Trauma and CSF Flashcards
What is the Glasgow coma scale used to assess?
Level of consciousness in response to defined stimuli
What three domains are tested in GCS?
Eye opening
Verbal response
Motor response
What occurs in decorticate posturing?
Severe brain damage causes the patient to present with abnormal arm flexion, leg extension and feet turned inward
What occurs in decerebrate posturing?
Patient presents with head arched back and both arms and legs extended
Where is CSF produced?
Choroid plexus in ventricles
CSF flows from the lateral ventricles to third ventricle via what structure?
Foramen of Monro
CSF flows through what structure to reach the fourth ventricle from the third ventricle?
Aqueduct of Sylvius
CSF circulates from the fourth ventricle to what?
Subarachnoid space
What structures absorb CSF into venous blood?
Arachnoid granulations
What are the three main intracranial components?
Brain tissue
CSF
Blood
Give some causes of raised intracranial pressure
Space occupying lesions
Cerebral oedema
CSF obstruction
Idiopathic intracranial hypertension
Give some clinical features of raised intracranial pressure
Headache N + V Papilloedema Drowsiness Cushing's triad
What occurs in an uncal herniation?
The medial temporal lobe herniates through the tentorium
What is the first symptom of uncal herniation?
Pupillary dilatation
What occurs in subfalcine herniation?
The cingulate gyrus herniates below the falx cerebri
What is the main symptom of subfalcine herniation?
Weakness of lower extremities
What occurs in tonsilar herniation?
Displacement of cerebellar tonsils into foramen magnum
Give some clinical features of tonsilar herniation
Neck stiffness
Abnormal neck posture
Respiratory anomaly
Central herniation of the brain stem can cause what symptom?
Diplopia due to CN VI palsy
What are the three layers of meninges?
Dura mater
Arachnoid mater
Pia mater
What is located between the periosteal and meningeal layer of dura?
Dural venous sinuses
What is the space underneath the arachnoid mater called and what does it contain?
Subarachnoid space - contains CSF
Where does blood accumulate in an extradural haematoma?
Between dura and bone
Where is the commonest source of bleeding in an EDH?
Middle meningeal artery
EDH patients have classically experienced what?
Closed head trauma
Give some symptoms of extradural haematoma
Brief loss of consciousness
Headache
Vomiting
Contralateral hemiparesis
What is the imaging modality of choice in head trauma patients?
CT scan
How are EDHs managed?
Immediate neurosurgical evacuation
Where does blood accumulate in subdural haematoma?
Between dura and arachnoid layers
What is the main cause of acute SDH?
Head trauma
What occurs in acute SDH?
The bridging veins are ruptured due to head trauma
What is the main cause of chronic SDH?
Brain atrophy
What occurs in chronic SDH?
Bridging veins become stretched and can rupture resulting in blood accumulating in the subdural space
How do patients with acute SDH present?
Severely decreased state of consciousness
How do patients with chronic SDH present?
Headache Confusion Urinary incontinence Seizures Weakness
How are SDHs imaged?
CT
What occurs in normal pressure hydrocephalus?
CSF builds up due to impaired resorption at arachnoid granulations or CSF overproduction
What is the triad of clinical features in NPH?
Apraxia of gait (shuffling)
Dementia
Urinary incontinence
How is NPH treated?
Ventriculo-peritoneal shunt
What occurs in hydrocephalus?
Excessive accumulation of CSF causing brain ventricle enlargement
Where is the pathology in communicating hydrocephalus?
Arachnoid granulations
Which part of the brain is affected in obstructive hydrocephalus?
Ventricular system
What is the main cause of congenital hydrocephalus?
Aqueductal stenosis
Give some clinical features of congenital hydrocephalus
Failure to thrive Dilated scalp veins Increased head circumfrence Impaired up gaze 'Setting sun' appearance
Give some clinical features of acquired hydrocephalus
Headaches Vomiting Diplopia Papilloedema Drowsiness
What is the best diagnostic imaging in a non-emergency situation for hydrocephalus?
MRI
What CSF diversion methods can be used for hydrocephalus?
Ventriculo-peritoneal
Endoscopic third ventriculostomy
ETV is more likely to be successful in obstructive/communicating hydrocephalus
Obstructive
What are Chiari malformations?
Congenital/acquired malformations affecting structural relationships between cerebellum, medulla and cervical spinal cord
What occurs in a Chiari I malformation?
Caudal displacement of cerebellar tonsils
Give some clinical features of Chiari I malformation
Headache (when coughing)
Downbeat nystagmus
Central cord syndromes
Ataxic gait
What occurs in a Chiari II malformation?
Caudal displacement of cerebellum and medulla below the foramen magnum
Chiari II malformations are associated with what condition?
Spina bifida
Give some signs and symptoms of Chiari II malformations
Dysphagia
Apnoea
Stridor
Weakness
How are Chiari malformations treated surgically?
Suboccipital craniectomy
Upper cervical laminectomy
Give some clinical features of idiopathic intracranial hypertension
Throbbing headache relieved on standing
Papilloedema
N + V
How is idiopathic intracranial hypertension managed?
Weight loss
Acetazolamide
