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NMF: Neurology > TRAUMA AND CSF > Flashcards

TRAUMA AND CSF Flashcards

1
Q

What is the most important score in the GCS?

A

motor response

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2
Q

Where is CSF produced?

A

choroid plexus in ventricles

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3
Q

CSF flow

A

lateral ventricles –> via foramen of munro –> third ventricle –> via aquedcut of sylvius –> fourth ventricle –> foramina of magendie and luschka –> subarachoid space –> arachnoid granulations –> venous blood

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4
Q

Symptoms of cerebral herniation

A
  • Extensor response
  • Cushing’s triad (hypertension, bradycardia and irregular breathing)
  • Unreactive pupil (uncal herniation)
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5
Q

Name the 3 types of herniation

A

Uncal, tonsilar, subfalcarine

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6
Q

Which part of the brain herniates in uncal herniation?

A

medial temporal lobe through the tentorium

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7
Q

How does an uncal herniation present?

A
  1. pupillary dilatation due to involvement of ipsilateral oculomotor nerve
  2. contralaterl hemiparesis
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8
Q

Which part of the brain herniated in a subfalcine herniation?

A

the cingulate gyrus

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9
Q

How does a subfalcine herniation present?

A

weakness in lower extremities

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10
Q

What part of the brain herniates in a tonsilar herniation?

A

cerebellar tonsils are displaced into the forman magnum

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11
Q

Give 2 causes of a tonsilar herniation

A
  • Posterior fossa lesion
  • Arnold-Chiari malformation
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12
Q

How does a tonsilar herniation present?

A

medullary compression and ischaemia characterized by neck stinfness, abnormal neck posture, respiration anomaly (Cheyne-Stokes breathing; periods of tachypnea and tachycardia followed by periods of bradycardia and bradypnea) and coma.

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13
Q

Following a car accident a patient presents with unilateral pupil mydriasis that does not constrict to light. Which type of herniation is this?

A

uncal herniation would present with pupillary dilatation due to compression of the ipsilateral oculomotor nerve

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14
Q

Normal ICP

A

5-15 mmHg

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15
Q

3 intracranial components

A

brain tissue, CSF and blood

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16
Q

PC: a progressive shuffling gait and urinary incontinence. His wife is claiming that he has been forgetting his keys and taking his medication. What is the most likely diagnosis?

A

Normal pressure hydrocephalus

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17
Q

Baby with big head, failure to thrive. On exam she has sunsetting eyes. Whats the most likely cause?

A

Non-communicating hydrocephalus due to aqueduct stenosis

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18
Q

How does an extradural haematoma present?

A
  • young adult with closed head trauma
  • brief loss of consciousness then lucid interval then deterioration
  • headache, vomiting, contralateral hemiparesis and ipsilatral pupillary dilatation
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19
Q

Investigation of extradural haematoma

A

CT shows lens-shaped haematoma that pushes away the dura

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20
Q

Between which layers is an extradural haematoma?

A

skull and dura

21
Q

Between which layers is a subdural haematoma?

A

dura and arachnoid

22
Q

Between which layers is a subarachnoid ?

A

arachnoid and pia

23
Q

How does an acute subdural haematoma present?

A
  • very severe head trauma
  • immediate symptoms
  • severely decreased consciousness
24
Q

How long after trauma does a chronic subdural haematoma display symptoms?

A

3-7 weeks

25
Q

What is the driving factor for chronic subdural haematoma?

A

brain atrophy which stretched the bridging veins allowing them to rupture with minor trauma

26
Q

Investigate subdural haematoma

A

CT shows crescent that cannot cross falx cerebri or tentorium

ACUTE: hyperdense crescent

CHRONIC: hypodense cresent, slow growing

27
Q

How does normal pressure hydrocephalus present?

A
  1. shuffling gait 2. dementia 3. urinary incontinence
28
Q

Treatment of normal pressure hydrocephalus

A

ventriculo-peritoneal shunt

29
Q

What is communicating hydrocephalus?

A

due to CSF absorption (impaired arachnoid granulations)

30
Q

What is non-communicating hydrocephalus?

A

obstruction of CSF flow

  • small fourth ventricle in comparison to others
31
Q

Causes of non-communicating hydrocephalus

A
  • tumours compressing the ventricles
  • a colloid cyst obstructing the third ventricle can be seen
  • stenosis of the aqueduct.
32
Q

Symptoms of congenital hydrocephalus

A
  • Failure to thrive.
  • Dilated scalp veins.
  • Increased head circumference.
  • Impaired upgaze due to compression on the tectal plate.
  • ‘Setting sun’ appearance: downward deviation of the globe on lid retraction.
  • Raised ICP and diplopia (due to sixth nerve palsy).
  • Vomiting.
  • Macewen sign: ‘cracked pot’ sound on head percussion.
33
Q

Signs and symptoms of acquired hydrocephalus

A
  • Headaches: more prominent in the mornings.
  • Vomiting.
  • Diplopia.
  • Impaired upgaze due to compression on the tectal plate.
  • Raised ICP.
  • Papillodema
  • Drowsiness.
  • Incontinence.
  • Gait abnormalities.
34
Q

Investigate hydrocephalus

A

MRI

35
Q

Manage hydrocephalus

A

VP shunt or endoscopic third ventriculostomy (ETV) if non-communicating

36
Q

What are Chiari malformations?

A
  • congenital or aquired
  • malformation of hindbrain
  • impaired CSF circulation through foramen magnum
37
Q

Which chiari malformation is more severe?

A

Chiari II (Arnold-Chiari)

38
Q

What is Chiari I ?

A
  • most common
  • caudal displacement of cerebellar tonsils below foramen magnum
  • +/- syringomyelia
39
Q

What is syringomyelia?

A

an expanding cystic cavity or syrinx forming in the spinal cord that can cause damage to the central spinal cord

40
Q

signs and symptoms of Chiari I

A
  • headache (esp with cough and neck extension)
  • downbeat nystagmus
  • central cord symptoms if syringomyelia
  • ataxic gait
41
Q

What is Arnold-Chiari?

A

Cerebellum and medulla are caudally displaced below the foramen magnum

and herniation of fourth ventricle

42
Q

What condition is Arnold-Chiari associated with?

A

spinabifida

43
Q

What age group does Arnold-Chiari affect?

A

symptomatic during infancy or childhood

44
Q

Syptoms of Arnold-Chiari

A
  • severe brainstem dysfunction causing dysphagia, apnoea, stridor and nystagmus
  • weakness that can progress to quadriplegia
45
Q

Treatment of chiari malformation

A

Suboccipital craniectomy and upper cervical laminectomy to decompress the malformation at the foramen magnum are usually required with cord drainage.

46
Q

Clinical featurs of idiopathic intracranial hypertension

A
  • headache (worse in morning, relieved by standing)
  • bilateral papilloedema
  • N+V
  • sixth nerve palsy
47
Q

What size are the ventricles in idiopathic itracranial hypertension?

A

normal or reduced

48
Q

Treatment of idiopathic intracranial hypertension

A

weight loss and diuretics

lumbo-peritoneal shunt (surgical)

NMF: Neurology (9 decks)

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