CSF (rare choroid plexus tumours)
  • decreased resorption of CSF by arachnoid granules (arachnoiditis after haemorrhage/meningitis)
  • obstruction of CSF flow (pus, tumour, congenital, SOL)
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3
Q

Name two types of hydrocephalus

A

Communicating and non-communicating

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4
Q

What is communicating hydrocephalus?

A

Obstruction to flow outside of the ventricular system e.g subarachnoid space or granulations

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5
Q

What is non-communicating hydrocephalus?

A

Obstruction to flow occurs within the ventricular system

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6
Q

When do cranial sutures close?

A

Between 2 and 3 years of age

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7
Q

What happens if hydrocephalus occurs before cranial sutures close?

A

Cranial enlargement, increase in occipital- frontal circumference

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8
Q

What happens if hydrocephalus occurs after cranial sutures close?

A

Expansion of ventricles, flattening of gyri and increased ICP

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9
Q

What is ex vaco?

A

Loss of brain parenchyma, not due to an increase in pressure but expansion of CSF and ventricle e.g alzheimers, infarct

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10
Q

What is normal ICP?

A

5-13mmHg

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11
Q

What can cause increased ICP?

A 
Increased CSF 
Focal lesions (SOL)
Diffuse lesion (oedema)
Increased venous volume 
Physiological (hypoxia, pain, hypercapnia)
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12
Q

What are the effects of increased ICP?

A 
Intracranial shifts and herniation 
Midline shift 
Distortion and pressure on cranial nerves and brain centres
Impaired blood flow 
Reduced consciousness
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13
Q

Name four types of herniation

A
  • subfalcine/cingulate
  • tentorial/uncal
  • cerebellar
  • transcalvarial
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14
Q

Describe subfalcine herniation

A

Displacement of cingulate gyrus under falx cerebri, anterior cerebral artery branches may be compressed- contralateral leg symptoms

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15
Q

Describe tentorial herniation

A

Compression of ipsilateral third cranial nerve - pupillary dilatation, uncus of the temporal lobe is pushed against the midbrain

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16
Q

Describe cerebellar/tonsillar herniation

A

Cerebellar tonsils are pushed through the foramen magnum, compresses vital respiratory centres and causes loss of consciousness

17
Q

Describe transcalvarial hernation

A

Associated with a defect in the dura/skull

18
Q

What are the clinical signs of increased ICP?

A
  • papilloedema
  • headache
  • nausea/vomiting
  • reduced consciousness
  • neck stiffness
19
Q

How do brain tumours often present?

A

Focal symptoms, headache - retain CO2 during sleep, increase in bloodflow means it will be worse in the morning, seizures and increased ICP

20
Q

How do single abscesses in the brain arise?

A

Local extension - chronic otitis media, sinusitis, tooth infections
Direct implantation - skull fracture

21
Q

How do multiple brain abscesses arise?

A

Haemtogenous spread - IV drug use, respiratory/cardiac infections, congenital heart disease

22
Q

Where do brain abscesses often occur?

A

Grey/white matter boundary

23
Q

Describe the pathology of a brain abscess

A

Oedema, can cause midline shift, surrounding ischaemia and excitotoxic injury

24
Q

What does an abscess look like on imaging?

A

Central necrosis with oedematous fibrous capsule - ring enhancing lesion

25
Q

What are the organisms associated with brain abscesses?

A

Staph, strep (aerobic and anaerobic)

Immunocompromised - fungi and protozoa

26
Q

Name three types of skull fracture

A

Linear
Compound
Depressed

27
Q

Describe a linear skull fracture

A

Straight, sharp fracture line that may cross sutures, associated with haematoma - if it occurs at the squamous portion of temporal bone it can rupture the middle meningeal artery causing a subdural haematoma

28
Q

Describe a compound fracture

A

Full thickness scalp lacerations usually open - base of skull fractures are an example as paranasal sinus injury is presumed

29
Q

What are surface contusions?

A

Bruises due to damage of tissue, they predominate in cortices but can move into white matter

30
Q

What part of the skull is susceptible to contusions?

A

Under surface of temporal and frontal lobes due to sharp bony prominences

31
Q

Describe the difference between coup and contra coup

A

coup - side of impact

contra-coup - non-impact side may occur at the same time or as rebound

32
Q

What provokes diffuse axonal injury?

A

Rotational movement

33
Q

Where does diffuse axonal injury tend to occur?

A
  • brainstem
  • corpus collosum
  • parasagittal area
  • interventricular septum
  • hippocampal formation
34
Q

What signs can be seen in axonal injury?

A

Microglia accumulation
Shear strain and transection of axons
Axonal bulging and blabbing

35
Q

Name types of secondary brain injury

A
  • haematoma
  • reduced blood flow
  • hypoxia
  • excitotoxicity
  • oedema
  • raised ICP
  • infection
  • reduced auto regulation

Neurology (29 decks)

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