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Neurology > Tutorial 2 > Flashcards

Tutorial 2 Flashcards

1
Q

Areas in brain that have pain receptors:

A

scalp, muscle, periosteum, blood vessels, meninges

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2
Q

Localization: Difficulty concentrating
Photophobia
Right face tingling
Right hemianopsia

A

Difficulty concentrating = bicerebral hemispheres
Right face tingling = left parietal lobe
Right hemianopsia = left cerebral hemisphere posterior to optic chiasm

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3
Q

Optic tracts and radiations path from eyes

A

optic chiasm -> through temporal and parietal lobes -> occipital lobes

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4
Q

Primary headaches

A

migraine, cluster, tension

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5
Q

Secondary headaches

A

Intracranial HTN, meningeal process, giant-cell arteritis, medication overuse

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6
Q

Giant Cell Arteritis

A

50+
Sx: fever, weight loss, monocular vision loss, jaw claudication, *polymyalgia rheumatic (aching pain/stiffness in neck, shoulders, hips), increase ESR & CRP
Mgmt: trend ESR and CRP, LT steroids, temporal artery Bx

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7
Q

Idiopathic Intracranial HTN

A 
"pseudotumor cerebri"
-obese, F, 15-45 yrs
-Sx: bilateral papilledema, headache, diplopia
Dx: MRI +/-, LP (open P)
Tx: acetazolamide/shunt
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8
Q

Medication overuse

A

1 chronic daily headache

Why? excessive analgesic use
Tx: withdrawal, migraine prophylaxis, sedate

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9
Q

Migraine w/o Aura

A

Frq - 5+ episdoes
Duration - 4-72hr
Quality: 2+ unilateral, pulsating, mod/severe, inc headache with physical activity
Assoc feature: 1+ N/V, photophobia, phonophobia
-Auto-dom
-4 possible phases: prodrome, aura, headache, postdrome-Triggers: (hormonal, smell, EtOH)
-Etiology: SER in brainstem *not vascular

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10
Q

Migraine when no need to test / when you should

A

No: Hx, Fhx, known triggers, visual sx, sensory sx over min (vs seizure = seconds)
Yes: sounds bad, abn neuro exam

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11
Q

Headache w/u, migraine proph fails

A

MRI +/- (tumor)
LP (mening, SAH)
ESR, CRP (Giant C Art)
EEG (seizsure?)

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12
Q

Migraine mgmt proph - choose based on?

A

Proph: Anti-HTN, Anticonvulsants, TCAs, NSAID, Other
Choose based on SFx (are they desired?):
All antihypertensives (hypotension),
Beta-blockers (depression, sedation),
Tricyclic antidepressants (weight gain, sedation),
Valproic acid (weight gain, hair loss),
Topiramate (weight loss, abnormal cognition),
Naproxen (ulcers, renal disease),
Magnesium (loose stools)

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13
Q

Migraine abortive (frequent, disrupt ADLs)

A

nonspecific single agent (acet, NSAIDs, narcotics)
nonspecific combo (Excedrin)
Triptans: SSR agonists *not for pregnant, 60+, vascular dz risk, migraines with aphasia/hemiplesia/vertigo
last line abort: irgot, “IV” chlorpromazine (Thorazine)

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14
Q

Eye Sx: progressive vs nonprogressive

A

progressive - pain*, worse w/eye mvmt = inflammatory or inf

nonprogressive = ischemic events, *no pain

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15
Q

L’hermitte’s sign

A

posterior columns - cervical SC, all 4 limbs affected
+ urinary frq/urgency/hesitancy
+intermittent shock-like vibratory sensations (triggered by neck flexion)

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16
Q

Uthoff’s phenomenon

A

worsening or triggering sx by *heat = demyelinating conditions
worsening baseline sx or fatigue–occurs with inc body temp. may have new lesions

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17
Q

Vertigo locations

A

peripheral lesion: vestibular nerve

central lesion or brainstem vestibular nuclei

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18
Q

MS visual Sx Ddx: Optic disc = papilledema, papillitis (optic neuritis).
afferent pupillary defect.

