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Neurology > Week 5 > Flashcards

Week 5 Flashcards

1
Q

what percentage of the skull does the brain take up

A

80-85%

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2
Q

how many mls of blood in the skull

A

100-150ml

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3
Q

how many mls of CSF in the skull

A

100-150mls

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4
Q

monroe-kellie doctrine

A

total volume in skull is constant. Made up of brain, blood and CSF.

According to the monroe-kellie doctrine, if there is an increase in the volume in one of these components, one or both of the others need to decrease. Otherwise increased ICP can occur.

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5
Q

what is the normal ICP

A

adults: 7-15mmHG
newborn: 1.5-6, often <0
young children: 3-7
older children: 10-15

usually by age 15 it’s reached adult level

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6
Q

what are the immediate compensatory mechanisms for expanding masses in the skull (to maintain ICP)

A
  • decrease in CSF volume by moving it out of foramen magnum
  • decrease in blood volume by squeezing sinuses
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7
Q

what is a delayed compensatory mechanism for expanding masses in the skull (to maintain ICP)

A
  • decrease in extracellular fluid
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8
Q

how much CSF is secreted in 24 hours

A

around 500mls

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9
Q

flow of CSF

A
  1. choroid plexus (lat ventricles) –> ventricular system —> subarachnoid space (come through from 4th ventricle via Magendie and Luschka) —> venous system (absorbed into bloodstream by arachnoid granulations)
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10
Q

what will any obstruction in CSF flow will lead to?

A

hydrocephalus (and increased intracranial pressure)

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11
Q

what is hydrocephalus

A

a neurological disorder caused by an abnormal build up of CSF in the ventricles

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12
Q

what is CBF

A

cerebral blood flow

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13
Q

how is cerebral blood flow autoregulated

A
  • pressure autoregulation (arterioles dilate or constrict in response to changes in BP or ICP
  • metabolic autoregulation (arterioles dilate in response to chemicals e.g. lactic acid and CO2)
  • CO2 is a potent dilator
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14
Q

problems with CSF

A
  • obstruction
  • increased production
  • decreased absorption (“communicating hydrocephalus”)
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15
Q

causes of obstructive hydrocephalus

A
  • masses
  • Chiari Syndrome
  • Outflow obstruction at foramen magnum
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16
Q

name a cause of increased CSF production

A

choroid plexus papilloma

17
Q

causes of decreased absorption of CSF

A
  • subarachnoid haemorrhage
  • meningitis
  • malignant meningeal disease
  • increased CSF protein
18
Q

Early signs of raised ICP

A
  • headache
  • pupillary dysfunction +/- papilloedema
  • changes in vision
  • nausea and vomiting
  • decreased level of consciousness
19
Q

later signs of raised ICP

A
  • coma
  • fixed, dilated pupils
  • hemiplegia
  • bradycardia –> cushings triad
  • hyperthermia
  • increased urinary output
20
Q

goals of therapy for patients with a raised ICP

A
  • maintain cerebral perfusion pressure (CPP)
  • prevent ischaemia and brain compression
21
Q

raised ICP management

A
  • maintain head in midline to facilitate blood flow
  • loosen tube ties, collars etc
  • head 30-45 degree elevation
  • avoid gagging, coughing etc
  • decrease environmental stimuli
  • treat hyperthermia
  • maintain fluid balance and normal electrolytes
  • maintain normocarbia

to do all this sometimes patients are put in coma

22
Q

volume pressure curve

A

patients can compensate for a while then suddenly reach a point when ICP goes up suddenly exponentially

23
Q

medical management of raised ICP

A
  • diuretics (mannitol, hypertonic saline, furosemide, urea)
  • barbiturate coma
  • antiepileptics
24
Q

surgical management of raised ICP

A
  • surgical decompression
  • other surgical treatment like remove mass lesions, CSF diversion
25
Q

types of hydrocephalus

A
  • obstruction
  • increased production of CSF
  • decreased absorption
26
Q

hydrocephalus classifications

A

communicating vs non-communicating

congenital vs acquired

aetiology

27
Q

what is chiari

A

cerebellum pushes down through foramen magnum into spinal cord

there are 4 main types

28
Q

what age group does normal pressure hydrocephalus usually affect

A

elderly

Neurology (12 decks)

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