Trauma and Demyelinating D/o Flashcards
EPIDURAL HEMATOMA: What is seen on CT? What is the chronology of Sx? What is the fatal complication?
LENS SHAPED HEMATOMA
LUCID period -> Rapid recurrent unconsciousness = RAPID PROGRESSION
UNCAL HERNIATION = fatal complication
EPIDURAL HEMATOMA: What is the most common location of trauma causing the epidural hematoma? Which artery is most commonly ruptured?
TEMPORAL BONE FRACTURE
Middle meningeal artery rupture
SUBDURAL HEMATOMA: What is most common cause of a subdural hematoma? Second most common cause? What is ruptured? How does this clinical presentation differ from EPIDURAL hematoma? What is the fatal complication?
Most common cause = TRAUMA to the head
Second most common cause = BRAIN ATROPHY -> resulting in lengthening of the cortical bridging veins
CORTICAL BRIDGING VEIN = Most commonly ruptured
SLOWER progression of Sx than epidural hematoma - Slower leaking blood
Fatal complication = HERNIATION
What are the 3 types of brain herniations (due to mass effect OR increased ICP)
- CEREBELLAR TONSILLAR HERNIATION
- SUBFALCINE HERNIATION
- UNCAL HERNIATION
CEREBELLAR TONSILLAR HERNIATION clinically presents as __?
Herniation into foramen magnum -> BRAINSTEM COMPRESSION -> CARDIOPULMONARY ARREST
What is a SUBFALCINE HERNIATION?
Herniation of CINGULATE GYRUS under the FALX CEREBRI (separating the left and right hemispheres)
What vascular supply does a SUBFALCINE HERNIATION compress?
ANTERIOR CEREBRAL ARTERY COMPRESSION -> ACA Infarct
What is an UNCAL HERNIATION?
Herniation of the TEMPORAL LOBE UNCUS under the TENTORIUM CEREBELLI (area between the cerebellum and brainstem)
What 3 structures does an UNCAL HERNIATION compress and what are the associated clinical signs?
- Compression of CN III - Eyes will move DOWN and OUT, DILATED PUPIL (mydriasis)
- Compression of POSTERIOR CEREBRAL ARTERY - Infarction of OCCIPITAL LOBE = CONTRALATERAL HOMONYMOUS HEMIANOPSIA
- Pull on and Rupture of PARAMEDIAN ARTERY (running along brainstem) = DURET HEMORRHAGES of brainstem
What is a LEUKODYSTROPHY?
Inherited mutations in enzymes necessary for PRODUCTION or MAINTENANCE of myelin
What is the most common LEUKODYSTROPHY? What enzyme is deficient? What accumulates as a result?
METACHROMATIC LEUKODYSTROPHY - AR mutation of arylsulfatase -> Sulfatides of myelin can NOT get degraded -> MYELIN accumulates in LYSOSOMES of OLIGODENDROCYTES
Other than a LEUKODYSTROPHY, how can METACHROMATIC LEUKODYSTROPHY be categorized? [HINT: Think organelle]
LYSOSOMAL STORAGE DISEASE
Accumulation of myelin that could NOT be degraded in OLIGODENDROCYTE LYSOSOMES
Name the 3 LEUKODYSTROPHIES.
- METACHROMATIC LEUKODYSTROPHY
- KRABBE DISEASE
- ADRENLEUKODYSTROPHY
What enzyme is deficient in KRABBE DISEASE? What accumulates as a result? Where does it accumulate?
BETA GALACTOCERBROSIDASE - Accumulation of GALACTOCEREBROSIDE in MACROPHAGES
What is the inheritance pattern of METACHROMATIC LEUKODYSTROPHY and KRABBE DISEASE?
AUTOSOMAL RECESSIVE
What is impaired in ADRENOLEUKODYSTROPHY? What accumulates as a result? Where does it accumulate?
Addition of COENZYME A to long chain fatty acids is impaired -> Accumulation of FATTY ACIDS in ADRENAL GLANDS + BRAIN WHITE MATTER
What is the inheritance pattern of ADRENOLEUKODYSTROPHY?
X-LINKED
What is the etiology of MULTIPLE SCLEROSIS? What is its strongest association?
AUTOIMMUNE destruction of MYELIN + OLIGODENDROCYTES
Strongest association with HLA-DR2
Like other autoimmune conditions, what is the genetic susceptibility + environmental trigger of MS?
GENETIC SUSCEPTIBILITY = HLA-DR2
ENVIRONMENTAL TRIGGER = Location - away from the equator
**UW: What is a common INITIAL MANIFESTATION of MS? What is affected?
OPTIC NEURITIS- Monocular visual loss with pain on eye movement
**UW DECREASED VISION + PAIN AROUND EYE
Due to involvement of OPTIC NERVE
What are other possible structures affected with MS and their associated clinical effect?
- BRAINSTEM: Vertigo + Scanned Speech (Mimics alcohol intoxication)
- LEFT MLF: Inability to do a RIGHTWARD gaze with right nystagmus (From functioning eye) - Right eye CAN look right (CN 6),
- PERIVENTRICULAR CEREBRAL WHITE MATTER: Hemiparesis/ Unilateral loss of sensation
- SPINAL CORD: LE loss of sensation/weakness
5: AUTONOMIC NERVOUS SYSTEM: Loss of bowel/bladder/sexual function
How is the diagnosis of MULTIPLE SCLEROSIS made (2 Diagnostic Tools)? What are the + results?
- MRI: Multiple OVOID, white matter lesions
- LP: INCREASED LYMPHOCYTES + OLIGOCLONAL IgG bands [high-resolution electrophoresis] + MYELIN BASIC PROTEIN (from myelin destruction and protein leakage)
NEUROLOGIC SYMPTOMS THAT PRESENT DISSEMINATED IN TIME AND SPACE = ?
MULTIPLE SCLEROSIS
What is seen on biopsy of MULTIPLE SCLEROSIS?
Loss of myelination = GRAY-APPEARING PLAQUES in the white matter
