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23 Cards in this Set

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what causes cerebral edema AKA brain swelling
abnl influx of fluid from intravascular compartment into interstitial or extracellular space of CNS parenchyuma, esp white matter
what happens to gyri in cerebral edema
they swell and flatten
midline shift
unilateral injury causes swelling, which displaces the interhemispheric midline toward the other side
cerebral edema implies
vasogenic edema
what is MC form of brain swelling
vasogenic edema
vasogenic edema
reflects damage to endothelial cells of vasculature-->compormises the "tight" (adherent) endothelial junctions-->lose barrier fxn
BBB
barrier fxn provided by unmique tight endothelial (near vessel) jxns of CNS
cytotoxic edema
*brain swelling d/t incr INTRACELLULAR accum of fluid, esp with neurons, d/t toxic-metabolic dz
*gray matter
hydrocephalic edema
obstructive hydrocephalus==>
stretching of ependymal cells lining the dilated ventricle
==>ependymal cell margins are opened
==>CSF enters adjacent CNS parenchyma
critical mass for resultant herniation of brain
1300 grams
subfalcine hemorrhage
-lateral displacement of cingulate gyrus of injured/swollen hemisphere thru the subfalcine space, beneath the free margin of the falx
*ACA
transtentortial herniation
-hippocampal gyrus (medial gyrus of inferior surface of temporary lobe) herniates thru tentorial notch
-mild forms: only uncus herniates thru tentortial notch
*PCA
*blown (fixed, dilated) pupil on ipsilateral side d/t compression of oculomotor nerve (PSNS)-->SNS predominates
hippocampal gyrus
medial gyrus of inferior surface of temporal lobe
blown pupil
fixed dlated pupil on ipsilaterla side d/t compression of oculomotor nerve (PSNS)
-->SNS predominates
*reliable localizing sign, indicating injury is on ipsilateral hemisphere (better localizing sign than hemiparesis)
Kernohan's Notch Phenomenon
false localizing sign, resulting from severe Transtentorial Herniation of injured cerebral hemisphere

i.e. hit right side
-->compress left corticosp tract-->hemiparesis on right side (ipsi hemiparesis)

hemiparesis is usually contralateral, but here it's ipsi (thus false localizing sign)
tonsillar herniation
both cerebellar tonsils forced thru foramen magnum
-->can compress adjacent cardio-resp centers in medulla
-->death
central (axial) herniation
entire brain stem forced downward along its own axis
-->basilar artery branches ripped out of parenchyma
-->massive focal hemorrhages in brainstein, esp at midbrain and upper pons ("Duret hemorrhage")
Duret hemorrhage
massive focal hemorrhages in brainstein, esp at midbrain and upper pons d/t ripping out branches of basilar artery during central (axial) herniation
fungus cerebrei
-extrustion of brain thru abnl aperture in skull d/t trauma
-swollen cortex and parenchyma extrudes thru the defect, resembling a mushroom with a narrow base at the aperture and ballooned dome of necrotic parenchyma
hydrocephalus
abnormally dilated ventricles (filled iwth CSF)
non-communicating hydrocephalus
-AKA obstructive hydrocephalus
-dilation of entire ventricular system above a point of blockage or stricture
-often situated at natural bottle neck, such as aquaduct or 4th ventricle
communicating hydrocephalus
-AKA non-obstructive hydrocephalus
-generalized blcokage of nl CSF circulation
-eg occlude posterior fossa outlet foraminae of Luschka and Magendie
ex vacuo hydrocephalus
-dilation of entire ventricular system related to adjacent injury and subsequent atrophy or resorption of damaged CNS parenchyma
-eg Alz Dz