A

Optic disc:
papilledema = inc ICP (swelling optic disc)
papillitis =
(anterior optic neuritis) optic nerve head inflam no swelling optic disc - with visual changes
optic neuritis: (other causes altitudinal defect or scotoma - progresses over hrs to days. involves entire visual field)
afferent pupillary defect = no PSNS activation to constrict pupils in response to light (RAPD-relative afferent pupillary defect)

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19
Q

Sensory level

loss proprioception

A

SC lesion at/near uppermost affected dermatome: Relative sensory level (decreased sensation),
Complete sensory level (complete loss of sensation)

loss proprioception: ataxia

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20
Q

Ddx Swollen Optic Disk (3):

A

Optic neuritis = young pt, triad: dec visual acuity, *painful, dyschromatopsia
Anterior ischemic optic neuropathy (AION):
old, dec visual acuity + painless
Papilledema: inc ICP, visual acuity is nrm**

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21
Q

Dz affect both optic nerve and SC: NMO, Lupus, Sarcoid, Syphilis, B12 def, Lyme, Lymphoma

A

Neuromyelitis Optica (NMO): demyelinating dz optic N + SC, no MRI MS lesions
Lupus: AI
Sarcoid: systemic granulomatous, neurosarcoidosis - meningeal involved: CN palsies: facial/optic N’s
Syphilis: chronic meningeal + vascular parenchymal, brain + SC. psychosis, uveitis, optic neuritis, CN palsies, tabes dorsalis
B12 def: paresthisias, sensory ataxia, cog changes, rare optic neuritis
Lyme: peripheral + cranial neuropathies, radiculopathies, meningitis, encephalitis, myelitis
Lymphoma - anywhere Nerv Sys: periph N, SC, brain parenchyma, meninges

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22
Q

MS Eval: MRI, LP

A

MRI C+T spine: T1 = active inflam
T2 = CSF bright, edema, ischemia, demyelinating lesions
T2 FLARE = CSF black, view lesions pariventricular lesions

LP - inf vs inflam CNS
view: myelin basic pr, oligoclonal bands, IgG synth rate

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23
Q

MS: prognosis, tx -proph/chronic

A

Relapse-remit: 70%
Primary Progressive (<5%)
Tx acute:*Before check/tx inf (UTI), No inf? = IV methylprednisolone (before PO)
Tx chronic: “ABCs” immunomodulators (dec exacerbations/relapse): INF-B, glatiramer. other-glatiramer, cytoxan

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24
Q

Tx other MS sx: spasticity, urinary, fatigue, depression, neuralgia

A 
spasticity: baclofen (GABA), tizanidine (a2-adrenergic, inhib presyn motor)
urinary = sx
fatigue = amantadine, modafinil
depression - SSRI
neuralgia - AEDs
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25
Q

PD primitive glabellar (Myerson’s) reflex

A
  • nonspecific, seen in neurodegen dz

- keep tapping forehead and pt can’t suppress blink (should be able to)

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26
Q

Basal Ganglia - what they do

A
  • interconnect thalamus, cortex, brainstem

- initiate/regulate motor movement

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27
Q

PD - idiopathic

A

progressive degen N’s in substantia nigra and midbrain

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28
Q

PD Ddx

A

idiopathic, heredodegenerative dz, Parkinson-plus syndromes, secondary PD, non-basal ganglia imitators

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29
Q

Heredodegenerative Dzs

A

-hereditary degen Ds’s:

Wilson’s Dz, HD

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30
Q

PD-Plus

A 
*respond poorly to PD Rx
PSP - supranuclear verticle gaze paresis + early falls (postural instability)
MSA-P -striatonigral degen
MSA-A -severe ANS dysfunction
LBD-dementia+early PD
AD-late stage parkinsonism
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31
Q

PD-secondary

A

Dmg basal ganglia or substantia nigra

  • acute
  • symmetric
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32
Q

Non-Basal Ganglia PD imitators

A

NPH, hypothyroid, ankylosing spondylitis, Rheum Dz

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33
Q

Idiopathic PD vs “Parkinsonism”

A

Idiopathic PD:
*prominent resting tremor, *assym, *levo response, *late dementia, *falls late
“Parkinsonism”: *no resting tremor, *symmetric, *poor response levo, *early dementia/falls

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34
Q

PD MRI- when?

