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Neurosurgery Resource > Trauma and CSF > Flashcards

Trauma and CSF Flashcards

1
Q

What is the Glasgow coma scale used to assess?

A

Level of consciousness in response to defined stimuli

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2
Q

What three domains are tested in GCS?

A

Eye opening
Verbal response
Motor response

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3
Q

What occurs in decorticate posturing?

A

Severe brain damage causes the patient to present with abnormal arm flexion, leg extension and feet turned inward

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4
Q

What occurs in decerebrate posturing?

A

Patient presents with head arched back and both arms and legs extended

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5
Q

Where is CSF produced?

A

Choroid plexus in ventricles

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6
Q

CSF flows from the lateral ventricles to third ventricle via what structure?

A

Foramen of Monro

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7
Q

CSF flows through what structure to reach the fourth ventricle from the third ventricle?

A

Aqueduct of Sylvius

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8
Q

CSF circulates from the fourth ventricle to what?

A

Subarachnoid space

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9
Q

What structures absorb CSF into venous blood?

A

Arachnoid granulations

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10
Q

What are the three main intracranial components?

A

Brain tissue
CSF
Blood

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11
Q

Give some causes of raised intracranial pressure

A

Space occupying lesions
Cerebral oedema
CSF obstruction
Idiopathic intracranial hypertension

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12
Q

Give some clinical features of raised intracranial pressure

A 
Headache 
N + V
Papilloedema
Drowsiness
Cushing's triad
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13
Q

What occurs in an uncal herniation?

A

The medial temporal lobe herniates through the tentorium

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14
Q

What is the first symptom of uncal herniation?

A

Pupillary dilatation

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15
Q

What occurs in subfalcine herniation?

A

The cingulate gyrus herniates below the falx cerebri

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16
Q

What is the main symptom of subfalcine herniation?

A

Weakness of lower extremities

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17
Q

What occurs in tonsilar herniation?

A

Displacement of cerebellar tonsils into foramen magnum

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18
Q

Give some clinical features of tonsilar herniation

A

Neck stiffness
Abnormal neck posture
Respiratory anomaly

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19
Q

Central herniation of the brain stem can cause what symptom?

A

Diplopia due to CN VI palsy

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20
Q

What are the three layers of meninges?

A

Dura mater
Arachnoid mater
Pia mater

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21
Q

What is located between the periosteal and meningeal layer of dura?

A

Dural venous sinuses

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22
Q

What is the space underneath the arachnoid mater called and what does it contain?

A

Subarachnoid space - contains CSF

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23
Q

Where does blood accumulate in an extradural haematoma?

A

Between dura and bone

24
Q

Where is the commonest source of bleeding in an EDH?

A

Middle meningeal artery

25
Q

EDH patients have classically experienced what?

A

Closed head trauma

26
Q

Give some symptoms of extradural haematoma

A

Brief loss of consciousness
Headache
Vomiting
Contralateral hemiparesis

27
Q

What is the imaging modality of choice in head trauma patients?

A

CT scan

28
Q

How are EDHs managed?

A

Immediate neurosurgical evacuation

29
Q

Where does blood accumulate in subdural haematoma?

A

Between dura and arachnoid layers

30
Q

What is the main cause of acute SDH?

A

Head trauma

31
Q

What occurs in acute SDH?

A

The bridging veins are ruptured due to head trauma

32
Q

What is the main cause of chronic SDH?

A

Brain atrophy

33
Q

What occurs in chronic SDH?

A

Bridging veins become stretched and can rupture resulting in blood accumulating in the subdural space

34
Q

How do patients with acute SDH present?

A

Severely decreased state of consciousness

35
Q

How do patients with chronic SDH present?

A 
Headache
Confusion
Urinary incontinence 
Seizures
Weakness
36
Q

How are SDHs imaged?

A

CT

37
Q

What occurs in normal pressure hydrocephalus?

A

CSF builds up due to impaired resorption at arachnoid granulations or CSF overproduction

38
Q

What is the triad of clinical features in NPH?

A

Apraxia of gait (shuffling)
Dementia
Urinary incontinence

39
Q

How is NPH treated?

A

Ventriculo-peritoneal shunt

40
Q

What occurs in hydrocephalus?

A

Excessive accumulation of CSF causing brain ventricle enlargement

41
Q

Where is the pathology in communicating hydrocephalus?

A

Arachnoid granulations

42
Q

Which part of the brain is affected in obstructive hydrocephalus?

A

Ventricular system

43
Q

What is the main cause of congenital hydrocephalus?

A

Aqueductal stenosis

44
Q

Give some clinical features of congenital hydrocephalus

A 
Failure to thrive
Dilated scalp veins
Increased head circumfrence
Impaired up gaze
'Setting sun' appearance
45
Q

Give some clinical features of acquired hydrocephalus

A 
Headaches
Vomiting
Diplopia
Papilloedema 
Drowsiness
46
Q

What is the best diagnostic imaging in a non-emergency situation for hydrocephalus?

A

MRI

47
Q

What CSF diversion methods can be used for hydrocephalus?

A

Ventriculo-peritoneal

Endoscopic third ventriculostomy

48
Q

ETV is more likely to be successful in obstructive/communicating hydrocephalus

A

Obstructive

49
Q

What are Chiari malformations?

A

Congenital/acquired malformations affecting structural relationships between cerebellum, medulla and cervical spinal cord

50
Q

What occurs in a Chiari I malformation?

A

Caudal displacement of cerebellar tonsils

51
Q

Give some clinical features of Chiari I malformation

A

Headache (when coughing)
Downbeat nystagmus
Central cord syndromes
Ataxic gait

52
Q

What occurs in a Chiari II malformation?

A

Caudal displacement of cerebellum and medulla below the foramen magnum

53
Q

Chiari II malformations are associated with what condition?

A

Spina bifida

54
Q

Give some signs and symptoms of Chiari II malformations

A

Dysphagia
Apnoea
Stridor
Weakness

55
Q

How are Chiari malformations treated surgically?

A

Suboccipital craniectomy

Upper cervical laminectomy

56
Q

Give some clinical features of idiopathic intracranial hypertension

A

Throbbing headache relieved on standing
Papilloedema
N + V

57
Q

How is idiopathic intracranial hypertension managed?

A

Weight loss

Acetazolamide

Neurosurgery Resource (5 decks)

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