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402: Neurology and neurosurgery > Tumours and bleeds > Flashcards

Tumours and bleeds Flashcards

1
Q

Gerstmann syndrome

A

4 clinical manifestations arising from a lesion near/ at the angular gyrus (temporal, parietal border)

  • Acalculia (inability to calculate numbers/ understand maths)
  • Left-right confusion
  • Alexia without agraphia (inability to read what is written)
  • Finger agnosia (inability to distinguish finger form hand)
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2
Q

Arteriovenous malformations

- Pathology

A

Malformation arises from a direct connection between the arteries and veins, without a capillary network

  • Creates high-pressure communications.
  • Predisposes to aneurysms
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3
Q

Name a genetic condition associated with cerebral AVMs

A

Hereditary haemorrhagic telangiectasia (HHT)/

Osler-Weber-Rendu syndrome

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4
Q

Hereditary haemorrhagic telangiectasia (HHT) is inherited in what fashion?

A

Autosomal dominant

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5
Q

What is the most common location for AVMs?

A

Supratentorial

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6
Q

Describe the presentation of AVMs

A
  1. As an intracranial haemorrhage
    - Most commonly, intracerebrally
  2. Headache
  3. Focal neurological deficit
    - Most commonly due to mass effect from haemorrhage
  4. Seizure
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7
Q

Which investigation is carried out in AVMs to rule out a haemorrhage?

A

Head CT

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8
Q

What investigation is carried out to assess the location, feeding arteries, associated aneurysms, and venous drainage of AVMs?

A

Brain digital subtracted angiogram

CT or MR angiograms can also detect the malformations and aneurysms

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9
Q

Management of small, superficial AVMs

A

Surgical resection

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10
Q

Management of large AVMs

A

Multi-method approach

  • Embolisation
  • Surgical resection
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11
Q

Management of inaccessible AVMs

A

Conservative if surgery is not appropriate
- Management of symptoms like seizures

Inaccessible AVMs
- Stereotactic radiosurgery

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12
Q

Subdural haematoma

- pathology

A

Bleed located between the dura matter and subarachnoid layer.
- Most commonly caused by the breaking of bridging veins from the subarachnoid space that permeate the dura mater and empty into the dural venous sinuses.

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13
Q

Most common cause of subdural haematoma

A

Head trauma

- Most commonly in the elderly

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14
Q

Risk factors for subdural haematoma

A

Older age

Coagulopathies

Anticoagulation

Arteriovenous malformations

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15
Q

Chronic subdural haematoma

- Pathology

A

An encapsulated subdural haematoma that occurs a few days after the bleed occurs.

Can cause a subdural hygroma.

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16
Q

What is a subdural hygroma

A

A collection of CSF subdurally that can occurs as a result of a chronic subdural haematoma.

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17
Q

Frontal lobe manifestations of intracranial bleeds

A

Confusion

Reduced cognitive/ executive function

Hemiparesis

Aphasia

Personality changes

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18
Q

Parietal lobe manifestations of intracranial bleeds

A

Aphasia

Sensory impairment

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19
Q

Posterior fossa manifestations of an intracranial bleed

A

CN palsy

Ataxia

Dysphagia

Vomiting

Unequal pupils

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20
Q

Signs of a chronic subdural haematoma

A

Headache

Cognitive impairment

Apathy

Depression

Seizures

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21
Q

First line imaging for a subdural haematoma

A

CT head

- Will reveal a crescent shaped bleed

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22
Q

Important blood tests for intracranial bleeds

A

FBC- rules out low platelets

Group and Save

U+Es

Clotting profile

  • aPTT
  • PT
  • Bleeding time

LFTs

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23
Q

Management of drowsiness/ bulbar symptoms in intracranial bleeds

A

Airway support

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24
Q

What is an important management with medication that must be carried out in intracranial bleeds?

A

Reversal or cessation of anticoagulants

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25
Q

How to reverse warfarin

  • Rapidly (1-2 hours)
  • Quickly (non-emergency surgery)
  • Slowly
A

Rapidly
- Prothrombin complex concentrate Octaplex/Beriplex

Quickly
- Vitamin K 10mg IV

Slowly
- Oral Vitamin K therapy

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26
Q

The effects of dabigatran is reversed using…

A

Idarucixumab

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27
Q

The effects of heparin/ LMWH is reversed using…

A

Protamin sulfate

28
Q

Epidural haemorrhage

- Pathology

A

Bleed between the skull and outer dura

- Most commonly caused by head trauma lacerating the middle meningeal artery

29
Q

The “lucid phase” is associated with what type of intracranial bleed

A

Epidural haematoma

- Presents with a lucid phase after the incident, before a deterioration in brain function

