Neuro Chapter 5 #131 cards

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1

Flow of CSF

Lateral ventricles-->3rd ventricle (foramen of monroe) 3rd ventricle-->4th ventricle (sylvian aqueduct) out through foramina of Luschka and Magendie, into subarachnoid space, up to arachnoid granulations to be reabsorbed into bloodstream.

2

vascular headache

- migraine - cluster headache

3

fortification scotoma

Often occurs during "aura" preceding migraine. Wavy, zigzagging, shimmering lines in vision.

4

cluster headache

- more common in males. - drilling behind one eye. - headaches multiple times per day over a few weeks, then vanish for a few months. - pulsing headaches; lower grade than migraine.

5

tension headache

- mild to moderate dull pain. - occurs from time to time, lasts for hours. - sometimes can last daily for years (seen in posttraumatic headache, e.g. from concussion)

6

pseudotumor cerebri

- headache and elevated intracranila pressure with no mass lesion.

7

mass effect

Any distortion of normal brain geometry due to a mass lesion. Can be as subtle as mild flattening (EFFACEMENT) of sulci

8

Effects of intracranial mass lesion

1. compression/destruction of adjacent regions of brain. 2. raise ICP 3. displace nervous system structures causing herniation (shifted into another compartment)

9

Signs and symptoms of elevated intracranial pressure

1. Headache 2. Altered mental status (esp. irritability and depressed level of alertness and attention) 3. nausea/vomiting 4. papilledema 5. visual loss 6. diplopia 7. cushings triad

10

Cushing's triad

1. hypertension 2. bradycardia 3. irregular respirations

11

papilledema

Engorgement/elevation of optic disc. Classic sign of elevated intracranial pressure. Often not present in the acute setting.

12

intracranial pressure

Formed by volume of CSF, blood, and brain tissue. Normal ICF = less than 20 cm H20 or less than 15 mmHg

13

transtentorial herniation

Herniation of the medial temporal lobe, especially the uncus (uncal herniation).

14

uncal herniation

Herniation of uncus (medial temporal lobe) through the tentorial notch. Clinical triad of "blown" (fixed and dilated) pupil, hemiplegia, and coma. Causes compression of CN III--> ipsilateral blown pupil.

15

central herniation

Central downward displacement of brainstem.

16

tonsillar herniation

Herniation of cerebellar tonsils downward through foramen magnum. Compresses medulla, leading to respiratory arrest and DEATH.

17

Herniations + posturing

Uncal herniation = flexor posturing Tonsillar herniation = extensor posturing

18

subfalcine herniation

Cingulate gyrus and other brain structures herniate under falx cerebri. No significant clinical features like others.

19

concussion

Reversible impairment of neurologic function for a period of minutes-hours following a head injury.

20

epidural hematoma (location, cause, appearance)

MEDICAL EMERGENCY. Location: space between dura and skull. Usual cause: rupture of middle meningeal artery due to fracture of temporal bone. Appearance: lens-shaped biconvex hematoma.

21

subdural hematoma (location, cause, appearance)

(*chronic and acute*) Location: between dura and arachnoid. Usual cause: rupture of the bridging veins. Appearance: crescent-shaped hematoma.

22

chronic subdural hematoma

Seen in: elderly (smaller brains). may have no history of trauma. vague symptoms. can have focal seizures.

23

acute subdural hematoma

Associated with serious injuries. Density depends on age of blood.

24

Blood density

Depends on age of blood. Hyperdense: (acute blood) bright on CT scan. Isodense: after 1-2 weeks. Hypodense: 3-4 weeks.

25

hematocrit effect

Sometimes seen in mixed-density hematomas. Denser acute blood settles to bottom.

26

subarachnoid hemorrhage

WORST HEADACHE OF LIFE. Causes: 1. aneurysm 2. AVMs (less common)

27

saccular/berry aneurysms

Usually arise from aterial branch points near circle of Willis. Balloon-like outpouchings of vessel wall with fragile dome that can rupture. Most commonly in anterior communicating artery.

28

hydrocephalus

Excess CSF in intracranial cavity.

29

causes of hydrocephalus

1. excess CSF production 2. obstruction of flow at any point in the ventricles or subarachnoid space 3. decrease in reabsorption via the arachnoid granulations

30

communicating hydrocephalus

Caused by impaired CSF reabsorption in the arachnoid granulations, obstruction of flow in subarachnoid space, or (rarely) by excess CSF production.

31

noncommunicating hydrocephalus

Caused by obstruction of flow within the ventricular system.