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Neuro > Strokes, raised ICP and CSF > Flashcards

Strokes, raised ICP and CSF Flashcards

1
Q

Consequences of left anterior cerebral artery occlusion

A

R sided lower limb flaccid paralysis followed by spasticity
R sided lower limb sensory loss of all modalities
Loss of voluntary control of micturation (if affects paracentral lobules)
Split brain, alien hand syndrome due to corpus collosum damage

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2
Q

Consequences of PROXIMAL left middle cerebral artery occlusion

A

Malignant MCA - large infarction causes large cerebral oedema leading to death or coma
Total right sided flaccid paralysis followed by spasticity due to damage to internal capsule
Right sided facial and upper limb sensory loss in all modalities
Right homonymous hemianopia (not macular sparing)
Global aphasia (Broca’s and Wernicke’s) if left is dominant hemisphere
Neglect if left is non-dominant hemisphere

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3
Q

Consequences of DISTAL left middle cerebral artery occlusion

A

Right sided facial and upper limb flaccid paralysis followed by spasticity
Right sided facial and upper limb sensory loss in all modalities
Right homonymous quadrantanopia (not macular sparing)
Wernicke’s aphasia if left is dominant hemisphere
Neglect if left is non-dominant hemisphere

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4
Q

Consequences of left posterior cerebral artery occlusion

A

Right homonymous hemianopia which is macular sparing

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5
Q

Consequences of PROXIMAL left cerebellar artery occlusion

A

Left sided DANISH signs
Right sided ascending and descending tract damage
Left sided cranial nerve nuclei damage

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6
Q

Consequences of DISTAL left cerebellar artery occlusion

A

Left sided DANISH signs

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7
Q

Consequences of PROXIMAL basilar artery occlusion

A

Locked in syndrome
CN1-4 intact (eye movements)
Sensation and consciousness intact

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8
Q

Consequences of DISTAL basilar artery occlusion

A

Cortical blindness due to bilateral occipital damage
Impaired sensation and consciousness due to bilateral thalamus damage
CNIII damage due to midbrain

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9
Q

Describe pure motor lacunar stroke syndrome

A

Lenticulostriate artery occlusion

Damage to internal capsule so contralateral paralysis

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10
Q

Describe pure sensory lacunar stroke syndromes

A

Thalamoperforator artery occlusion

Damage to thalamus so contralateral sensory loss of all modalities

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11
Q

Function of thalamus in sensation

A

Relays sensory information to postcentral gyrus

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12
Q

What is used to investigate strokes

A

CT because:
Quick
Determines wether haemorrhage or infarction

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13
Q

What mimics a stroke

A

Hypoglycaemia
Epilepsy
Migraine
Intracranial tumours/infection

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14
Q

Stroke management

A 
Rule out haemorrhage 
Thrombolysis within 4.5hrs
Stroke unit
Swallowing assessment 
PT/OT
Aspirin for 14 days 
Statin
Investigate cause
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15
Q

What contributes to intracranial pressure

A

Brain
Blood
CSF

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16
Q

How can you measure ICP

A

LP

IC catheter

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17
Q

How is ICP regulated within normal range

A

Autoregulation

Vasodilation if pH decreases

18
Q

When does raised ICP become symptomatic

A

When lost maximum blood and CSF because compression of brain

19
Q

What is Cushing’s reflex

A

Triad of symptoms:
Bradycardia
Decreased RR
Increased BP

Due to herniation of brainstem through foramen magnum

20
Q

Symptoms of raised ICP

A

Generalised headache worse in morning and with coughing/sneezing/bending over
N+V to eventual projectile vomiting as activation of vomiting centre
Decreased consciousness
Visual disturbances

21
Q

Why is headache with raised ICP worse in morning

A

Hypoventilation during sleep leads to vasodilation so increased blood in cerebral circulation
Lying down increases ICP

22
Q

Why does raised ICP impair consciousness

A

Compression of reticular formation

23
Q

What visual disturbances may someone experience with raised ICP

A

Transient blindness when coughing/sneezing/bending over - optic nerve compression
Papilloedema in chronic
CNVI palsy

24
Q

Stages of worsening papilloedema on fundoscopy

A

1-2: grey halo around optic disc

3-5: compressed blood vessels

25
Q

4 broad causes of raised ICP

A

Increased cerebral blood flow - venous sinus thrombosis
Increased CSF - hydrocephalus, idiopathic intracranial hypertension
SOL - haemorrhage, tumour, abscess
Cerebral oedema - meningitis, encephalitis, diffuse HI or infarction

26
Q

Management for increased CSF as cause of raised ICP

A

Diuretics
CSF drainage
VP shunt

27
Q

Describe idiopathic intracranial haemorrhage

A

Mostly affects young obese women

First line management is weight loss

28
Q

Acute management of raised ICP

A

No LP, nil by mouth, put patient at 45 degrees
ABCDE - give O2, shock?, rule out hypoglycaemia
If not in shock, give hypertonic saline
Call anaesthetist to intubate as low GCS=hypoventilation
CT when stable

29
Q

Treatment for cerebral oedema

A

Treat underlying cause

Hypertonic saline

30
Q

Describe production and absorption of CSF

A

Choroid plexus cells filter arterial blood to produce CSF
CSF drains back into circulation:
Subarachnoid space-> Meninges-> Arachnoid villus-> Saggital venous sinus

31
Q

What layers of the meninges does CSF go through

A

Only arachnoid mater as the arachnoid Vikki pierce through the dura mater

32
Q

Describe CSF flow within the ventricular system

A 
Lateral ventricles 
Interventricular foramina
3rd ventricle
Cerebral aqueduct
4th ventricle 
Median and lateral apertures
Venous circulation
33
Q

Definition of hydrocephalus

A

Imbalance between production and absorption of CSF with subsequent ventricular enlargement

34
Q

Categories of causes of hydrocephalus

A

Non-communicating: CSF obstructed within ventricles or between ventricles and subarachnoid space

Communicating: decreased absorption or increased production with no obstruction

35
Q

Examples of communicating hydrocephalus causes

A

Post meningitis
SAH
Choroid plexus papilloma

36
Q

Examples of non-communicating hydrocephalus causes

A

Cerebral aqueduct stenosis, atresia compression

37
Q

Common brain tumours in each demographic

A

Children: astrocytomas or medulloblastomas (most near midline so surgery difficult)
Adults: most are metastases but also gliomas and meningiomas

38
Q

Definition of a stroke

A

Sudden onset, focal neurological deficit specific to a vascular territory

39
Q

Definition of papilloedema

A

BILATERAL optic disc swelling

40
Q

Triad of normal pressure hydrocephalus

A

Apraxic gait
Urine incontinence - S2-4 damage
Confusion - periventricular tissue damage

41
Q

Cause of NPH

A

Decreased CSF absorption

42
Q

Management of NPH

A

VP shunt
Acetazolamide
Regular LP to remove CSF

Neuro (19 decks)

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