W23 - Cerebrovascular disease and trauma Flashcards
What are the 2 types of cerebral oedema? Define each
- Vasogenic = disruption of BBB
- Cytotoxic = 2ndary to cellular damage i.e. hypoxia, ischaemia
Cerebral oedema leads to ______ _______
Cerebral oedema leads to raised ICP
There is a rarer form of oedema called hydrocephalic oedema. What is it?
Hydrocephalic oedema = movement of water across the ventricle ependyma cells into the astrocytes
What do you see?
Loss of 1) sulci, 2) gyri, 3) ventricles = cerebral oedema
CSF is produced by the _____ _____ in the ________ ________
CSF is produced by the choroid plexus in the lateral ventricles
There are 2 types of hydrocephalus - name and define them.
Non-communicating = involves obstruction of CSF flow
Communicating = involves no obstruction but problems with reabsorption of CSF into venous sinuses (i.e. in meningitis) - problem is usually in the subarachnoid space
Normal ICP is _____ for a supine adult at rest
Normal ICP is 7-15 mmHg for a supine adult at rest
Name 3 herniation types in brain
- Subfalcine herniation
- Transtentorial herniation
- Tonsillar herniation
What is the consequence of raised ICP?
herniation of brain where space is available
Subfalcine herniation - what is it?
generally caused by unilateral frontal, parietal or temporal lobe disease that creates a mass effect with medial direction of the ipsilateral cingulate gyrus beneath the free edge of the falx cerebri due to raised intracranial pressure.
relatively rare and not too acute
Transtentorial herniation - what is it?
aka uncal herniation, is when the medial temporal lobe is squeezed by a unilateral mass across and under the tentlike tentorium that supports the temporal lobe
Tonsillar herniation - what is it?
the cause is an expanding infratentorial mass (eg, cerebellar hemorrhage), forcing the cerebellar tonsils, through the foramen magnum.
When the integrity of the BBB is disrupted, the resultant oedema is described as ______
vasogenic
Which of the following types of herniation does not involve cerebral cortex?
A) Subfalcine
B) Transtentorial
C) Tonsillar
D) Uncal
C) Tonsillar
TIA - usually lasts ______ and there is usually no permanent brain injury
_____ of those with TIA get significant infarct within 5 years
TIA - usually lasts 5 minutes and there is usually no permanent brain injury
1/3 of those with TIA get significant infarct within 5 years
What do you see?
Axial CT
Large mass in left occipital lobe
You can see it has holes in it = AVM mass with tissue in the middle of it
This is a brain resection. What do you see?
AVM resection
Non-traumatic intra-parenchymal haemorrhage:
- most common location?
- most common cause?
Non-traumatic intra-parenchymal haemorrhage:
- most common location = basal ganglia
- most common cause = hypertension (>50% of bleeds)
AVM:
- location in the brain?
- Age at presentation?
- Sequelae of AVM bleed?
- Treatment of AVM bleed?
AVM:
- location in the brain = anywhere in the CNS
- Age at presentation = 20s-50s
- Sequelae of AVM bleed = high presssure bleed so it’s MASSIVE (high mortality/morbidity)
- Treatment of AVM bleed = surgery, embolization, IR surgery
Brain resection - what is it?
Cavernous angioma - it’s all blood vessels, no brain parenchyma
Define cavernous angioma
Well-defined malformative lesion composed of closely packed vessels with no parenchyma interposed between vascular spaces
*AVM has parenchyma inbetween, cavernous angioma does not**
What do these 2 images show?
Left = rupture of berry aneurysm with lots of blood leaked out
Right = 3 berry aneurysms (typically at bifurcations)
Cavernous angioma:
- where does it occur?
- at what age does it present?
- Sequlae of bleed?
- Treatment?
Cavernous angioma:
- where does it occur = anywhere in the CNS
- at what age does it present = after 50s
- Sequlae of bleed = low pressure, recurrent bleeds
- Treatment = surgery
What signs are these called?
What are they a sign of?
Name additional presentations
- Left (battle sign) - mastoid process haemorrhaging, right (raccoon eyes)
- Indicate skull base fracture
- Ottorhoea, rhinorrhoea
