STROKE,BRAIN TUMOURS, Gullian barre syndrome

Question 1

DF and Etiology of Stroke

Answer 1

-DF: ACUTE INJURY to the brain due to a VASCULAR problem.
* It produces neurological deficits:
- Acute in onset.
- Persistent for more than 24 hours.
-ETIOLOGY:
1. Ischemic stroke: “ The most common cause “ 85 %
OCCLUSION of a blood vessel to a part of the brain ~ Ischemia.
* Thrombosis: Acute occlusion.
* Embolism: Sudden occlusion.
2. Hemorrhagic stroke: “Less common cause “ 15%
RUPTURE of a blood vessel in a part of the brain ~ Bleeding.

Question 2

Risk Factors

Answer 2

• Heart diseases: especially valvular heart diseases & AF.
• Hyperlipidemia: inc total cholesterol, j LDL, t HDL.
• HYPERTENSION: causes endothelial damage.
• Diabetes mellitus.
• Cigarette smoking.

Question 3

CLINICAL PICTURE of stroke

Answer 3

• Neurological deficits commonly roduced de end on the affected brain area:
  1. HEMIPLEGIA.
  2. HEMIANESTHESIA.
  3. Speech problems: Aphasia or Dysarthria.
  4. Vision problems_: especially field defects.
  5. Ataxia:
  6. Cranial nerve paralysis

Question 4

INVESTIGATIONS of stroke

Answer 4

I. BRAIN IMAGING
a) CT scan
b) MRI
II. OTHER IMAGING
a) CARDIAC IMAGING: CXR, ECG, Echocardiography.
b) VASCULAR IMAGINMG: DOPPLER ultrasonic imaging.
III. LABORATORY TESTS
a) CBC.
b ) PT & APTT.
C) Risk factors: e .g. blood glucose, lipid profile, UA, homocysteine.
d) hypercoagulability: e.g. protein C, protein S, Antithrombin III.

Question 5

TREATMENT

Answer 5

-SYMPTOMATIC:
1. EARLY:
* Cerebral dehydrating agents (e.g. Mannitol): to l brain oedema.
* Prophylaxis against STRESS ULCER: “Refer to Cardiology”.
2. LATE: PHYSIOTHERAPY.
——-
- Antiplatelets:
* Aspirin (low dose): 75 - 300 mg I day (single dose).
* Dipyridamole: 75 mg twice daily.
* Ticlopidine: 2 5 0 mg twice daily.
* Clopidogrel: 7 5 mg once daily.

Question 6

DF / classification/pathophysiology of BRAIN TUMOURS

Answer 6

-DF: Space - occupying neoplasms in the cranial cavity.
-CLASSIFICATION:
I. Primary Tumours
* From the meninges: Meningiomas.
* From the brain tissue: Gliomas.
* From the pituitary: Pituitary tumours.
* From the cranial nerves: Acoustic neuroma (of the 8th nerve).
* From the blood vessels: Hemangiomas & Hemangioblastomas.
II. Secondary Tumours
* Metastasis.
——-
-Pathophysiology:
- Tumors of the brain produce neurologic manifestations through:
1) Damage of specific neural pathways traversing the brain.
2) Infiltration of normal parenchymal tissue, disrupting normal function.
3) Inc ICT through:
* Space occupying lesion.
* Neovascularization —+ Brain oedema.
* Breakdown of TEJ —+ Dismption of BBB.
* Obstmction of CSF flow ( obstructive hydrocephalus).

Question 7

CLINICAL PICTURE

Answer 7

-we have two types :
1. Manifestations of increased ICT.
2. Focal manifestations.
——-
- Manifestations of increased ICT:
1. HEADACHE
2. VOMITING
3.PAPILLOEDEMA
4. OTHERS
* Syncope ( 1’ ICP -+ temporary stoppage of cerebral perfusion).
* DCL (sustained pressure on midbrain reticular formation).
* Cranial nerves (6th nerve palsy as it runs a long course .in the cranial cavity).
* Cushing’s triad (Bradycardia, Hypertension, Respiratory depression).
——————-
Focal manifestations :- These are specific symptoms & signs that depend on the specific site of the tumour.
1. FRONTAL LOBE TUMOURS.
2. PARIETAL LOBE TUMOURS.
3. TEMPORAL LOBE TUMOURS.
4. OCCIPITAL LOBE TUMOURS.
(Refer to: areas of the Cerebral cortex)
5. CEREBELLO-PONTINE ANGLE TUMOURS: (Acoustic neuromas)
* lpsilateral ataxia.
6. PITUITARY TUMOURS:
A. Subrasellar Tumours: “Craniopharyngioma”
I. Hypothalamic syndrome: Diabetes insipidus, obesity & hypersomnia.
2. Panbypopituitarism.
3. Bitemporal hemianopia.
B. lntrasellar Tumours:
1. Hormonal manifestations:
* Chromophobe adenoma: Panhypopituitarism.
* Acidophil adenoma: Gigantism or Acromegaly.
* Basophil adenoma: Cushing’s syndrome.

Question 8

INVISTAGTION OF Brain tumours / Treatment

Answer 8

1. MRI & CT scan:
   - The best & most accurate investigations.
2. Plain X-ray of the skull:
   a) Signs of increased ICT: 3 S
   * Silver-beaten appearance: finger prints appearance.
   * Separation of the cranial sutures.
   * Sellar changes ( in pituitary tumours): enlargement of the sella turcica.
3. Cerebral angiography:
   * Abnormal vessels feeding the tumour.
4. Air or myodil ventriculography:
   * Filling defect.
   * Displacement of the ventricular system.
5. Ophthalmoscopic examination:
   * Papilloedema.
   ———————————————
   -Treatment : - Surgical removal of the tumour, if possible