A

no 55+
yes atypical/rapid/young pt

T2 view BG/hydrocephalus (CSF bright)

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35
Q

PD - TRAP

A

Tremor
Rigidity
Akinesia (brady)
Postural instability

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36
Q

PD-late: gait

A

gait px worse

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37
Q

PD-Other Sx

A

Drooling - tx Anticholinergics (trihexyphenidyl, benztropine)ANS - constipation, sex, seborrheic dermatitis
Dementia - late
Depression - SSRIs
Psychosis + Dyskinesias (from DA agents, can use atypical antipsychotic quetiapine)

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38
Q

PD RX

A

1 - Carbidopa/Levodopa -vs brady/rigidity (wearing off effect)
2 - DA agonists: ropinrole, pramipexole, bromocriptine, rotigotine (SFx: sleep attacks, pathologic gambling)
3 - COMT inhibitors: entacapone, tolcapone (inhibits Levo->DA in periph)
4 - MAO-B inhibitors: selegiline (inhibits metab of meperidine=cause death), rasagiline (stop brain DA breakdown-neuroprotective)(SFx: cognitive)**be careful SER Syndrome with SSRIs
5 - Anticholinergics: trihexy, benz (vs tremor and drooling)
6 - Amantadine (inc DA release, SFx confusion/hallucinations/nightmares)
7 - Sxx DBS
*do not give Rx with metoclopramide, typical antipsychotics (with block DA)

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39
Q

Paraspinal tenderness?

A

epidural abscess, hematoma, mass lesion

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40
Q

Bilateral medial cerebral hemispheres or brainstem - what finding makes less likely

A

normal mental status, normal CN exam

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41
Q

Sensation: relative vs absolute, “hung”

A

relative - diminished
absolute - gone
“hung” below lesion lvl

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42
Q

Ddx Polyneuropathy: cord compression, myelitis, SC AVM, SC tumor

A

Cord compression: by bone, tumor, inf, hemorrhage pain
Myelitis (transverse myelitis-TM): inflam myelopathy, *hrs to days, etio-post inf TM (bacteria/virus/lupus/sarcoid)
SC AVM: bleed, compress, shunt blood
SC Tumor: intramedullary (in SC), extramedullary (meningioma/NF), extradural (bony met), intradural (low-grade: astrocytoma, ependymoma, hemangioblastoma)

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43
Q

Cervical synringomyelia

A

-w/cong brainstem anomalies, SC trauma, SC tumors.
-vs ant horn cells, ant white commissure, lateral columns: 1-hand weakness, atrophy
2-cape-distribution pinprick+temp loss
3-spastic paraparesis

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44
Q

Neurosyphilis

A

-tabes dorsalis
-posterior columns:
1 - loss vibration/proprioception

45
Q

B12

A
  • myelopathy, wk-mo
  • Sx like HIV vacuolar myelopathy
  • posterior columns, lateral corticospinal tract: dec vibration/proprio, spastic parapareis
46
Q

Anterior SC infarction

A
  • (ant bc posterior has 2 vessels)
  • 2/3 cord
  • lateral columns, spinothalamic tracts: spastic paraparesis, loss pain/temp
  • Etio: trauma, dissecting aortic aneurysm, hypotensive crisis
47
Q