30
Q

Signs of raised ICP include

A

Nausea and Vomiting

Blurred vision

Drowsiness

Seizures

Headache

Ipsilateral dilated pupil

31
Q

Features of the Cushing’s triad

A

Sign of raised ICP:

Hypertension

Bradycardia

Respiratory depression

32
Q

Indications of surgery for intracranial bleeds

A

Large haematomas

changes in brain function

Midline shift >5mm

Fixed, dilated pupils

33
Q

Management of raised ICP in intracranial bleeds

A

Mannitol
- Osmotic diuretic

Hypertonic saline

34
Q

CT appearance of epidural bleeds

A

Convex/ lens haematoma

35
Q

CT appearance of subarachnoid bleeds

A

Bleeds in the sulcus
- Above the pia matter

Blood in the ventricles

36
Q

CT appearance of intracerebral bleeds

A

Hyperdensity (new bleed) or hypodensity intraparanchymal cerebral tissue.

37
Q

Features of a large vestibular schwnomma

A

Ataxia/ balance problems
- Due to compression of brainstem

Hydrocephalus–> raised ICP
- Due to compression of 4th ventricles

38
Q

Conditions caused by a pituitary adenoma

A

Prolactinoma (excess prolactin)

Cushing’s disease (excess ACTH)

Acromegaly (excess GH)

Panhypopituitarism (non-secreting adenoma)

Apoplexy (bleed into pituitary)

39
Q

The most common glioma is…

A

Glioblastoma multiforme (astrocytoma)

40
Q

What genetic conditions increase the risk of gliomas?

A

Neurofibromatosis 1 and 2

Li-Fraumeni syndrome

41
Q

The most common primary malignant tumour of the brain in adults is…

A

Glioblastoma

42
Q

The gold standard imaging for glioma diagnosis is…

A

Gadolinium contrast MRI head

43
Q

Presentation of gliomas

A

Headache

Raised ICP features

Frontal= Personality/ executive function/ cognition changes

CN palsy

Spinal cord compression

Cerebellar signs

44
Q

Features of raised ICP

A

Headache

Nausea/ vomiting

Blurred vision

Altered consciousness

Seizures

45
Q

Managemnt of raised ICP/ vasogenic oedema in gliomas

A

Dexamethasone

46
Q

Management of seizures in glioma

A

Keppra / phenytoin

47
Q

Meningioma most commonly arises from….

A

The arachnoid layer of the meninges

48
Q

Most meningiomas are located…

A

Supratentorially

49
Q

Meningiomas can cause compression of _______ or lead to excessive ________

A

Compression of optic nerve

Excessive bone growth/ protrusion

50
Q

Meningiomas are associated with which genetic condition

A

Neurofibromatosis type 2

51
Q

Pituitary macroadenomas are defined as sizes…

A

> 10mm

52
Q

Pituitary adenomas are associated with which genetic condition?

A

Multiple endocrine neoplasia 1 (MEN1)

53
Q

Types of pituitary adenomas causing hyperpituitarism

A

Cushing’s disease (corticotrophic)

Acromegaly (somatotrophic)

Prolactinoma (lactrotrophic)

Hyperthyroidism (thyrotrophic)

Gonadotrophic

54
Q

Pitutary adenoma can cause central diabetes insipidus via…

A

Hypopituitarism (macroadenoma)= low ADH production

55
Q

Prolactinoma is primary treated with…

A

Cabergoline (dopamine antagonist)

56
Q

The surgical management of Cushing’s disease is…

A

Trans-sphenoidal adenectomy

57
Q

___________ is a somatostatin analogue used to treat _________

A

Octreotide - treats somatrophic adenoma

58
Q

The most common type of intracranial vascular anuerysm is…

A

Saccular aneurysm (90%)

59
Q

Saccular aneurysms common occur at which part of the Circle of Willis?

A

Anterior communicating artery

60
Q

What 3 genetic conditions are associated with intracranial aneurysms?

A

Autosomal dominant polycystic kidney disease

Elhers Danlos syndrome

Neurofibromatosis

61
Q

Lifestyle factors associated with intracranial aneurysms

A

Alcohol, smoking

Age

Hypertension

62
Q

Posterior communicating aneurysm can present with what nerve palsy?

A

Unilateral CN3

63
Q

What intracranial aneurysm can present with bitemporal hemianopia?

A

Anterior communicating artery aneurysm

64
Q

What is the gold-standard investigation for intracranial aneurysms?

A

Cerebral intra-arterial digital subtraction angiography

65
Q

What are the surgical options of symptomatic intracranial aneurysms

A

Endovascular coiling

Open surgical clipping

402: Neurology and neurosurgery (11 decks)

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