HTLV-1

A

T-cell leukemia/T-lymphoma retrovirus

  • inf of SC
  • chronic progressive demyelinating inflam myelopathy
  • cortico-spinal tracts of thoracic cord: bilateral LE weakness and spasticity
48
Q

Brown-Sequard Syndrome

A
  • SC hemisection
  • posterior columns, lateral corticospinal, spino-thalamic: weakness and sensory lvl to vibration & proprio ipsilateral below lesion, pain/temp contralateral below lesion
49
Q

SC eval: (4)

A

1 - xray (bone)
2 - MRI cervical/upper thoracic (SC, CSF, bony strxs)
3 - labs
4 - LP

50
Q

SC with meningioma - Mgmt

A
  • irreversible dmg after 24hrs
  • IV Cytoxan
  • Emergent neuroSxx consult = resect mass, decompression of SC
  • Cx: autonomic hyperreflexia C/T cord lesions (stim excessive SNS activation- inc BP, inc HR, sweat, flush), Neurogenic bladder, Neuropathic pain
51
Q

HTN Due to sleep apnea - where localize?

A

hypothalamus

52
Q

OSA triad

A

daytime sleepiness, obese, HTN

53
Q

HF in OSA?

A

right HF, repetitive anoxic insult to myocardium during sleep

54
Q

Ddx Daytime Sleepiness

A
  • Insufficient sleep
  • Toxic-metabolic abn (Rx, electrolyte, inf, hypothyroid)
  • sleep apnea: central and obstruct
  • Narcolepsy-cataplexy/other
  • RLS (85% pt have periodic limb mvmt)
  • Periodic limb mvmt Ds
  • Cardiac rhythm Ds
  • Depression
55
Q

Eval Daytime Sleepiness: (3)

A

labs - CBC, chemistries, TFTs (polycythemia?)

  • polysomnography
  • TTE
56
Q

RDI/Apnea-Hypopnea Index 9AHI)

A

RDI > 5 is abn

sum of both apneas/hr

57
Q

Apnea (2 types)

A

central - cessation of respiratory effort
obstructive - respiratory effort continues but airflow is obstructed
(loss oxygen > 10 sec)

OSA can cause transient central sleep apnea if dec oxygen and inc CO2 –> transient BS dysfcn

58
Q

OSA -NS

A

impaired oropharyngeal dilatation during sleep

  • inc SNS activity = acute inc BP, tachycardia
  • cyclic PSNS = bradyarrhythmias
  • over time: chronic nocturnal hypoxemia nd hypercapnia –> cHTN and arrhythmias
59
Q

OSA - Apnea Cycle

A

Onset of sleep

Airway obstruction

Apnea (cessation of breathing):
Hypoxia & apnea - results in bradycardia early in the cycle
Hypercapnia & hypoxia - trigger sympathetic activation, HTN, tachycardia, & other arrhythmias late in the cycle
Hypercapnia - triggers ventilatory effort. These efforts, although ineffective, cause changes in intrathoracic pressure that affect BP and cardiac output
Following the apnea cycle - marked in sympathetic activity results in bradycardia

Arousal

Breathing resumes but sleep architecture is disturbed

60
Q

Narcolepsy - findings

A
  • nrm polysomnography, abn multiple sleep latency testing (MSLT)
  • 1st degree relatives/HLA
  • dec hypocretins/orexins: hypothal NTs
  • inc incident sleep apnea, periodic limb movements
61
Q

Narcolepsy - tetrad and tx

A

1 - Narco appears
2 - Cataplexy 70%
3 - Sleep paralysis
4 - Hypnagogic Hallucinations (visual, auditory, tactile)

Tx:
Narco - naps, stimulants
Cataplexy - TCAs, SSRIs

62
Q

subhyaloid hemorrhages

A

preretinal (subhyaloid) hemorrhages - assoc w/sx: N/V, acute headache, lethargy…suggest inc ICP

63
Q

Ddx Sudden Onset, Severe Headache

A

SAH, Intracerebral hemorrhage (inc ICP, esp when extends into ventricular system), subdural hematoma, meningitis, migraine

64
Q

Acute severe headache - w/u path

A

1 - get CT-, is it + for SAH?
2 - yes: get cerebral angiogram (look for other aneurysms)
3 - no: get LP (RBCs in 2hr, breakdown 4-6 and see for 2 wks. yellow=bili. xanthrochromia)

65
Q

SAH CT- review (4) areas

A

fissures, sulci, ventricles, cisterns
(interhemispheric fissure, suprasellar cistern, sylvian fissures, lateral ventricles)
*CSF is dark, blood will show up bright

66
Q

Brain MRA and CT Angio common aneurysm locations

A

1 - ACA (40%)
2 - PCA (30%)
3 - MCA (20%)
4 - Basilar A (10%)

67
Q

Risk Factors for SAH

A 
ADPKD
Fibromuscular dysplasia
AVM
CT Ds
Aortic Coarc
Cigarettes
Fhx
68
Q

sentinel headache/bleed

A

minor blood leakage from an aneurysm –SAH occurs hrs to mo’s later

69
Q

CN 3 and SAH

A
  • exits midbrain anteriorly -> cavernous sinus -> orbit

* PCA aneurysm = compresses CN3 and assoc PSNS fibers –> CN3 palsy + dilated, nonreactive pupil

70
Q

SAH Cx Mgmt:

A

1 - Rebleed: Clip/Coil
2 - Vasospasm: nimodipine
3 - Seizures: fosphenytoin prophylaxis
4 - Hyponatremia(SIADH): avoid fluid restriction
5 - Hydrocephalus: shunt
6 - Cardiac arrhythmia/MI (because catecholamines): ECG, NO anticoag

71
Q

SAH - Mgmt Vasospasm and Delayed Cerebral Ischemia (DCI)

A

-Oral nimodipine
-Have a constant transcranial doppler running-checks arteries for vasospasm
-Triple-H Therapy (in order):
1 - Hypervolume: IV NS
2 - Hemodilution: albumin
3 - HTN: DA
-Triple-H fails: Go to Intra-arterial therapy:
Angioplasty, papaverine, nicardipine

72
Q

Asymptomatic aneurysms: when intervention?

A
  • watch if <7mm with serial MRI/MRA

- >7mm = intervention

73
Q

Ddx Vesicles Under Breast

A

HSZ, Candida albicans, Monoradiculopathy (dmg to nerve root): DM (nerve-root ischemia), cMeningitis (nerve root inflammation), Osteophyte/Tumor (nerve root compression)

74
Q

HZV + Herpetic Neuralgia Mgmt

A

1 - most pts: oral antiviral +/- prednisone (Acyclovir, Valcyclovir, Famcyclovir)
2- ImC pts: IV antivirals (Acyclovir, Foscarnet)

75
Q

Neuropathic Pain defined and Mgmt

A

Def: dmg to central or peripheral nerve fibers. Responds poorly to pain Tx. Leads to disability. “burning, stabbing, electric shock”
PO Rx: Antidepressents (TCAs, other), Antiepileptic drugs,
gabapentin/carbamazepine, topical capsaicin, lidocaine analgesic patch

Sxx: Dorsal root entry zone lesioning, epidural steroid injections, nerve blocks

76
Q

HZV vaccine

A

Zostavx, 60+, ImmunoCOMPETENT

77
Q

Other neuropathic pain syndromes: Trigeminal neuralgia, Chronic polyneuropathy (DM), Thalamic pain syndrome

A

Trigeminal neuralgia - unilateral face pain: triggered by move/touch, relieved by carbamazepine, idiopathic

Thalamic pain syndrome: 2-4 wks after thalamic stroke* –develops same area as impacted by stroke

78
Q

Basilar Skull Fx Signs:

A

Racoon sign - periorbital hematoma
Battle sign - postauricular hematoma
CSF rhinorrhea - CSF leak from nose
CSF otorrhea - CSF leak from ear

79
Q

Levels of consciousness

A

Alert - awake/attentive
Lethargic
Stuporous
Comatose - not arousable

80
Q

Lesions localization:
R homonymous hemianopsia
R facial weakness

A

R homonymous hemianopsia - L temporoparietal or occipital cortex

R facial weakness - L cerebral hemisphere (CS tract) or *R pons (R facial nerve nucleus)

81
Q

Ddx SDH Sx

A

SDH, Epidural hematoma, Cerebral contusion, Intracerebral hemorrhage, Ischemic stroke, Mass lesion

82
Q

SDH/EDH - CT and MRI evaluation

A

CT:
acute = bright/hyperdense
subacute = isodense (same as brain tissue)
chronic = dark/hypodense

MRI:
T1 - acute = bright
T2 FLAIR - subacute = bright

83
Q

SDH - MGMT

A

1 - make coagulable state: stop warfarin (ASA till cleared by neurosxx), FFP, give vit K
2 - Sxx: neurosxx evacuation

84
Q

DDx Previously healthy man, found confused

A

cerebral stroke with aphasia, brain tumor, seizure and postictal state, toxic-metabolic encephalopathy, meningitis

85
Q

Acute bicerebral dysfunction w/ dec consciousness and attention = ? (2)

A

delirium or acute confusional state

86
Q

Delirium vs Dementia vs Aphasia

A

Delirium - acute, change in consciousness, agitation/autonomic hyperactivity (tachy-cardia/pnea). Pt does and says strange things

Dementia - chronic, no change in consciousness

Aphasia - not confused, does not do strange things, says strange things, dominant hemisphere findings

87
Q

global aphasia

A

broca + Wernicke

88
Q

expressive vs receptive

A 
expressive = motor = anterior 
receptive = sensory = posterior
89
Q

all aphasias

A

dysnomia - difficulty naming objects (*first test if pt “confused” or abn speech)

90
Q

Delirium Ddx

A

Toxic-metabolic (Rx, chemistries, systemic inf/fever), meningeal Dzs (meningitis, SAH), focal brain lesions w/bicerebral dysfunction (bi-thalamus ischemic strokes, cerebral vein thrombosis, PML, herpes encephalitis, SDH, complex-partial seizures)

91
Q

Delirium Eval

A

1 - CT
2 - Labs: chemistries (calcium), CBC, tox
3 - LP

92
Q

Tx delirium secondary to hypercalcemia (lung CA)

A

1 - IV NS (dilution)
2 - Loop diuretics
3 - Bisphosphonates (pamidronate) - inhibit osteoclast activity

93
Q

Binocular diplopia

A

-double vision resolves when one eye is closed
-due to weakness of extraocular muscle
1 - horizontal diplopia: medial or lateral rectus weakness (medial rectus weakness CN3 compression by aneurysm or uncal herniation. Lateral rectus weakness from CN6 compression against bony strxs due to inc ICP
-“false localizing sign”

94
Q

Transient visual obscurations (TVO)

A

-bilateral visual loss (seconds) –> inc ICP transmitted along the optic nerve sheath

95
Q

Cushing’s Response to inc intracranial P:

A

HTN, bradycardia, irregular respirations

96
Q

Cheyne-Stokes respirations

A

variable respiratory rate associated with apnea

-etiology: maybe bilateral deep brain lesions

97
Q

CN3 Palsies +/- dilated, unresponsive pupil

A

CN 3 palsy (-) dilated, unresponsive pupil = infarction of the CN 3 nerve, spares overlying PSNS

CN 3 palsy (+) dilated, unresponsive pupil = right ptosis w/dil unresp pupil w/ inability to adduct the right eye on Doll’s eye maneuver ===compressive lesion

98
Q

Hyperreflexia signs: clonus, Hoffmann, Babinski

A
  • Clonus
  • Hoffman sign: flicking terminal phalanx of one finger and observing forward flexion of the thumb
  • Babinski sign
99
Q

Glasgow Coma Scale – when bad prognosis?

A
  • Eye opening (4-1)
  • Best Motor (6-1)
  • Best Verbal (5-1)

*GCS <9 poor prognosis

100
Q

Abnormal Posturing - CNS damage

A

-any combination possible
1 - decerebrate (upper midbrain lesion by lesion or compressions of BS): arm rigidly extended/internally rotated, wrist flexed, leg extended
2 - decoritate (dmg corticospinal tract between midbrain and cortex): leg extended, arm flexed/adducted over chest
*better than decerebrate

101
Q

Localize ICP, Bilateral upper midbrain

A

Increased intracranial pressure
Chronic progressive headache, worse upon awakening
Transient CN 6 palsies and TVOs
Bilateral upper midbrain, right > left
Decreased consciousness  brainstem vs. bicerebral process
Right CN 3 palsy with dilated pupil *  upper right midbrain
Left decerebrate posturing  upper right midbrain
Cheyne-Stokes respirations  upper midbrain
Bilateral hyperreflexia, Hoffmann, Babinski bilateral UMN

102
Q

Subfalcine (cingulate) herniation

A

medial frontal lobe is pushed under the falx cerebri, an extension of the dura mater that separates the cerebral hemispheres.

103
Q

Central (transtentorial) herniation

A

structures that lie above the tentorium cerebelli are squeezed downward, compressing the brainstem. The tentorium cerebelli is an extension of the dura that separates the cerebellum from the occipital lobes. The anterior border of the tentorium cerebelli forms a large oval opening, the incisura tentorii, which surrounds the midbrain as the brainstem descends through this opening.

104
Q

Uncal (transtentorial) herniation

A

most medial part of the temporal lobe, the uncus, is squeezed through the incisura tentorii, resulting in unilateral midbrain compression. Cranial nerve 3 and its associated parasympathetic fibers exit the midbrain anteriorly on their way to the orbit and are often compressed, resulting in a 3rd nerve palsy with a dilated, unresponsive pupil.

105
Q

Herniation of the cerebellar tonsils

A

brainstem is pushed downward through the foramen magnum. Compression of the medulla results in respiratory and cardiac arrest and is usually fatal.

106
Q

Monro-Kellie Hypothesis/Doctrine

A
  • rigid container = cranium, vertebral canal, dura
  • 3 intracranial components: brain, blood, CSF
  • inc vol of components inc ICP… inc one component = dec other 2 components
107
Q

Ddx for inc ICP and bilateral upper midbrain R>L

A
  • Tumor (primary, met) Px: hemorrhage or seizure
  • AVM (mature capillary bed fails to form. direct flow A to V) Px: hemorrhage, seizure, headache, neuro deficit
  • Abscess. Px: fever, headache, lethargy, seizure, neuro def
  • Hemorrhage
  • Infarction (cerebral infarction, cause brain herniation, cerebral edema peaks 48-72 hrs)
108
Q

CT with mets and herniation concern

A
  • see ring-enhancing masses
  • diffuse bilateral hypodense regions = vasogenic edema -> uncal herniation, obliteration of ventricles and perimesenscephalic cisterns
109
Q

Mgmt: CA mets, vasogenic edema, uncal herniation (4 steps)

vs traumatic brain injury (do Hypothermia)

A

1 - Elevate head 30 deg (optimize venous drainage, maintain cerebral perfusion -> patency jugular veins)

2 - Intubate and hyperventilate (pCO2 28-32 = vasoconstriction intracerebral vessels -> dec cerebral BF, lower ICP (fast pCO2 reduction =ischemic injury to brain))

3 - Mannitol IV push 100 g (+bladder cath) (osmostic diuretic moves brain water to capillaries and reduce ICP *give IVFH)

4 - Dexamethasone (dec vasogenic edema by stop BBB breach inflame)

Neurology (5 decks)

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